Informed Diabetics

A March 2024 study by the University of Coimbra said,

• “Our main motivation was to contribute to the reduction of the existing disparity in the knowledge that diabetic patients have regarding their disease,”

• “With this study we evidenced the need to improve the disease knowledge of type 2 diabetic patients.”

•  “One of the main reasons for this disparity in knowledge is probably the behavior of health professionals and the areas that are prioritized when informing patients,”

• “We focused on patients’ own knowledge of their disease, rather than disease management being based solely on biological indicators. We hope that the results obtained will allow professionals to change the way they inform patients,”

Non-invasive blood glucose monitoring

In a March 2024 study by Tomoya Nakazawa of Hamamatsu Photonics (Japan) on near-infrared light (NIR) to estimate blood glucose levels, said

“[The] phase delay-based metabolic index, which has not been reported by other researchers, is a scientifically important discovery,”

“The proposed method can in principle be implemented in existing smart devices with a pulse oximetry function and is inexpensive, battery-saving, and simple compared with other noninvasive blood glucose monitoring techniques. Thus, our approach could be a powerful tool towards portable and accessible BGL monitoring devices in the future.”

Prioritizing Patient Experiences in the Management of Diabetes and Its Complications

A February 2024 roundtable report (at https://www.eurekalert.org/news-releases/1034628 ) by the Endocrine Society set out a position statement offering a framework for leveraging the experiences of people with diabetes to optimize health outcomes in several important areas, including:

• Use of person-centered language in the health care setting

• Ensuring that referrals to diabetes self-management and support service programs are timely and accessible to all people with diabetes.

• Effectively navigating available therapeutic options together and explaining complex regimens to people with diabetes to encourage them to take medication as prescribed.

• Considering ways to adjust an individual’s treatment plan in a timely manner if they aren’t meeting therapeutic goals to prevent therapeutic inertia.

• Discussing strategies for assessment of hypoglycemia—low blood glucose episodes that can be dangerous—as well as prevention and treatment of hypoglycemia.

• Improving cardiovascular and renal outcomes using newer therapeutic options.

• Using telehealth in the appropriate clinical setting.

• Using and incorporating diabetes technologies such as insulin pumps and continuous glucose monitoring systems into the diabetes management plan, when appropriate.

Predicting Diabetes Early

A January 2024 study by Ruhr- University Bochum said,

• “Thirty percent of all people who suffer from diabetes haven’t yet been diagnosed and, consequently, don’t receive any treatment,”

• “Diabetes sets in gradually, and our diagnostic options are not sensitive enough to detect it; moreover, they aren’t specific enough, meaning that false positive results can also occur,”

• “We enter these values (insulin value and glucose value) into an equation that describes the body’s control loop for sugar metabolism and break it down according to a certain variable,”

• “We found that the [calculated static disposition index] SPINA-DI correlated with relevant indicators of metabolic function, such as the response to an oral glucose tolerance test,”

• “The new method is not only cost-effective, but also precise and reliable,”

• “It could complement and, in many cases, even replace more complex established methods.”

Diabetes, Cardiovascular Disease, Chronic Kidney Disease

A January 2024 study by Professor Edward Gregg, Head of the School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland, and colleagues said, “As the first intervention study to associate remission with reduction of diabetes-related complications, this is encouraging news for those who can achieve remission from type 2 diabetes. While our study is also a reminder that maintenance of weight loss and remission is difficult, our findings suggests any success with remission is associated with later health benefits.”

JOURNAL

Diabetologia

ARTICLE TITLE

Impact of remission from type 2 diabetes on long‑term health outcomes: findings from the Look AHEAD study

ARTICLE PUBLICATION DATE

18-Jan-2024

COI STATEMENT

See full paper for disclosures

Walking and Diabetes

A November 2023 study said

“The present meta-analysis of cohort studies suggests that fairly brisk and brisk/striding walking, independent of the total volume of physical activity or time spent walking per day, may be associated with a lower risk of type 2 diabetes in adults.”

“While current strategies to increase total walking time are beneficial, it may also be reasonable to encourage people to walk at faster speeds to further increase the health benefits of walking.”

