A treasure-trove of nutrients, this winter vegetable has always been a popular choice for regulating blood sugar and managing diabetes.

• Green peas are used extensively in every kitchen across India
• It contains dietary fibre that helps slow down rise in our blood sugar
• Green pea pods are also deemed great for weight loss

It is that time of the year when our vegetable baskets are filled with fresh and crunchy green peas. Also called matar in Hindi, this fibrous vegetable is delicious and can be eaten in various forms. From nibbling it as is to adding to various winter-special recipes – green peas are used extensively in every kitchen across India. And what adds to its credits is the rich nutrient-profile. Green peas are loaded with vitamins, dietary fibre, protein, antioxidants etc that benefits our health in several ways.

Green Peas For Diabetes | Matar Health Benefits:

A treasure-trove of nutrients, this winter vegetable has always been a popular choice for regulating blood sugar and managing diabetes. It contains dietary fibre that helps slow down the rise in our blood sugar level. For the unversed, an earlier study found that eating more dietary fibre can boost a group of healthy gut bacteria that further helps prevent type-2 diabetes. The findings were published in the journal Science. As per experts, the low calorie and rich potassium content of green peas further help to keep a check on our blood sugar levels.

Alongside managing diabetes, these sweet and fibrous pea pods are also deemed great for weight loss, managing cholesterol levels and promoting bone health.

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The post More than half of 20-year-olds in India’s metros likely to develop diabetes in lifetime: Study appeared first on MyMedicPlus.

A new post-hoc analysis from Novo Nordisk of their SUSTAIN 6 and PIONEER 6 studies into semaglutide is looking to help ‘individualise’ treatment for diabetes patients by better predicting their cardiovascular lifetime risk. We spoke to lead study investigator, Utrecht University’s Dr Jan Westerink, to find out how he sees the results being used in daily practice.

The heightened risk of cardiovascular disease remains a pressing concern for type-2 diabetes patients, and one that many healthcare systems have not quite got a handle on yet.

Dr Jan Westerink, assistant professor of internal medicine, University Medical Center, Utrecht, believes that one issue is that the guidelines for addressing cardiovascular risk are too rigid, and don’t take into account each patient’s individual circumstance.

“People always say that patients and doctors should share decision making and discuss treatments with one another, but in reality, most of us just follow the guidelines.

“The problem is, if you have a high risk of cardiovascular disease, the guidelines might suggest that you are given statins and told to take them for the next 50 years, with no discussion at all.”

But Dr Westerink believes there needs to be more room for nuance and an understanding of lifetime risk.

“If you start taking a diabetes treatment with cardiovascular benefits whilst you’re relatively young, you will benefit more than a person who started taking it in their 70s.

“It’s like starting a savings account; if you start young then the benefits will be a lot greater than if you started at a higher age.”

But current guidelines do not always take into account this type of reasoning.

Applying a new model

To help understand the lifetime risk of developing CVD and how diabetes drugs like semaglutide can affect this for individual patients, Novo Nordisk conducted a post-hoc analysis by applying the Diabetes Lifetime-perspective prediction (DIAL) of cardiovascular risk model to data from two of Novo Nordisk’s phase 3 trials into semaglutide – SUSTAIN 6 and PIONEER 6.

This model was specifically developed for use in people with type 2 diabetes for lifetime risk prediction of cardiovascular events as well as the years free from cardiovascular disease gained from an intervention.

It was based on data from 389,366 people with type 2 diabetes in the Swedish National Diabetes Registry and externally validated across multiple geographical regions.

Prediction models like this are recommended to help prediction and prevention of cardiovascular disease by leading cardiology associations, including the European Society of Cardiology (ESC).

“As a lifetime risk model, it estimates your life expectancy without cardiovascular disease, whilst also taking into account that you have a risk of dying from other causes,” Westerink, who was lead investigator of the analysis, says.

The two studies included 6,480 people with type 2 diabetes with high cardiovascular risk aged between 50-90 years.

The analysis showed that the addition of semaglutide to standard of care may extend life without a cardiovascular event, such as heart attack or stroke, in people with type 2 diabetes and high cardiovascular risk for up to 3 years, with the average being 18 months.

The results also showed a 20% risk reduction in ten-year risk of experiencing cardiovascular events for participants receiving semaglutide compared to standard of care alone.

With semaglutide, the average number of years during which participants did not experience a cardiovascular event was extended by 7-35 months across all age groups (50 – 90 years), with the greatest benefit seen in people aged between 50 -65 years and with high cardiovascular risk.

