New Approach for Diabetes Treatment!

Researchers are trying new approaches to treat Type 2 diabetes amid widespread uncertainty about the most effective therapies and concerns that current strategies might be doing some patients more harm than good.

New guidelines for treating the disease, which many experts consider a public-health crisis among millions of mostly overweight individuals, suggest doctors vary treatments depending on a patient's age, general health and even personal preferences. The recently updated guidelines recommend that doctors back away from pushing patients to get their blood sugar down to a standard targeted level. Aiming for a very low blood-sugar level might be appropriate for a younger person, for example, while older patients might do better with a less aggressive approach, according to the guidelines, published in June in the journal Diabetes Care.

'We need to be less dogmatic about what matters and be open to different approaches and give patients a voice' in treatment decisions, says Victor Montori, a diabetes specialist at Mayo Clinic, in Rochester, Minn., who wasn't involved with writing the guidelines but supports the new direction.

Another approach gaining wider acceptance for some patients is the use of bariatric surgery, which results in dramatic weight loss. Though it comes with risk of serious complications, the operation has been shown in recent studies to lead to a rapid lowering of blood sugar, often enabling patients to go off most or all of their diabetes medicines.

Some experts also are questioning the benefits of gradually stepping up the intensity of drug therapy, a widely accepted approach that was reaffirmed in the latest guidelines. The aim is to maintain a patient's blood-sugar level while keeping up with the progressive nature of the disease. But researchers at UT Southwestern Medical Center in Dallas, for instance, argue in a recent small study that hitting the disease early and hard is better.

More than 24 million Americans have Type 2 diabetes, the version of the disease usually associated with being overweight and living a sedentary lifestyle. By some estimates the number could double by 2025.

In diabetes, the body isn't able to effectively use insulin or to make enough of it to metabolize glucose in the food we eat, resulting in higher than normal levels of blood sugar. Heart attacks and strokes, kidney failure, nerve damage, blindness and vascular problems leading to amputation are among the long-term complications when the disease isn't well controlled. That makes diabetes a precursor to many of medicine's most debilitating conditions. Annual costs for treatment and loss of productivity associated with the disease are about $174 billion, according to the American Diabetes Association, an education and research association that devised the new treatment guidelines in collaboration with its counterpart the European Association for the Study of Diabetes.

There have been conflicting findings over the benefits for patients of keeping blood sugar strictly controlled, helping to fuel uncertainty about how best to treat the disease. Some popular diabetes drugs come with side effects─including weight gain, bone loss and even a small risk of certain cancers. And some data have shown that aggressive efforts to achieve tight glucose control, until recently considered a desirable goal, can lead to troubling episodes of low blood sugar called hypoglycemia or to increased risk for serious heart-related problems.

Although available drugs all improve blood-sugar levels, there is a lack of data to show whether they actually prevent or delay development of diabetes' long-term consequences.

'The goal for treatment and the choice of individual drug must be personalized depending on the patient,' says Vivian Fonseca, the ADA's president for science and medicine and chief of endocrinology at Tulane University Health Sciences Center, in New Orleans.

For most patients newly diagnosed with Type 2 diabetes, the first line of therapy is to improve diet and exercise habits to reduce blood-sugar levels. Usually metformin, a basic diabetes medication, is also prescribed. But patients with only mildly elevated blood-sugar levels may try to improve their health habits for up to six months to see if they can control the disease before beginning medication.

Blood sugar is typically defined as being under control for diabetic patients when it is below 7%, using a measure known as hemoglobin A1c, or HbA1c, according to the ADA. Under the new guidelines, that level is still desirable. But younger, newly diagnosed and well-motivated patients with a long life expectancy may want to aim for even lower levels, closer to 6%, according to the recommendations. Such aggressive therapy is expected to better keep the disease from progressing.

For older patients vulnerable to severe hypoglycemia or who may already have advanced cardiovascular disease, less stringent targets of up to 8% or even a little higher would be sufficient, the guidelines say. This also could reduce the burden of side effects from medications.

* Originally posted: Top Diagnosis

Weight-Loss Surgery is Also Helpful to Diabetes

Brief: The latest release of the two scientific research results show that usually the bypass surgery that been operated for obese patients to loss weight that can also improve their symptoms of diatbetes signigicantly, and it can even reversed the effect of the diesease. Now researchers are studing whether this surgery is also effective to those non-obesity diabetic patients.

Cristina Iaboni, a diabetic, underwent gastric bypass surgery at New York-Presbyterian/Weill Cornell in the fall of 2009 as part of a study. After losing 50 pounds, her blood sugar was nearly normal. She is pictured here in June 2010.

We've been hearing about health care law. Now, simply health care. Two studies released today address options for diabetics. They have found that surgical procedures commonly used to help obese people lose weight can also dramatically improve or even reverse diabetes.

That may offer an alternative treatment for diabetics, as NPR's Rob Stein explains.

Diabetes is one of the nation's biggest health problems and the disease is often caused by obesity. Diabetic Tim Ferree of Macedonia, Ohio, struggled with his weight for years. He knew his out-of-control blood sugar would eventually cause serious problems.

You're looking at, you know, losing your vision, losing your feet, having problems with your kidneys, going blind, you know, heart disease, strokes.