AI Voice Detection of Diabetes

Scientists at Klick Labs report, October 2023, said,

• “Our research highlights significant vocal variations between individuals with and without Type 2 diabetes and could transform how the medical community screens for diabetes,”

• “Current methods of detection can require a lot of time, travel, and cost. Voice technology has the potential to remove these barriers entirely.”

• “Our research underscores the tremendous potential of voice technology in identifying Type 2 diabetes and other health conditions,”

• “Voice technology could revolutionize healthcare practices as an accessible and affordable digital screening tool.”

muscle mass, heart disease, diabetes

An October 2023 report presented to the Annual Meeting of the European Association for the Study of Diabetes (EASD) said,

• “Our results suggest that the increased risk of death in individuals with diabetes who have low muscle mass isn’t mediated or influenced by frailty, poor blood sugar control or microvascular complications but due to the loss of muscle itself.  More research is needed to determine just how sarcopenia increases the risk of death.”

• “For most people with type 2 diabetes and overweight or obesity, guidelines recommend nutrition, physical activity and behavioural therapies to achieve and maintain weight loss.”

• “However, there are limitations to assessing treatment goals based on weight loss alone because body weight cannot distinguish between fat and muscle mass and so does not reveal if someone is sarcopenic.”

• “It is important to consider body composition when treating obesity and managing weight in people with diabetes.”

Diabetes ultra-processed foods

A July 2023 study by the Istituto Neurologico Mediterranean Nueromed found

• "Over an average follow-up of 12 years we observed that a diet rich in ultra-processed foods exposed people with diabetes to a greater risk of death. Participants reporting a higher consumption of ultra-processed foods had 60% increased risk of dying from any cause, compared to people consuming less of these products. The risk of mortality from cardiovascular diseases, which is a leading cause of death for people with diabetes, was more than doubled."

• "One of the most interesting results of this study is that the increased risk linked to ultra-processed foods was observed even when participants reported a good adherence to the Mediterranean Diet. These findings suggest that if the dietary share of ultra-processed foods is high, the potential advantages of a healthful Mediterranean Diet risk to be overlooked”.

• "These results may have important implications for future dietary guidelines to manage type 2 diabetes. In addition to the adoption of a diet based on well-known nutritional requirements, dietary recommendations should also suggest limiting the consumption of ultra-processed foods as much as possible. In this context, and not only for people with diabetes, the front-of-pack nutrition labels should also include information on the degree of food processing".

Protein restriction, obesity and diabetes

A September 2022 study by Harvard Medical School said, 

• “The study showed that cutting protein intake to 0.8 g per kg of body weight was sufficient to achieve almost the same clinical results as restricting calories, but without the need to reduce calorie intake. The results suggest that protein restriction may be one of the key factors leading to the known benefits of dietary restriction. Protein restriction dieting may therefore be a more attractive nutritional strategy and easier to follow for people with metabolic syndrome,” 

• “After 27 days of monitoring, both groups had similar results in terms of lower blood sugar, weight loss, controlled blood pressure, and lower levels of triglycerides and cholesterol. Both diets improved insulin sensitivity after treatment. Body fat decreased, as did waist and hip circumference, but without loss of muscle mass,” 

• “Here, however, we succeeded in conducting a fully controlled randomized clinical trial lasting 27 days, with a personalized menu designed to meet each patient’s needs,” 

• “We demonstrated that protein restriction reduces body fat while maintaining muscle mass. That’s important since the weight loss resulting from restrictive diets is often associated with loss of muscle mass,” 

• “We only have hypotheses so far. One is that molecular pathways are activated to interpret the reduction in essential amino acids as being a signal to reduce food intake while leading to the production of hormones that typically increase when we’re fasting,”

• “Studies in animal models have shown the involvement of such pathways in the effects of both protein and calorie restriction, both of which lead to fat loss.”

• “Nevertheless, it’s tempting to extrapolate the results. We know research has shown vegan diets to be positive for cases of metabolic syndrome. It’s also been found that the excessive protein intake common in the standard Western diet can be a problem. Every case should be analyzed on its own merits. We shouldn’t forget protein deficiency can lead to severe health problems, as has been well-described in pregnant women, for example,”

Potatoes

A December 2022 study by Edith Cowan University said, 

• “In previous studies, potatoes have been positively linked to incidence of diabetes, regardless of how they’re prepared — but we found that’s not true,” 

• “In Denmark, people consume potatoes prepared in many different ways; in our study, we could distinguish between the different preparation methods.