The team then took the MACE hazard ratio from the trial cohort – 0.76 – and applied it to patient-level lifetime risk of cardiovascular disease events derived from the DIAL model. From that, they were able to calculate the return on investment from lifetime use of semaglutide for individual patients.

For example, for a specific patient, a 61-year old man with type 2 diabetes and a history of cardiovascular disease, the DIAL model showed that adding semaglutide to standard of care reduced the 10-year risk of having a cardiovascular event by 21% and provided almost two-and-a-half years (29 months) free of cardiovascular events.

“What we found is that, as expected, if you have a large population and you calculate absolute benefits in all those individual patients and you make a histogram, you can see that they have a very wide distribution,” says Dr Westerink.

“Although there’s an average hazard ratio of 0.76 and a 20% risk reduction when looking at every patient, not everybody’s got to benefit to the same extent.”

“By using the results of the analysis on individual patient cases, we can show that with the use of semaglutide added to standard of care, some patients will have less than one year’s worth of benefits, and some patients will have more than two years. The mean benefit there would be 1.7 years, but it’s very different for each individual patient.”

Logical treatment

Dr Westerink hopes that insights like this could lead to recommendations for diabetes treatment becoming more personalised, based on each individual patient’s lifetime risk.

He adds that the most important aspect of this approach is its simplicity and logic.

“I’ve never met anybody who doesn’t understand the concept when they hear it,” he says. “The only problem at the moment is that it’s not what doctors are taught to do. Everybody feels that they shouldn’t give older patients certain kinds of drugs, or that they shouldn’t just tell young people to improve their lifestyle and not medicate them at all. In reality, we know that’s not really how it’s supposed to work, and that’s what makes this approach so logical.”

Dr Westerink hopes that eventually this approach will be included in international guidelines, although he acknowledges that changing practice will take “a different way of thinking” from doctors. For example, they might be required to do more in-depth interviews with patients to be able to accurately predict risk.

Westerink adds that individualising treatment in this way could ultimately lead to higher adherence.

“It lets the patient take the lead in their own treatment and lets them know exactly why they are taking a drug,” he says.

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Living with diabetes is not easy. It is an existence of a lifetime of pills, jabs and dietary restrictions. Yet the disease is ruthless and continues to increase in severity and complications.

New Delhi: Diabetes and obesity are chronic progressive diseases that are on the rise all over the world. India has the dubious distinction of being the diabetes capital of the world with more than 50 million people who suffer from diabetes. There is evidence to suggest a strong association between obesity and development of type 2 diabetes and back in 1970’s the term “diabesity” was coined to address these two twin diseases together. 

In the last 30 years, India has experienced unprecedented economic growth. There has been a surge in the consumption of high-calorie convenience and junk foods as well as an increasing tendency to be sedentary. Today we eat a lot more and exercise a lot less. Additionally, we are genetically prone to have a higher body fat percentage as compared to the western population. Indians typically have greater fat deposition around their bellies (visceral fat) which makes them more prone to developing diabetes even at lower weight and body mass index. 

Both obesity and type 2 diabetes are linked to insulin resistance. Type 2 diabetes results as a combination of less insulin production from the pancreas and increased insulin resistance. Individuals who have more visceral fat (fat around the belly area) tend to be more insulin resistant. With rapidly rising rates of obesity in India, it is predicted that the number of patients suffering from diabetes will rise to 87 million by the end of 2030.  Diabetes further leads to micro and macrovascular complications. Longstanding diabetes leads to side effects on eyes (retinopathy), nerves (neuropathy), kidneys (nephropathy) and leads to increased risk for heart disease eventually. 

Living with diabetes is not easy. It is an existence of a lifetime of pills, jabs and dietary restrictions. Yet the disease is ruthless and continues to increase in severity and complications over a period of years. Weight management is an integral part of the management of type 2 diabetes. Patients who suffer from type 2 diabetes tend to lose weight slower than those who do not have diabetes. Unfortunately, losing weight can be a frustrating exercise and most patients tend to get demotivated after multiple unsuccessful attempts. 

