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.

Acupuncture for Combat-Related PTSD

A February 2024 study by Michael Hollifield, M.D at Tibor Rubin VA Medical Center, California, reported in Eureka, which said that “The acupuncture intervention used in this randomized clinical trial including 93 participants was clinically efficacious and favorably affected the psychobiology of posttraumatic stress disorder (PTSD) in combat veterans. These data build on extant literature and suggest that clinical implementation of acupuncture for PTSD, along with further research about comparative efficacy, durability, and mechanisms of effects, is warranted.“

New "Steps" Target

A February 2024 study by New York University at Buffalo said,

• “In ambulatory older women, higher amounts of usual daily light and moderate intensity activities were associated with lower risk of developing heart failure with preserved ejection fraction independent of demographic and clinical factors associated with heart failure risk,”

• “Accumulating 3,000 steps per day might be a reasonable target that would be consistent with the amount of daily activity performed by women in this study.”

• “This is a major, unique finding of our study because there is very little published data on physical activity and HFpEF, so we are providing new information upon which other studies can build,”

• “More importantly, [in] the most common form of heart failure seen in older women and among racial and ethnic minority groups, and at present there are few established treatment options, which makes primary prevention all the more relevant…. The potential for light intensity activities of daily life to contribute to the prevention of [this type of heart failure] in older women is an exciting and promising result for future studies to evaluate in other groups, including older men,”

• “…conveying how much activity is always a challenge to incorporate as part of clinical and public health recommendations,”

• “Steps per day is easily understood and can be measured by a variety of consumer-level wearable devices to help people monitor their physical activity levels.”

• “It appeared that intensity of stepping did not influence the lower risk of heart failure as results were comparable for light intensity steps and for more vigorous steps,”

• “Our results showing heart failure prevention in older women might be enhanced through walking around 3,000 steps or so per day at usual pace is very relevant given the current emphasis at the federal level on identifying an amount of daily physical activity that can be referenced against steps per day for cardiovascular health and resilience to incorporate in future public health guidelines.”

Exercise and Depression

A February 2024 study in the BMJ said,

• Walking or jogging, yoga, and strength training “could be considered alongside psychotherapy and drugs as core treatments for depression.”

• “Our findings support the inclusion of exercise as part of clinical practice guidelines for depression, particularly vigorous intensity exercise,”

• “Health systems may want to provide these treatments as alternatives or adjuvants to other established interventions, while also attenuating risks to physical health associated with depression.”

• “Primary care clinicians can now recommend exercise, psychotherapy, or antidepressants as standalone alternatives for adults with mild or moderate depression,”

Protein, Breakfasts and Saeity

A February 2024 study by Aarhus University said,

• "We found that a protein-rich breakfast with skyr (a sour-milk product) and oats increased satiety and concentration in the participants, but it did not reduce the overall energy intake compared to skipping breakfast or eating a carbohydrate-rich breakfast,"

• "The results confirm that protein-rich meals increase a sense of satiety, which is positive with regard to preventing weight gain. However, the results also suggest that for this nutritional strategy to be effective, it’s not enough to just eat a protein-rich breakfast."

• "It’s intriguing that there can be such a big difference in the satiety effect of two different meals with the same calorie content. Had the women in the project been allowed to choose the size of the meal themselves, it’s likely that they’d have consumed more food and thereby more calories on the day they were served bread and jam than on the day they were given skyr and oats,"

• "We already have new data incoming from a trial where participants received either a high-protein breakfast or a low-protein breakfast. The objective was to study how the different types of breakfast affect body composition and other parameters such as microbiota and cholesterol levels,"

Nudged towards Healthier Deits

A February 2024 study by the University of Göttingen said,

• “Understanding public support – and its drivers – is important for designing politically viable, ethical, and effective nudges,”

• “We were surprised to find that the personal circumstances of our participants and whether their own behaviour would be affected by the nudge had little effect on their support. We found that the perception of upholding free choice and of effectiveness were key to public support.”

Kimchi Lowering Obesity Risk

A January 2024 study reported in BMJ Open compared with those who ate less than 1 daily serving of total kimchi, participants who ate 5 or more servings weighed more, had a larger waist size, and were more likely to be obese. They were also more likely to not be highly educated, have a low income, and to drink alcohol.

But after accounting for potentially influential factors, eating up to 3 daily servings of total kimchi was associated with an 11% lower prevalence of obesity compared with less than 1 daily serving.

“Since all results observed a ‘J-shaped’ association, excessive consumption suggests the potential for an increase in obesity prevalence. And as kimchi is one of the major sources of sodium intake, a moderate amount should be recommended for the health benefits of its other components.”

