Dose-Response Effect of Fruit and Vegetables on Insulin Resistance in People at High Risk of Cardiovascular Disease A randomized controlled trial

Diabetes Care: October 15, 2013

Prevention of Type 2 Diabetes in Subjects With Prediabetes and Metabolic Syndrome Treated With Phentermine and Topiramate Extended-Release

Diabetes Care: October 8, 2013

Lifestyle Interventions for Patients With and at Risk for Type 2 Diabetes: A Systematic Review and Meta-analysis

Ann Intern Med.: 10/15/13

Background: The effect of multifaceted lifestyle interventions on clinically oriented outcomes across a spectrum of metabolic risk factors and abnormal glucose is unclear.

Purpose: To systematically review the effectiveness of lifestyle interventions on minimizing progression to diabetes in high-risk patients or progression to clinical outcomes (such as cardiovascular disease and death) in patients with type 2 diabetes.

Data Sources: 5 electronic databases (1980 to June 2013), reference lists, and gray literature.

Study Selection: Two reviewers independently identified randomized, controlled trials of lifestyle interventions (≥3 months’ duration) that included exercise, diet, and at least 1 other component; the comparator was standard care.

Data Extraction: One reviewer extracted and a second verified data. Two reviewers independently assessed methodological quality.

Data Synthesis: Nine randomized, controlled trials with patients who were at risk for diabetes and 11 with patients who had diabetes were included. Seven studies reported that lifestyle interventions decreased the risk for diabetes from the end of intervention up to 10 years after it. In patients with diabetes, 2 randomized, controlled trials (which included pharmacotherapy) reported no improvement in all-cause mortality (risk ratio, 0.75 [95% CI, 0.53 to 1.06]). Composite outcomes for cardiovascular disease were too heterogeneous to pool. One trial reported improvement in microvascular outcomes at 13-year follow-up. Read More

American Diabetes Association Releases New Nutritional Guidelines

American Diabetes Association: October 9, 2013

Statement Notes: When It Comes to Nutrition, There is No “One Size Fits All”

The American Diabetes Association recommends all people living with diabetes make nutrition therapy a part of their diabetes treatment plan, but emphasizes that there is no single eating pattern that is best for everyone, according to a position statement being published online Oct. 9 in Diabetes Care.

This position statement replaces the nutrition therapy recommendations for the management of adults with diabetes published in 2008.  The 2013 statement provides a set of recommendations based on review of recent scientific evidence. It calls for all adults diagnosed with diabetes to eat a variety of nutrient-dense foods in appropriate portion sizes as part of an eating plan that takes into account individual preferences, culture, religious beliefs, traditions and metabolic goals. Since people eat food and not single nutrients such as carbohydrates, protein and fat, the report includes a new section on eating patterns.

“Just because you have been diagnosed with diabetes does not mean you can no longer enjoy the foods you love or your cultural traditions,” said Alison Evert, MS, RD, CDE, Coordinator of Diabetes Education Programs – University of Washington Medical Center, Diabetes Care Center. “Ideally the person with diabetes should be referred to a registered dietitian or participate in a diabetes self-management education program, soon after diagnosis. An important goal of nutrition therapy for adults with diabetes includes the collaborative development of an individualized eating plan with ongoing support to promote health behavior change.” read  more

New Drugs Improve Glycemic Control in Type 2 Diabetes, But Improving Heart Health Remains Elusive

JAMA: October 9, 2013

New research findings reported last month found that compared with placebo, 2 drugs improved glycemic control in patients with type 2 diabetes without increasing major adverse cardiovascular events. But is that good enough?

For years, conventional wisdom held that achieving near-normal blood glucose levels in these patients would decrease their risk for microvascular complications such as diabetic retinopathy, nephropathy, and neuropathy and macrovascular complications such as cardiovascular disease and stroke. However, although glycemic control is associated with decreased risk of microvascular complications, studies have yet to find robust evidence that glycemic control decreases macrovascular complications. Indeed, an emerging body of evidence suggests that tight glycemic control increases risk for cardiovascular disease and stroke. Read More

Validation of Pediatric Diabetes Case Identification Approaches for Diagnosed Cases by Using Information in the Electronic Health Records of a Large Integrated Managed Health Care Organization

Am. J. Epidemiol: October 7, 2013

We explored the utility of different algorithms for diabetes case identification by using electronic health records. Inpatient and outpatient diagnosis codes, as well as data on laboratory results and dispensing of antidiabetic medications were extracted from electronic health records of Kaiser Permanente Southern California members who were less than 20 years of age in 2009. Diabetes cases were ascertained by using the SEARCH for Diabetes in Youth Study protocol and comprised the “gold standard.” Sensitivity, specificity, positive and negative predictive values, accuracy, and the area under the receiver operating characteristic curve (AUC) were compared in 1,000 bootstrapped samples. Based on data from 792,992 youth, of whom 1,568 had diabetes (77.2%, type 1 diabetes; 22.2%, type 2 diabetes; 0.6%, other), case identification accuracy was highest in 75% of bootstrapped samples for those who had 1 or more outpatient diabetes diagnoses or 1 or more insulin prescriptions (sensitivity, 95.9%; positive predictive value, 95.5%; AUC, 97.9%) and in 25% of samples for those who had 2 or more outpatient diabetes diagnoses and 1 or more antidiabetic medications (sensitivity, 92.4%; positive predictive value, 98.4%; AUC, 96.2%). Read More

Health Insurance Update: Protections for People With Diabetes

Clinical Diabetes: October 1, 2013

The Affordable Care Act, passed in 2010, includes a number of changes to improve access to health insurance for individuals and families and make coverage more affordable. Some parts of the law are already in place and people with diabetes are already benefiting from them, while many other protections go into effect in 2014.