Weight management must be done as per the grade of obesity to be effective. While diet and lifestyle modification are the cornerstones for all weight loss programs, they work best for patients who are over-weight (BMI= 23.5 – 27.5 Kg/m2) or suffer from grade 1 obesity (BMI= 27.5 – 32.5 Kg/m2). For patients who suffer from grade 2 or 3 obesity (BMI ≥ 32.5 Kg/m2) along with type 2 diabetes, bariatric/metabolic surgery is an effective weight-loss option. Bariatric/metabolic surgery not only leads to weight loss but also leads to remission of type 2 diabetes in many patients. The level of improvement in blood sugar control after bariatric/metabolic surgery depends on the duration of diabetes, age of the patient, body mass index, pancreatic function and whether the patient is on insulin. Generally, it is seen that patients with lesser duration of diabetes and good pancreatic function achieve blood sugar control within days or months of surgery. The need for intake of diabetic medications also goes down drastically after bariatric/metabolic surgery. The onset of diabetes-related micro and macrovascular complications is also delayed, thus adding more healthy years to a patient’s life. Bariatric and metabolic surgery were included as a part of the treatment algorithm of type 2 diabetes by the American Diabetes Association (ADA) in 2009.

In conclusion, obesity and type 2 diabetes are closely related. Weight management is an important part of diabetes management. Bariatric/metabolic surgery has emerged as an effective treatment options treatment of type 2 diabetes in patients suffering from grade 2 and 3 obesity.

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Type 2 diabetes is one of the seven major risk factors for heart disease that you can control. Patti Cook, RN, BSN, diabetes education coordinator, joins us to explain that you can take control, as November 4-10 is National Diabetes Education Week.

1). If you are a diabetic, what can you do to arm yourself against the risk of heart disease?

People with type 2 diabetes have double the risk of heart disease. If you have diabetes, you are more likely to have other conditions like high blood pressure, high cholesterol, high triglycerides, and unmanaged blood glucose (called blood sugar). These also increase the risk for heart disease, but managing these can help decrease your risk. Arm yourself with the facts.

· Understand the risk for heart disease.

Talk to your doctor regularly about whole body health and your next steps.

· Trade unhealthy for healthy behaviors. Eat right and keep moving.

2). What is the connection between Type 2 diabetes and heart disease? Why does diabetes more than likely lead to heart disease?

Adults with diabetes are two times more likely to have a heart attack or stroke than people without diabetes. The combination of high blood pressure and diabetes drastically increases your risks of a heart disease. Managing your blood pressure is one way to lower your risk of heart disease. That is why it is vital to keep your blood pressure in a healthy range. High blood pressure is anything above 120/80 mmHg.

3. What are some questions that we should be asking our health care provider about diabetes and heart disease?

The following are questions are important; however, there are certainly other questions to consider asking your doctor:

· What can I do to lower my risk for heart disease and stroke?

· Do any of my medications help me manage my risks for heart disease or other complications?

The post House Call: Know Your Diabetes by Heart appeared first on MyMedicPlus.

New concerns in the management of the disease with the Covid 19 pandemic have created a state of anxiety amongst expectant mothers.

New Delhi: The rising incidence of gestational diabetes in India and globally is a cause for global concern amongst clinicians and obstetricians. Prevalence of the condition is higher in the urban than the rural population in India. Established risk factors for GDM are a family history of diabetes, obesity, advancing maternal age, reduced physical activity, desk jobs, sedentary lifestyle, unhealthy eating habits, smoking and alcohol consumption, history of PCOD and associated factors such as hypertension.

Due to compromised fetal outcomes in the form of higher incidence of miscarriages, congenital birth defects, higher risk of preterm deliveries, acute respiratory distress and hyaline membrane disease, heart disease, complicated labour due to the large size of the foetus leading to a higher incidence of shoulder dystocia and a higher risk of caesarean sections, hypoglycaemia in the newborn, obesity and a higher incidence of diabetes in the newborn, prevention and active management of altered blood sugars imperative.

How COVID-19 pandemic has changed consultation, diagnosis of gestational diabetes

New concerns in the management of the disease with the COVID-19 pandemic have created a state of anxiety amongst expectant mothers.