•  “When we separated boiled potatoes from mashed potatoes, fries or crisps, boiled potatoes were no longer associated with a higher risk of diabetes: they had a null effect.”

•   “In our study, people who ate the most potatoes also consumed more butter, red meat and soft drink — foods known to increase your risk of Type 2 diabetes,”

• “When you account for that, boiled potatoes are no longer associated with diabetes. It’s only fries and mashed potatoes, the latter likely because it is usually made with butter, cream and the like.”

•  “The finding that vegetables lower diabetes risk is crucial for public health recommendations, and we shouldn’t ignore it,”

•  “Regarding potatoes, we can’t say they have a benefit in terms of type 2 diabetes, but they also aren’t bad if prepared in a healthy way.”

• “We should separate potatoes and other vegetables in regard to messaging about disease prevention but replacing refined grains such as white rice and pasta with potatoes can improve your diet quality because of fibre and other nutrients found in potatoes.”

•  “Potatoes have fibre and nutrients, which are good for you,”

•  “People talk about carbs being bad, but it’s more about the type of carbs you’re having; compared to something like white rice, boiled potatoes are a good quality of carbohydrate.

•  “But just take care how you prepare them: don’t eat fries, or mash with extras in it all the time.”

•  “Just boil them and eat them like other greens or other foods — and you don’t need to have it with red meat all the time.”

Cold exposure and diabetes

A September 2022 study by Maastricht University in The Netherlands said,

• “Brown fat is a metabolic heating system inside our bodies, burning calories”, 

• “This generates heat and prevents calories from being deposited as normal white fat. Brown fat is activated during cold and when we eat, but its activity is less in older adults and in individuals with obesity and diabetes.”

• “When we are cold, we can activate our brown fat because it burns energy and releases heat to protect us. In addition, muscle can contract mechanically, or shivers, thereby generating heat. As there is considerably more muscle than brown fat in a human, shivering can burn more calories and produce more heat”

• “Nevertheless, this is an important first step investigating the effect of shivering on health. Our findings are promising and may have important health implications, given that shivering improved many cardiometabolic health outcomes which are associated with diseases like type 2 diabetes”

• “In future studies, we plan to assess the effect of shivering in adults with type 2 diabetes.”

Mind-body practices, blood sugar, diabetes

A September 2022 study by the Keck School of Medicine of USC

• “The most surprising finding was the magnitude of the benefit these practices provide,”

• “We expected there to be a benefit, but never anticipated it would be this large.”

• “What is important about this study is that the effect is very strong and that it is on top of the standard of care,” 

• “This could be an important tool for many people because type 2 diabetes is a major chronic health problem and we are not doing a good enough job at controlling it,” 

• “Although this study does not address it as a preventive measure, it does suggest it could help people who are pre-diabetic reduce their risk for future type 2 diabetes.”

Fruit and type 2 diabetes

A June 2021 study by Edith Cowan University said,

• "We found an association between fruit intake and markers of insulin sensitivity, suggesting that people who consumed more fruit had to produce less insulin to lower their blood glucose levels,”

• "This is important because high levels of circulating insulin (hyperinsulinemia) can damage blood vessels and are related not only to diabetes, but also to high blood pressure, obesity, and heart disease.

• "A healthy diet and lifestyle, which includes the consumption of whole fruits, is a great strategy to lower your risk of developing type 2 diabetes."

• "Higher insulin sensitivity and a lower risk of diabetes was only observed for people who consumed whole fruit, not fruit juice,"

• "This is likely because juice tends to be much higher in sugar and lower in fibre."

• "As well as being high in vitamins and minerals, fruits are a great source of phytochemicals which may increase insulin sensitivity, and fibre which helps regulate the release of sugar into the blood and also helps people feel fuller for longer," she said.

• "Furthermore, most fruits typically have a low glycaemic index, which means the fruit's sugar is digested and absorbed into the body more slowly."

