Taking Your Type 2 Diabetes Diagnosis Seriously


Advertisements

Why Don’t People Take Diabetes Seriously?


 

When we hear that a loved one or friend has a serious illness it can evoke in us strong emotions of fear, worry, sadness and compassion. “I’m so sorry” and “How can I help?” are commonly offered sentiments in these difficult situations. Hearing the news that someone has diabetes does not often herald the same degree of concern.

Why is this? I believe that the reasons are multifactorial.

Broad Terms Contribute to Confusion

If we consider the word “cancer” people typically have an immediate reaction of alarm. However, cancer is a large umbrella representing over 100 distinct diseases depending on the organ or system affected. Prognoses for cancer are widely variable and many cancers are curable with early diagnosis and treatment.

These important distinctions reflective of cancer’s diverse landscape are often lost on the public’s perception. Thus, people may endure unnecessary anxiety, dread and anguish. Society’s increased understanding of the medical and scientific advances in cancer treatments would alleviate a lot of suffering and fear and replace it with hope and optimism. Even those who can’t be cured are often able to have significantly lengthened periods of disease-free survival and enhanced quality of life due to new treatments.

While the term diabetes is not as deceptively broad as cancer it does represent over seven distinct conditions each with its own pathophysiology. If you consider that diabetes may occur as a result of another disease or condition like cystic fibrosis, hemochromatosis or chronic pancreatitis, just to name a few, there are even more types of diabetes.

Unless you’ve personally known someone with diabetes and seen firsthand either a complication of the disease or its daily, labor-intensive management you may not grasp the seriousness of the diagnosis. Perhaps we’ve heard the word so much that we are desensitized to it. This is unfortunate since diabetes has become one of the fastest growing risks to human health throughout the world.

Since my own child was diagnosed with type one diabetes in 2013 I’ve become very attuned to how diabetes is perceived both in personal encounters and in the media. In our circle of family, friends and teachers, the reactions to my son’s diagnosis were a mix of bewilderment, sadness and nonchalance. Most people simply didn’t know what it was.

The knowledge gap with T1D may partially be attributed to its name. For clarity, I tell people that it was previously called Juvenile Diabetes. That charged term usually captures attention. Putting “juvenile” in front of any word will often do that (e.g., juvenile delinquency, juvenile detention center, etc.)

In my experience people generally assumed that my son would now need some sort of low-level lifestyle tweaks. The word sugar was always coming up. Should we get some sugar-free foods for him? Can he have cake? Wouldn’t some exercise, a “balanced diet” and a Crystal Light or two keep this thing in “control?”

Someone once told me to ditch my son’s insulin and go macrobiotic. Although disturbing, at least one of my son’s classmates understood that diabetes was serious. Lacking a filter he felt compelled to share that he had a relative who had his leg amputated. My husband who is an ICU physician had to reassure my son that these complications are very rare.

Pre-Diabetes

With so many different types of diabetes it’s no wonder that such a knowledge deficit exists. Take prediabetes as a perfect example.

According to the American Diabetes Association, in 2015 an astonishing 84.1 million Americans or more than 1 out of 3 adults had pre-diabetes. A person may leave an annual doctor’s visit with this news and a general recommendation to lose weight and exercise more. He may compare notes with his friends and discover that some of his buddies are in the same boat. With the tendency to feel like there is safety in numbers one might be inclined to either ignore the diagnosis or just try a few lifestyle tweaks like joining a gym or eating brown rice instead or white.

Unlike those with type 1, those with pre-diabetes don’t leave the doctor’s office with an abrupt and permanent new way of life requiring 24/7 insulin. Perhaps this is another factor that contributes to a lack of urgency to reverse pre-diabetes. Some will gamble that they can coast along with no lifestyle changes without converting to type 2 diabetes. They might be right but they need to know the real risks of this strategy.

Pre-diabetes means that something is wrong with a fundamentally important body function: glucose metabolism. Even if an individual does not ultimately receive a type 2 diagnosis he is still at risk for serious complications like retinopathy and neuropathy. So, feeling “fine” with this relatively silent condition is, indeed, a false sense of security.

Inspiration from a Type 2

Before my own child was diagnosed with type one I had a grim, skewed perception that diabetes was either coping with spirit crushing food restrictions or trying to persevere through difficult complications. Two relatives with type 2 succumbed to those complications. I just didn’t understand the other perfectly viable scenario of a healthy life filled with abundance.

One type 2 thriver who has intruigued me so much is the acclaimed English actor, Robin Ellis. In the 1970s he was the heartthrob leading man, Captain Ross Poldark, of the beloved BBC and Masterpiece Theatre series, Poldark.

A remake of it is currently thrilling millions on Masterpiece Theatre.

A huge fan of the original, I was fascinated to discover that Mr. Ellis is an inspiring type 2 diabetic. He has contributed to the diabetes community by being very transparent about his condition and his successful journey adapting to it.

An accomplished chef, Mr. Ellis’s lushly photographed and delectable diabetic-friendly cookbooks are a wonderful resource. Anyone with diabetes perusing these books may begin to feel that there is, indeed, another way to not just live with diabetes, but flourish as a result of it.

His latest, Mediterranean Cooking for Diabetics: Delicious Dishes to Control or Avoid Diabetes, is a go-to book in my cookbook collection. My type one son is a big fan of Mr. Ellis’s lower carb recipes and it makes me feel good to cook his healthy and flavorful dishes for my entire family.