The standard glucose tolerance test which was previously held as the gold standard for monitoring women with altered blood sugars has now taken the backseat. Prioritising on social distancing, reducing frequent visits to labs, now monitoring expectant mothers with fasting blood glucose and HbA1c (of 5.7) are now accepted contrary to the glucose tolerance test. Altered routine prenatal visits, lack of personal consultation with the obstetrician and a phobia to visit labs has modified the management criteria. Lifestyle management comprising healthy dietary habits and increased physical activity, regular home monitoring (self) of blood sugars and fortnightly video consultation, routine antenatal tests for maternal well-being with a proper genetic history of any congenital defects or history of consanguinity, an early ultrasound helps rule out the possibility of an extrauterine pregnancy (ectopic) and confirms a healthy heart activity by 5.5 weeks thus ruling out chances of a missed aborption. All expectant mothers are offered the option of prenatal screening for Down’s syndrome (blood tests like the NIPT and dual markers) at 12 weeks, quadruple markers at 14 to 16 weeks, an anomaly scan at 19 weeks and most importantly a fetal cardiac anomaly scan at 23 weeks. Patients prefer to visit stand-alone ultrasound clinics with prior appointments following all the Covid-19 precautions. A repeat ultrasound Doppler at 28 to 30 weeks to check for the interim growth possibility of fetal macrosomia is advisable. At 32 weeks again an HbA1c to monitor blood sugars is advisable with home charting. Known diabetics in pregnancy have to follow up closely with the diabetologist to adjust the dose of insulin. In case of preterm labour, a hospitalization with tocolytics and antenatal betamethasone injection to promote lung maturity is advisable, and should such patients progress to irreversible preterm labour then drugs such as magnesium sulphate are offered as an option after counselling the expectant mother for neuroprotection for the foetus. Delivering such patients is preferred in tertiary care centres where all facilities for neonatal care are available owing to the high incidence of hyaline membrane disease and acute respiratory distress syndrome. COVID-19 evaluation is mandatory for patients prior to admission. Each index case if affected with COVID-19 behaves differently and needs individually tailored treatment for her symptoms. Vertical transmission is not a reason to fear as it is seldom encountered. Commonly encountered heart defects are usually diagnosed early in pregnancy during the anomaly scans. Late-onset issues in infants of diabetic mothers could be macrosomia, fetal cardiomyopathy, cardiomegaly, acute respiratory distress with fetal hypoglycaemia which warrant intensive care.

Maternal issues such as a higher incidence of prolonged labour, obstructed labour, higher incidence of caesarean sections, the associated risk of hypertension, are observed. To avoid these, prevention is better than cure, and hence expectant mothers with a high risk of gestational diabetes with obesity or PCOD are advised monitored weight gain of not more than 7-8 kg. Close monitoring of blood sugars from the first trimester helps reduce the chances of fetal and maternal complications. The TDAP vaccine is offered to all mothers at 32 weeks.

In conclusion, we as physicians have to constantly tailor monitoring techniques, counsel expectant couples with close follow-ups to monitor fetal and maternal well-being. The COVID-19 precautions are here to stay till we see the end of the tunnel in this global pandemic.

The post Impact of COVID-19 pandemic on diagnosis and testing of gestational diabetes appeared first on MyMedicPlus.

As Diwali is around the corner, chances are high that one might indulge in deep-fried snacks and sugar-laden sweets. However, this unhealthy indulgence can impact people with diabetes. Several doctors have recommended a few tips or ways through, you can tackle the situation while indulging in your favourite foods.
According to a BeatO study, festivals adversely impact people’s blood-glucose levels, especially during Diwali. People with levels above 250 mg/dL (milligrams per decilitre) saw an almost 15 per cent rise while those having blood-glucose levels above 300 mg/dL had an 18 per cent increase. Typically, this trend continued until three days after Diwali as per insights based on its data of the last three years’ festive season, beginning on Durga Puja and ending with Diwali. Interestingly, this year Diwali is being celebrated on November 14, which coincides with World Diabetes Day.

“Indian festivals reflect our rich and diverse culture along with the celebration, colors, food, and happiness, and the positive impact of which cannot possibly be quantified. Whether an individual has a chronic health condition or not, it is important not to snatch away the joy of enjoying a festival and everything that it brings along,” Dr Bhavik Saglani, Diabetes Health Physician and Consultant at Mumbai’s Apollo Spectra Hospital, told IANSlife.

Dr Saglani added, “Festivals may involve fasting or feasting or in some instances a bit of both. Exercise routine usually takes a backseat and activity levels to tend to drop. It is a combination of the above that needs to be taken into consideration in individuals with diabetes. Ensuring good pre-festival sugar control, discussing with your physician whether or not fasting is advisable in your case, ensuring that sugary sweets and other carbohydrate-rich snacks are avoided or their portion size is limited, trying to compensate for all of it by ensuring your exercise routine does not take a back seat, keeping yourself well hydrated and ensuring regular home testing are some of the key steps to strike the right balance between enjoying a festival and managing diabetes. Extra care needs to be taken for those who are on insulin and those who have high sugar levels even prior to the festive period. There is a risk of hypoglycaemia (low sugar levels) or hyperglycemia (high sugar levels) due to one or more of the above mentioned factors and it is imperative to get a review with your treating physician prior to the festive period.”