Stress and Wellbeing

A February 2024 study by the University of Bath said,

• “We found a convincing link between mental and physical ill-health, and the way a person typically views stressful situations,”

• “The more you’re able to appraise a stressful situation as a challenge, the more likely you are to report good health and wellbeing.”

• “Researchers have speculated for the past 15 years that people who repeatedly believe they don’t have the resources to cope in stressful situations are putting their health at risk, but we believe this is the first time the theory has been properly tested, leading to us finding a link between stress appraisals and health.”

• “Most people will fluctuate in the way they appraise a situation, depending on the details of the specific situation, however, some people are far more likely to appraise all stressful situations as a threat, and this study shows that this tendency is associated with poorer health and wellbeing.”

Food Preservatives and the Gut Microbiome

Eureka states: “Lanthipeptides, a class of bacteriocins with especially potent antimicrobial properties, are widely used by the food industry and have become known as “lantibiotics” (a scientific portmanteau of lanthipeptide and antibiotics).”

A February 2024 study by the University of Chicago said,

• “Nisin is, in essence, an antibiotic that has been added to our food for a long time, but how it might impact our gut microbes is not well studied,”

• “Even though it might be very effective in preventing food contamination, it might also have a greater impact on our human gut microbes.”

• “This study is one of the first to show that gut commensals are susceptible to lantibiotics, and are sometimes more sensitive than pathogens,”

• “With the levels of lantibiotics currently present in food, it’s very probable that they might impact our gut health as well.”

• “It seems that lantibiotics and lantibiotic-producing bacteria are not always good for health, so we are looking for ways to counter the potential bad influence while taking advantage of their more beneficial antimicrobial properties,”

Energy Drinks and Sleep

A January 2024 study of Danish students found a link between energy drinks and poor quality sleep and insomnia saying, “Identifying modifiable risk factors for sleep problems among college and university students is vital and our results suggest that the frequency of …consumption could be a possible target for interventions.”

Prostate Screening - PSA better than Rectal Exam

A January 2024 study by the Medical University of Vienna said,

• “The validity of rectal examination in detecting prostate cancer is not particularly impressive, suggesting that it may not be necessary to perform this examination routinely as part of screening in the absence of clinical symptoms and signs,"

• "The continuous improvement of prostate cancer screening methods remains of paramount importance to protect the health and well-being of men worldwide. We certainly hope that by removing this barrier, more men will go for prostate cancer screening."

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.”

Snoring Signs

A January 2024 study by St James’s University Hospital, Leeds, said,

• “Up to one fifth of collisions on the road may be caused by fatigue or sleepiness. Many obstructive sleep apnoea (OSA) patients drive either for personal or for professional reasons and there is good evidence to suggest that some patients are at increased risk of collisions on the road.”

• “Doctors are often asked to make recommendations about their patient’s fitness to drive. This can be challenging as it can have major implications on a patient’s livelihood, particularly if they are a professional driver. However, there is a duty of care on doctors to discourage patients from driving if are at high risk of causing a collision.”

•  “Our research suggests that untreated OSA patients often use coping strategies that could be surrogate markers of sleepiness. Asking about these strategies in the clinic may help doctors identifying patients who are at risk of driving incidents and to advise appropriately.”

•  “Obstructive sleep apnoea is of high public health relevance due to its high prevalence, symptoms that impair quality of life and potential cardiovascular consequences. In addition to choking, fragmented sleep and unrefreshing sleep, possible symptoms include difficulty concentrating, tiredness and a tendency to fall asleep during the day. Fortunately, awareness of OSA has increased somewhat in recent years. Today, treatment recommendations are based on the different risk factors, symptom groups and cardiovascular consequences of certain OSA types. Various treatment approaches geared to different types of OSA can be offered to successfully treat the symptoms, including daytime sleepiness.”

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

Boswellia - Frankincense - Breast Cancer

A January 2024 study by the Medical University of South Carolina said,

• “We looked at differences in the growth rate of the tumors before and after treatment, and we found that the tumors after treatment had a lower growth rate compared to before treatment,”

• “We saw a statistically significant reduction in tumor proliferation compared to the non-treated group, so the implications are that Boswellia, this extract of frankincense, does have anti-cancer activity in humans,”

• “This study was not designed to look at survival or recurrence – it was designed to see if this supplement has anti-cancer activity in humans. Since this was a positive trial, larger studies to look at endpoints of survival and recurrence are warranted,”

• “This does not imply that patients should take Boswellia in place of standard breast cancer treatment.” 

• “What's strange about Boswellia is that it’s probably been used in medicine longer than any other plant-based product, but we still don’t have any purified active drug products from the plant,”

• “It is disappointing – but based on the difficulty we had in identifying the active pharmaceutical ingredient, perhaps not surprising.” 