So why do some people with diabetes like Robin Ellis become converts to a new way of living with diabetes? Growing up with a mother with type 1 diabetes who passed away from a heart attack due to her condition, Robin was cognizant of the dangers of diabetes as a result of this terrible loss.

However, I believe his motivation for a lifestyle change was not simply motivated by fear. Living in the French countryside with his supportive wife, Meredith, Mr. Ellis embraced the healthy culinary treasures of this region. He used his diagnosis as a springboard to explore new possibilities in food, exercise and wellbeing.

As the mighty Theodore Roosevelt used to say, “get action.” Take diabetes seriously no matter what type you have. Don’t let denial put your health at risk. You can shift from a place of worrisome vulnerability to one of hopeful optimism and fortitude if you are open to change.

There is a full life of abundance waiting for you.

Eye benefits of tight glycaemic control persist over time


Nearly 4 years of intensive glycaemic control in patients with type 2 diabetes (T2D) reduces retinopathy progression for up to 4 years after stopping treatment, the ACCORDION* study has shown, a phenomenon researchers described as a “legacy effect.”

“The study sends a powerful message to people with T2D who worry about losing vision,” said study author Dr. Emily Y. Chew of the National Eye Institute in Bethesda, Maryland, US, who presented the findings at the American Diabetes Association 2016 Congress in New Orleans, Louisiana, US. “Well-controlled glycaemia, or blood sugar level, has a positive, measurable, and lasting effect on eye health.”

At year 8, the lower risk of retinopathy progression in patients who had received intensive glycaemic control in the original ACCORD study persisted. Diabetic retinopathy had progressed 3 or more steps on the Early Treatment Diabetic Retinopathy Study (ETDRS) scale in 5.8 percent of patients who had received intensive glycaemic treatment versus 12.7 percent in those who had received standard glycaemic treatment (adjusted odds ratio [aOR], 0.42; p<0.0001). [Diabetes Care 2016;doi: 10.2337/dc16-0024]

ACCORDION was a follow-on study of diabetic retinopathy progression in 1,310 patients who participated in the original ACCORD** study. Researchers also assessed lipid-lowering therapy with fenofibrate 160 mg daily plus simvastatin vs simvastatin alone. However, the reduced retinopathy progression previously seen with fenofibrate in the ACCORD study did not persist in ACCORDION.

The researchers said the beneficial effect of fenofibrate on diabetic retinopathy may be “real,” but this effect requires continued treatment to maintain benefit. Further studies of fenofibrate in diabetic retinopathy are therefore warranted.

The ACCORD study randomized patients to intensive or standard treatment for glycaemia (A1C level <6.0 versus 7.0-7.9 percent), systolic BP (<120 vs 140 mm Hg) and dyslipidaemia (fenofibrate 160 mg daily plus simvastatin or simvastatin alone. Both intensive glycaemic control and fenofibrate, but not intensive BP control – another aspect of the trial – reduced retinopathy progression. [N Engl J Med2010; 363:233-244]

“Our study results provide evidence that intensive glycaemic control is beneficial for reducing the progression of diabetic retinopathy and that the legacy effect is evident in people with diabetes,” said the researchers. “The addition of the ACCORDION retinal results to prior findings demonstrates a posttreatment benefit of intensive glycaemia control on the progression of eye, kidney and nerve disease.”

Lowering blood glucose can reduce progression of retinal disease relatively late in the course of T2D and even short-term changes in glucose have an effect, according to a press release from the US National Eye Institute. However, the benefits of intensive glycaemic therapy must be weighed against the potential risks, particularly the increased risk of death observed in ACCORD.

Lower Oxygen Saturation Levels in Preemies Associated with Higher Mortality by Discharge .


The question of which oxygen-saturation level is best for very premature infants remains open after the publication of two studies over the weekend. Commentators suggest that levels under 90% should be avoided, however.

Researchers in the BOOST II study (published in the New England Journal of Medicine) report outcomes at hospital discharge for some 2400 infants randomized to lower (85 to 89%) or higher (91 to 95%) saturation levels. Interpretation is muddied somewhat by the fact that the oximeters had a measurement flaw that wasn’t discovered until halfway through the study. Among infants measured with corrected oximeters, mortality was higher for those receiving lower oxygen saturation (23% vs. 16%). Retinopathy was lower with lower saturation.

In JAMA, COT study researchers found no significant differences in the rates of mortality or retinopathy by 18 months in some 1200 infants similarly studied.

Commentators say the best interim course would be to target saturation levels between 90% and 95%, realizing the dangers of retinopathy.

Source: NEJM 

 

 

Retinopathy in Blacks Starts at Lower Levels of HbA1c Than in Whites.


Although blacks generally have higher glycated hemoglobin levels than whites at the same blood glucose levels, they develop retinopathy at lower HbA1c levels than whites, an Annals of Internal Medicine study finds. The authors say this difference in retinopathy risk argues against setting higher diagnostic levels of HbA1c for blacks.

Researchers examined U.S. NHANES data on over 3000 people. They found that after adjustment for such factors as hypertension and BMI, higher risks for retinopathy started at HbA1c levels of 6.0% and higher in whites, but at levels of 5.5% and higher in blacks. The reasons underlying the risk difference are unknown.

The authors conclude that their results “suggest that the HbA1c levels at which the risk for prevalent retinopathy begins to increase are lower in black adults than in white adults, arguing against a higher HbA1c diagnostic cutoff for blacks.”

Source: Annals of Internal Medicine article