According to Dr Sanjay Ingle, Zonal Pathologist, and Technical Head West India, Apollo Diagnostics, Pune, one must monitor their blood sugar levels in order to check the insulin dose before every meal. Not doing so can invite a lot of problems. “Similarly, those with type 2 diabetes are suggested to go for intensive insulin therapy under the doctor’s supervision. Moreover, even self-monitoring of blood glucose (SMBG) is essential in these people too. There are some people who are on less intensive insulin therapy and they tend to monitor it little or not at all, this is an ineffective practice, as well-controlled patients need monitoring of glucose levels to avoid hypoglycemia, and poorly controlled patients need to control it properly.”

“Your doctor will recommend changes in the diet, will ask you to do physical activity, and opt for medication after assessing your blood sugar levels. You will have to work in sync with your doctor to help yourself get back on track. Even if it is festive season or no, make sure you monitor your blood sugar levels and manage diabetes,” explains Dr Ingle.

For those who are not fasting but prefer to feast on the variety of foods that are served during festivals, there are certain important measures to be taken to ensure the blood sugar control does not go haywire, adds Dr Nishant Singh, Consultant, General Medicine and Diabetology, Meddo Clinic.

One can follow these simple measures:

• Break your meals into smaller portions of about 4 to 5 times every day, instead of 3 large meals through out the day. This can keep your blood sugar levels more stable, while you are nourished adequately.
• You can opt for healthy snacking options such as nuts, olives or a piece of fruit. You could replace traditional sweets with such healthy options to ensure healthy is not compromised in celebrations. Ensure keeping your body hydrated and nourished. However, you can have a small piece of sweets.
• Consider consuming good-quality dark chocolate instead of milk chocolate as they consist of less sugar. One should try and avoid sugary drinks and replace them with either water, sugar free lime juice or even a small tumbler of tender coconut water would be a good choice.
• White rice is a favorite of many however, ones with diabetes should try and avoid it as it has a high glycaemic index and glycaemic load and can increase your blood sugars drastically. Instead, consume brown rice or whole grains as these keep the sugar levels a lot better controlled.
• Bakery foods such as biscuits and cakes must be avoided completely. Avoid deep-fried foods such as samosas and pakodas.
• One should try and avoid excessive indulgence in alcohol during festival seasons. Alcohol also contains a large quantity of sugar in it and can increase blood sugar levels.

Indian festivals are joyous occasions that are marked by the serving of sweets and savoury items. Those with diabetes can still enjoy these festivals, provided certain simple measures are followed to keep the blood sugar levels under check.

The post Follow these 7 tips to manage diabetes during festive season appeared first on MyMedicPlus.

Past studies have suggested that impaired biosynthesis could be the result of diverse mutations that hinder the foldability of proinsulin.

New York: The evolution of insulin in vertebrates — including humans — has encountered a roadblock, limiting its ability to adapt to obesity and thereby rendering most people vulnerable to Type 2 diabetes, a significant research has claimed.

Scientists from Indiana University (IU), University of Michigan and Case Western Reserve University determined that the sequence of insulin has become entrenched at the edge of impaired production — an intrinsic vulnerability unmasked by rare mutations in the insulin gene causing diabetes in childhood.

Insulin is produced by a series of highly specific processes that occur in specialised cells called beta cells.

A key step is the folding of a biosynthetic precursor, called proinsulin, to achieve the hormone’s functional three-dimensional structure.

Past studies have suggested that impaired biosynthesis could be the result of diverse mutations that hinder the foldability of proinsulin.

“Biological processes ordinarily evolve to be robust, and this protects us in the majority of cases from birth defects and diseases. Yet, diabetes seems to be an exception,” said Michael Weiss, Distinguished Professor at IU School of Medicine.

The group discovered that even the slightest variation of the insulin-sequencing process not only impairs insulin folding (and eventual insulin secretion) but also induces cellular stress that leads to beta cell dysfunction and eventually permanent damage.

The study, published in the Proceedings of the National Academy of Sciences, highlights the importance of folding efficiency as a critical but hidden factor in the evolution of insulin over the past 540 million years.