So when Ferree heard about an operation that might help with his weight and his diabetes, he volunteered to get it.

With a brand new baby in the house, that's really what prompted me to take a very aggressive course towards treating the diabetes.

Surgeons have been operating on obese people for years, making their stomachs smaller and rearranging their digestive systems. And doctors realized that patients who got the operations often had their diabetes get much better. Sometimes it even went away completely. But they didn't have good research that proved surgery was really effective.

What's been lacking is a head-to-head comparison of surgery versus some of the newer anti-diabetic drugs.

That's Philip R. Schauer of the Cleveland Clinic. He led one of the studies released today. The results showed that patients who got the operations were much more likely to have their blood sugar go down. Many were able to stop taking any diabetes drugs altogether.

Just the fact we were able to see this many people achieve normal blood sugar without medications is somewhat astonishing. In a sense, we're reversing the disease.

After the surgery, patients would sometimes get better within hours or days. And when that happens, its clear there's something more going on than just the effects of getting thinner. One theory is that re-arranging the digestive system affects important hormones.

There appears to be an increased production of special hormones from the intestinal tract. And these hormones are know to directly stimulate the pancreas to make more insulin.

And insulin controls blood sugar levels. This research raises an important question: Should diabetics start getting this operation more often? It's called bariatric surgery. Paul Zimmet of the International Diabetes Federation thinks they should.

Diabetes coupled with obesity is probably the largest epidemic in human history. At the moment, bariatric surgery is being seen as a last resort. And it should be offered earlier in management.

But others aren't so sure. The new studies only followed about 200 patients. And while the operations appear to be pretty safe, there can be complications. And the complications can be serious.

Vivian Fonseca, a  top scientist at the American Diabetes Association, said: I think we need longer-term follow-up than what was done in these studies, to make sure that you're not trading one problem for another.

For his part, Tim Ferree is thankful. He's 60 pounds lighter. He's off all his drugs - not only for his diabetes, but also for blood pressure and cholesterol.

I'm not staring down the barrel of being diabetic. I'm not looking at a future of potentially having to give myself several insulin shots every day. I'm not potentially looking at, you know, losing a foot or losing my eyesight or having a stroke. That's a great relief, I think, for anyone.

Researchers are now testing whether the surgery works on diabetics who aren't even obese - people with BMIs as low as 26. And doctors and patients are waiting to see if insurance companies will pay for the operations just to treat diabetes.

* Originally Posted: Top Diagnosis

A New Monitor Chip will Change the Way Diabetics Live

Guide: British researchers now are testing a new type of chip, this tiny device could help doctors to monitor the blood glucose level of diabetes all around the clock. Allegedly, this technology has good prospects, it can also be used as a monitor device for other chronic diseases.

A small, insignificant looking square pad, the size of a finger nail, could change the way diabetics live. Almost invisible, on the surface of the pads are scores of needles.

Each micro-needle, which measures one millimeter long, contains its own sophisticated sensor, or nano wire; completely invisible to the naked eye. Together, the needles are in a constant cycle of collecting and analyzing the blood of the patient it's attached to.

You won't be able to feel it either according to its inventors, who say it's designed to stay permanently and painlessly in contact with a patient's arm.

The technology, being developed at Swansea University, is in its infancy stage. The team is now in the middle of developing a transmitter which will be able to send an SMS message to a hospital, or to relatives as soon as a patient is at risk of a hypoglycemic attack.

The idea is to ensure that there is no delay in providing emergency treatment, even if the diabetic is alone and unconscious. Dr Vincent Teng is Swansea University's nano-technology expert.

"The length of a needle is about 1mm and they have a diameter of about 15 microns. That offers a painless experience to a patient when using it. These needles will be attached to the arm of the patient and blood sample will be drawn using these micro-needles. The sensors, which are developed using nano-wire technology, will be integrated into the micro-needles, and that offers painless detection of blood glucose, and continuous monitoring of blood glucose."

An undetected hypoglycemic attack can prove fatal for people with type 1 diabetes. Sufferers need to take insulin injections, meaning they must test their blood glucose levels up to 10 times every day. Such a device would mean they wouldn't need to carry blood sugar testing equipment around with them at all times.

The micro-needles are just part of the work from the University's Health Informatics Research laboratories, directed by Professor David Ford. He says the device being developed here is aimed at ensuring that diabetics are not at risk of fainting, or going into shock, when they're asleep, or alone.

Ford says the system of continual monitoring is an exciting development.

"If a patient was to wear this 24 hours a day it would be an enormous benefit in terms of understanding the way that their blood glucose responds to what they eat and what they do during the day, and potentially could have a role in perhaps automating the introduction of insulin into the bloodstream, which is the mechanism that is used naturally to moderate blood glucose levels."

This technology for diabetics is still a few years away from being tested. But Teng says that the team hopes the same system can be widened to provide pioneering care applications for people who suffer from heart disease and strokes.

"With the use of the right bio markers on the nano wires we'll be able to use this technology to detect other chronic diseases. Say, for example, heart disease, asthma, and also stroke, which is very common. In fact the number of people who suffer from this chronic disease has increased rapidly in recent times."

The WHO says non-communicable diseases, or NCDs, are the leading cause of death in the world. That's 63 per cent of all deaths each year.

* Originally Posted: Top Diagnosis