Biomarkers for Heart Risk

A January 2024 study by St Jude Children’s Research Hospital said,

• “This may be a much more sensitive way to identify childhood cancer survivors that might benefit from intervention at an earlier stage,”

• “We were somewhat surprised by the magnitude of risk for declining heart function over such a relatively short period in individuals with abnormal GLS and NT-proBNP, suggesting a need for early and effective interventions that we hope will prevent progression to heart failure over time.”  

•  “This means doing more for patients at greatest risk while avoiding unnecessary tests for patients who will not benefit from them,”

• “A survivor with a normal ejection fraction at baseline with abnormal ranges of both biomarkers was at a fourfold increased risk for a worsening ejection fraction in the next five years,”

•  “One of the promising aspects of our findings is that both of these measures are readily available and, therefore, have the potential to impact care more immediately. Most cardiologists are already using GLS … and NT-proBNP has been around for a long time.” 

•  “The exciting part of this study is that it potentially helps to identify a population that we would have otherwise looked at and said, ‘You’re at risk for abnormal heart function, but everything looks good today. We’ll reevaluate your heart in two to five years,’”

• “Whereas now we have reason to believe those with abnormal biomarkers are a particularly high-risk group that may benefit from closer follow-up or more proactive interventions to reduce risk. The findings set the stage for future studies evaluating novel screening and early intervention strategies that we hope will ultimately improve survivors’ cardiac health and well-being.”  

Stress, inflammation and Metabolic Syndrome

A January 2024 study by Ohio State University said,

• “We were specifically examining people in midlife – a time that is critical to determine those who will experience accelerated aging. Stress is an important contributor to several negative health outcomes as we age,”

• “There are many variables that influence metabolic syndrome, some we can’t modify, but others that we can. Everybody experiences stress,”

• “And stress management is one modifiable factor that’s cost-effective as well as something people can do in their daily lives without having to get medical professionals involved.”

• “There’s not much research that has looked at all three variables at one time,” said Jurgens, a psychology graduate student in Hayes’ lab. “There’s a lot of work that suggests stress is associated with inflammation, inflammation is associated with metabolic syndrome, and stress is associated with metabolic syndrome. But putting all those pieces together is rare.”

• Inflammation composite scores were calculated using biomarkers that included the better-known IL-6 and C-reactive protein as well as E-selectin and ICAM-1, which help recruit white blood cells during inflammation, and fibrinogen, a protein essential to blood clot formation.

• The statistical modeling showed that stress does indeed have a relationship with metabolic syndrome, and inflammation explained over half of that connection – 61.5%, to be exact.

• “There is a small effect of perceived stress on metabolic syndrome, but inflammation explained a large proportion of that,”

• “People think of stress as mental health, that it’s all psychological. It is not. There are real physical effects to having chronic stress,”

• “It could be inflammation, it could be metabolic syndrome, or a number of things. This is another reminder of that.”

Physical Healing and the Perception of Time

A January 2024 study by Harvard University said that perceived time has a significant impact on the actual time it takes to heal physical wounds.

Disrupted Sleep, Memory and Cognition

A January 2024 study the University of California, San Francisco said,

• “Given that signs of Alzheimer’s disease start to accumulate in the brain several decades before symptoms begin, understanding the connection between sleep and cognition earlier in life is critical for understanding the role of sleep problems as a risk factor for the disease,”

• “Our findings indicate that the quality rather than the quantity of sleep matters most for cognitive health in middle age.”

• “More research is needed to assess the link between sleep disturbances and cognition at different stages of life and to identify if critical life periods exist when sleep is more strongly associated with cognition,”

• “Future studies could open up new opportunities for the prevention of Alzheimer’s disease later in life.”

MYC PROTEINS (GREY RIBBONS) MYC Proteins (Grey Ribbons) and Cancer

A January 2024 study by the University of California, Riverside, said

• “Normally, MYC’s activity is strictly controlled. In cancer cells, it becomes hyper active, and is not regulated properly,”  

• “MYC is less like food for cancer cells and more like a steroid that promotes cancer’s rapid growth,”

• “That is why MYC is a culprit in 75% of all human cancer cases.”

• “It’s basically a glob of randomness,”

• “Conventional drug discovery pipelines rely on well-defined structures, and this does not exist for MYC.”

• “Peptides can assume a variety of forms, shapes, and positions,”

• “Once you bend and connect them to form rings, they cannot adopt other possible forms, so they then have a low level of randomness. This helps with the binding.” 

• “We improved the binding performance of this peptide over previous versions by two orders of magnitude,”

• “This makes it closer to our drug development goals.”

• “MYC represents chaos, basically, because it lacks structure. That, and its direct impact on so many types of cancer make it one of the holy grails of cancer drug development,”

• “We are very excited that it is now within our grasp.”