Humans have evolved to be vulnerable to diverse mutations in the insulin gene and that this vulnerability underlies a rare monogenic form of diabetes and provides an evolutionary backdrop to the present obesity-related diabetes pandemic.

“The authors highlight the fact that the insulin gene has been susceptible throughout evolution to mutations that impair insulin’s function or stress beta cells,” said Barbara Kahn from Harvard Medical School.

“As we approach the 100th anniversary of the discovery of insulin, these elegant observations might lead to a better understanding of the pathogenesis of Type 2 diabetes”.

The group will work to fully define the sequence determinants that make proinsulin foldable in beta cells.

The post Diabetes risk increase among humans as evolution of insulin hits roadblock appeared first on MyMedicPlus.

Source – https://www.themonitor.com/

By: Samuel K Snyder, M.D., F.A.C.S.
Chief of Endocrine Surgery, DHR Diabetes and Endocrinology Institute

If this test result has occurred outside the hospital through your doctor’s office, there is a high likelihood that you have parathyroid gland disease. There are several causes of hypercalcemia, but the most common one is primary hyperparathyroidism. Four small pea-size parathyroid glands make parathyroid hormone, which controls the blood calcium level. “Para” means “next to” and that is what parathyroid glands are anatomically. They are typically located on the backside of the thyroid gland, 2 on each side, upper and lower parathyroid glands. Parathyroid hormone increases the blood calcium by removing calcium from bone, increasing calcium absorption from the intestine, and reducing calcium excretion in the kidneys. If the blood calcium is elevated, then the parathyroid hormone level should be appropriately low. When an individual has primary hyperparathyroidism, the parathyroid hormone level is inappropriately elevated or high normal in the face of elevated blood calcium. If the first check of the blood parathyroid hormone level is inappropriately high, then the diagnosis of primary hyperparathyroidism is established.

The cause of primary hyperparathyroidism is unknown, but individuals with this disease invariably have low blood vitamin-D levels. Vitamin-D helps with absorption of calcium from the intestine, so a deficiency of it can lead to relatively low blood calcium that requires more parathyroid hormone secretion to keep the calcium normal. Individuals with low vitamin-D levels frequently have elevated parathyroid hormone levels. Correcting this deficiency can lower the parathyroid hormone level to normal, if the blood calcium is also normal. Vitamin-D deficiency is very prevalent in the Rio Grande Valley so it is wise to check the vitamin-D blood level, particularly with primary hyperparathyroidism.

Primary hyperparathyroidism is typically caused by a single benign parathyroid tumor in 1 of the 4 glands. The tumor secretes excessive parathyroid hormone. This can lead to complications over time with high urine calcium, causing kidney stones/damage or leaching of calcium from bones to cause osteoporosis. Calcium is important for normal nerve and muscle function, so patients with high calcium may have symptoms of fatigue, or difficulty with memory and concentration. The location of the parathyroid tumor can be determined by neck ultrasound, a nuclear medicine scan with technetium sestamibi that gets picked up by a parathyroid tumor preferentially, or a special 4D-CT x-ray with timed intravenous contrast to localize the hypervascular parathyroid tumor.

Once the location of the parathyroid tumor is determined, a minimally-invasive approach to parathyroid surgery can be used. Technetium sestamibi can be injected just prior to surgery to allow using a Geiger counter device to guide surgery. The half-life of parathyroid hormone is 3 to 5 minutes. The parathyroid hormone blood level is checked 5 and 10 minutes after removing the parathyroid tumor. A marked reduction in the parathyroid hormone level confirms that the primary hyperparathyroidism is corrected and surgery can be minimized and done as an outpatient procedure. Options to surgery include just monitoring the severity of the disease or when the risk of surgery is high, giving calcimimetic medication to try to reduce the parathyroid hormone level.

The post My Blood Calcium Level is Elevated, What Does That Mean? appeared first on MyMedicPlus.

Taking care of your diet and lifestyle could go a long way in healthy diabetes management.

• Diabetics should eat at regular intervals
• Diabetics need to keep their calorie intake in check
• Diabetics should refrain from simple carbs

If we were to count the most common health conditions of the millennium, diabetes would perhaps be somewhere on the top of the charts. Diabetes mellitus is a metabolic disease that is characterised by blood sugar fluctuations. Afflicting over millions of people across the world, diabetes stands as one of the biggest threats for people both young and old as it has no known cure. It is believed that the condition cannot be reversed, but there are plenty of measures you can take to manage the condition and its symptoms. Taking care of your diet and lifestyle could go a long way in healthy diabetes management.