Yoghurt and Diabetes

A March 2022 study by Université Laval and Danone Nutricia Research said, 

• “These metabolites, called branched chain hydroxy acids (BCHA), result from the action of yogurt lactic bacteria on naturally occurring amino acids in milk,”

• “In the group that was not given yogurt, the amount of these metabolites in the bloodstream and in the liver decreased with weight gain. In the yogurt group, the amount of BCHA was partially maintained,” 

• “We also found that an abundance of BCHA in the liver was tied to improved fasting glucose and hepatic triglycerides.” 

• “BCHA are found in fermented dairy products and are particularly abundant in yogurt. Our body produces BCHA naturally, but weight gain seems to affect the process,” 

sucrose and high fructose corn syrup and health risks

An August 2021 study by University of California, Davis, said,

• “This is the first dietary intervention study to show that consumption of both sucrose- and high fructose corn-sweetened beverages increase liver fat and decrease insulin sensitivity,” 

• “People often have a skewed perspective of aspartame and give sucrose a pass, but this study suggests that consumers should be equally concerned about both major added sugars in our food supply.”

• “Within the span of two weeks, we observed a significant change in liver fat and insulin sensitivity in the two groups consuming sucrose- or high fructose corn syrup-sweetened beverages,” 

• “That’s concerning because the prevalence of fatty liver [nonalcoholic fatty liver disease] and Type 2 diabetes continues to increase globally.”

• “It’s all physiologically connected, although we’re not sure [in what] direction it goes,” 

• “It’s very likely that the mechanism by which we develop metabolic syndrome goes through liver fat and insulin resistance. An increase in liver fat can be benign for a certain amount of time and for certain people. But it can also progress to associated inflammation in liver cells that causes fibrosis and negatively impacts liver function, which can make an individual more prone to liver cancer.”

Diet and Diabetes

A September 2021 study by the University of British Columbia and Teesside University said, 

• “Type 2 diabetes can be treated, and sometimes reversed, with dietary interventions,” 

• “However, we needed a strategy to help people implement these interventions while keeping an eye on their medication changes.”

• “Community pharmacists have expertise in medication management and can serve an important role in overall diabetes care,” 

• “When Type 2 diabetes patients follow a very low-carbohydrate or low-calorie diet, there is a need to reduce or eliminate glucose-lowering medications. Community pharmacists are ideally positioned to safely and effectively deliver interventions targeted at reducing diabetes medications while promoting Type 2 diabetes remission.”

• “The intervention was effective in reducing the need for glucose-lowering medications for many in our study,” 

• “This indicates that community pharmacists are a viable and innovative option for implementing short-term nutritional interventions for people with Type 2 diabetes, particularly when medication management is a safety concern.”

The personal fat threshold

A September 2022 study by Newcastle University, of which Eureka notes

• “Everyone has a ‘personal fat threshold’ which, if exceeded, will allow type 2 diabetes (T2D) to develop, even if they are of a lower body weight”

• “The most common form of diabetes, T2D occurs when the pancreas can’t make enough insulin (a hormone which helps move the sugar in food into cells for energy) or the insulin it makes doesn’t work properly.”

• “Having a BMI over 30 is a risk factor for T2D”

• “An intensive weight loss programme can put T2D into remission in people who are living with obesity or overweight.”

• “But not everyone with T2D is overweight.”

Newcastle University said,

• “But if they lost around 10% of their weight, they would have a very good chance of putting their type 2 diabetes into remission,”

• “The results also support the personal fat threshold concept that anyone with type 2 diabetes has a little more fat on board than they individually can cope with.  This is determined by your genes. Each of us has a threshold level under which they can store fat safely and that this has little to do with BMI.”

• “If you develop type 2 diabetes, you simply have more fat inside your body than you can cope with, even if apparently slim.”

• “This excess fat spills into your liver and pancreas stopping normal function and causing type 2 diabetes. You only need an extra half gram of fat in the pancreas to prevent normal insulin production.”

• “‘I’m often asked, “Why have I got type 2 diabetes when all my friends are larger than me and do not have diabetes?” The present work answers this conundrum.”

• “This should help to remove some of the stigma that attaches to type 2 diabetes. It is clearly a condition which is not “caused” by being over any level of BMI but by storing a little too much fat inside liver and pancreas, whatever your weight.”

Diabetes, diet and blood pressure

A May 2021 study at the Universities of Glasgow and Newcastle for the Diabetes UK-funded DIabetes REmission Clinical Trial (DIRECT), said, 

• "We wanted to evaluate the safety and efficacy of withdrawing blood pressure medication when beginning our specially-designed weight-loss programme for type 2 diabetes, and we are really pleased with the results.

• "Our study shows that, in addition to possible remission from type 2 diabetes, there are other very important health benefits, as weight loss is a very effective treatment for hypertension and its associated serious health risks.

• "Currently, over half of all the 4.5 million people with type 2 diabetes in UK also require tablets for hypertension, to reduce serious vascular complications. Being overweight is the main cause, and losing weight can bring a remission from hypertension for many, as well as a remission of diabetes. Withdrawing blood pressure medications is safe, provided people lost weight and blood pressure was checked regularly, in case tablets needed to be reintroduced.”

• "The DiRECT trial was done entirely in primary care. The evidence shows that GPs can safely offer an evidence-based intensive weight management intervention, aiming for substantial weight loss and remission of type 2 diabetes. The study further highlights the links between diet, weight, type 2 diabetes and hypertension, and how long-term support to maintain weight loss is vital."

Newcastle University, said,

• "Guidelines encourage doctors to start tablets but there have been few demonstrations of how tablets can be stopped.

• "My patients, like so many, do not like swallowing multiple tablets, and this study is important as we can now reassure them that stopping blood pressure tablets is not only safe but also good for their health. We've shown that when substantial weight loss is achieved and maintained, patients can effectively manage both their blood pressure and type 2 diabetes without drugs."

University of Glasgow, said, 

”The potential to no longer need medications for blood pressure and diabetes is a big incentive for people. We hope our results will reassure health professionals that this is possible, and encourage the wider provision of diabetes remission services."

Diabetes UK, said,

 "These important results show that the Diabetes UK-funded DiRECT low-calorie, weight management programme not only helps some people put their type 2 diabetes into remission, but can also lower blood pressure, allowing some people to safely stop taking their blood pressure medication.”

"We're delighted to see more evidence of the life-changing impact of the DiRECT programme on people's health. This makes us even more determined to make sure as many people as possible have access to type 2 diabetes remission services."

Millet and Diabetes

A July 2021 study, the largest systematic review on the topic to date, said, 

• “No one knew there were so many scientific studies undertaken on millets’ effect on diabetes and these benefits were often contested. This systematic review of the studies published in scientific journals has proven that millets can keep blood glucose levels in check and reduce the risk of diabetes. It has also shown just how well these smart foods do it,”

• “Awareness of this ancient grain is just starting to spread globally, and our review shows millets having a promising role in managing and preventing type 2 diabetes. In the largest review and analysis of research into different types of millet compared to other grains such as refined rice, maize and wheat we found that millets outperform their comparison crops with lower GI and lower blood glucose levels in participants,”

• “Millets are grown on all inhabited continents, yet they remain a ‘forgotten food’. We hope this will change from 2023, when the world observes the United Nations declared International Year of Millets, and with studies like this that show that millets outperform white rice, maize and wheat,”

• “The global health crisis of undernutrition and over-nutrition coexisting is a sign that our food systems need fixing. Greater diversity both on-farm and on-plate is the key to transforming food systems. On-farm diversity is a risk mitigating strategy for farmers in the face of climate change while on-plate diversity helps counter lifestyle diseases such as diabetes. Millets are part of the solution to mitigate the challenges associated with malnutrition, human health, natural resource degradation, and climate change. Trans-disciplinary research involving multiple stakeholders is required to create resilient, sustainable and nutritious food systems,”

• “This study is first in a series of studies that has been worked on for the last four years as a part of the Smart Food initiative led by ICRISAT that will be progressively released in 2021. Included are systematic reviews with meta-analyses of the impacts of millets on: diabetes, anemia and iron requirements, cholesterol and cardiovascular diseases and calcium deficiencies as well as a review on zinc levels. As part of this, ICRISAT and the Institute for Food Nutrition and Health at the University of Reading have formed a strategic partnership to research and promote the Smart Food vision of making our diets healthier, more sustainable on the environment and good for those who produce it,”