Many nutritionists vouch for including seasonal fruits and vegetables to one’s diet. Guava is one of our most favourite winter fruits that we can have in any form and anytime of the day, and guess no one is complaining because it is so healthy too. Guava is a treasure trove of antioxidants, vitamins and minerals. Moreover, it is a very good addition to a diabetes diet too. It is replete with good quality fibres and also has a very low Glycaemic Index of 15. In other words, eating guavas may not have a detrimental effect on your blood sugar levels, as they do not get digested too soon and enable gradual release of sugar into the bloodstream.

Including chunks of crunchy guava in your salad could not only enhance the flavour and texture of your salad but also make it a very healthy meal option, if you happen to be a diabetic. And why just stick to guava, there are plenty of diabetic-friendly foods around you that could do the trick.

(Also Read: Diabetes Diet: 5 Foods And Herbs That May Help Regulate Blood Sugar Levels)

This salad by celebrity chef Vikas Khanna comes with the goodness of guavas, paneer, moong dal sprouts, apples, tamarind pulp and black salt. There, we saw you slurping!

Almost all of these ingredients are high in fibre and in protein, both of which are crucial for diabetes management. The recipe also uses jaggery, which is said to be a healthy alternative of sugar. But if you are wary of using jaggery, you may as well skip it. In fact, if you happen to mix and match things, rule out some ingredients, add some of your own you can do so- it is your salad after all!

The post Diabetes? This Winter Salad By Chef Vikas Khanna Is Ideal For Your Diabetes Diet appeared first on MyMedicPlus.

The Smart Diabetes Management Market 2020 Global Report serves as a document containing aggregate information, which promotes and assists in the estimation of all aspects of the Smart Diabetes Management Market. It gives an image of the base and framework of the Smart Diabetes Management market, which describes its favorable or restrictive points for global and regional growth. It describes the current situation of the Smart Diabetes Management market by examining in depth various producers, unions, organizations, suppliers and industries under the Smart Diabetes Management market. In addition, the Global Smart Diabetes Management Market 2020 report provides meaningful information on segmentation, distribution network, estimated growth trends, monetary and trading terms, and many other crucial components relevant to the Smart Diabetes Management market.

The size of the global Smart Diabetes Management market is expected to grow in the forecast period from 2020 to 2027, with a CAGR of XX. x% over the forecast period from 2020 to 2027 and is expected to reach XXX. X million by 2027, starting at XXX. X million in 2019.

Global Smart Diabetes Management Market competition by Top Key Players: F. Hoffmann-La Roche, Medtronic, Dexcom, Insulet Corporation, Abbott, Jiangsu Delfu medical device, DIAMESCO, LifeScan, Glooko, GlucoMe.

Segmentation: The report has been separated into separate categories, such as product type, application, end user, and region. Each segment is evaluated based on the CAGR, share and growth potential. In the regional analysis, the report highlights the prospective region, which should generate opportunities in the global Smart Diabetes Management market in the years to come. This segment analysis will surely prove to be a useful tool for readers, stakeholders and market participants to get a full picture of the Smart Diabetes Management global market and its growth potential in the years to come.

Global Smart Diabetes Management Market Segmentation:

On the Basis of Type:
Type 1 Diabetes

Type 2 Diabetes

On the Basis of Application:
Hospital

Specialty Diabetes Clinics

Home

Regions Covered in the Global Smart Diabetes Management Market:
The Middle East and Africa
North America
South America
Europe
Asia-Pacific

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Analysis of the competitive landscape: The competitive landscape is an essential aspect that all key players must know. The report highlights the competitive scenario of the Smart Diabetes Management global market for competition nationally and globally. Market experts also presented an overview of all major players in the global Smart Diabetes Management market, taking into account key aspects such as the areas of operation, production and the product portfolio. In addition, the companies in the report are studied based on key factors such as company size, market share, market growth, revenues, production volume and profits.

Scope of the report: – This report describes the global Smart Diabetes Management market, in particular in North America, South America, Africa, Europe and Asia-Pacific, and the Middle East. This report segments the market based on producers, regions, type and use. In the next time, Smart Diabetes Management will have good demand, although the value may fluctuate due to the rapid transformation in the availability of raw materials and other resources.

Research methodology

The report includes an in-depth study of various aspects of the Smart Diabetes Management market. The overall research and analysis is derived from primary and secondary research. The main sources include interviews, surveys and observations of seasoned analysts, and secondary sources cover reputable paid sources, trade journals and databases of industry organizations. Other research methods include SWOT analysis and the use of Porter’s five-force model to extract growth potential from the market.

Table of Content (TOC):

Chapter 1 Introduction and Overview

Chapter 2 Industry Cost Structure and Economic Impact

Chapter 3 Rising Trends and New Technologies with Major key players

Chapter 4 Global Smart Diabetes Management Market Analysis, Trends, Growth Factor

Chapter 5 Smart Diabetes Management Market Application and Business with Potential Analysis

Chapter 6 Global Smart Diabetes Management Market Segment, Type, Application

Chapter 7 Global Smart Diabetes Management Market Analysis (by Application, Type, End User)

Chapter 8 Major Key Vendors Analysis of Smart Diabetes Management Market

Chapter 9 Development Trend of Analysis

Chapter 10 Conclusion

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14 out of 630 patents, with no history of diabetes during COVID-19 treatment, were diagnosed with diabetes at follow up clinics.

CHENNAI: Newly found diabetes among COVID-19 recovered patients is becoming a serious health condition, observed doctors in Chennai. Out of the 630 people who visited the post-COVID follow up clinic at the Rajiv Gandhi Government General Hospital, doctors said 14 people were diagnosed with diabetes.

This phenomenon has been observed worldwide lately by experts, who are trying to understand whether and how COVID-19 might be triggering diabetes among those who didn’t have the disease before. A senior doctor in-charge of the follow-up clinic said that none of the patients had diabetes during their stay at the hospital and it is only found weeks or even a month after their recovery.

“While most people who returned to the hospital with poor health conditions were aged above 45, the people with newly found diabetes post-recovery were just aged between 40-45,” the doctor said.

The doctor said that while breathing issues and myalgia (muscle pain) have been the common health condition that majority of people have come up with, the diabetes is something new. “Sugar checks are mandatory as part of COVID checks. Even for diabetes patients, insulin shots are given to keep sugar in check during treatment,” said that doctor, adding that the reason for people developing diabetes post-COVID recovery is not known.

The medico added that the patients are given insulin shots and are directed to undergo routine treatment for diabetes. Doctors said that the hospital keeps check of the patients’ health condition daily for 14 days after discharge and most patients returned back with health conditions after two weeks.

Steroids a possible reason?

Dr V Mohan, chairman, Dr Mohan’s Diabetes Specialities Centre, said high doses of steroids during the COVID-19 treatment could be a reason for sugar levels going up post-discharge. “Initially, patients are given intravenous steroids and subsequently, it is reduced to oral doses before the doses are stopped. Sugar levels too are supposed to reduce after this but some people without any diabetes too show high sugar levels post discharge,” Dr Mohan said.

He said that it is unknown whether COVID -19is directly involved in the increase in sugar levels but steroids could possibly have an impact. Various studies globally have highlighted that the immunosuppressive tendencies of steroids facilities in sugar levels are going uncontrolled among patients.

Dr Subramanian Swaminathan, Infectious Diseases Specialist at Gleneagles Global Health City said this trend of patients developing diabetes is seen worldwide. “Whether COVID-19 has caused diabetes or unmasked diabetes, we don’t know yet,” he said.

Dr Swaminathan said that even patients with mild COVID are developing diabetes later on. “In such a scenario, we can’t say the medicine is solely responsible for causing diabetes. Maybe it just has some part to do with this,” he said. Dr Swaminathan added that chronic fatigue syndrome, intermittent fever and inflammatory syndrome are widely observed among patients post-recovery.

“Unless we follow up on more patients, we won’t know the exact reasons for health complications. It is a good initiative to have follow up clinics and we need to expand it,” he said.

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Source – https://www.medicalnewstoday.com/

Researchers have uncovered new clues to the mystery of how the gut’s nervous system affects glucose metabolism in the rest of the body. Their findings could lead to new treatments for type 2 diabetes.

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Ertugliflozin is the most recent SGLT-2 inhibitor approved by the FDA. Recent studies, such as DAPA-HF and the EMPEROR-Reduced trial, have shown that SGLT-2 inhibitors have significant cardiovascular benefits in patients with and without type 2 diabetes. SGLT-2 inhibitors are now recommended to add-on to metformin in patients with type 2 diabetes and evidence of HFrEF or CKD by the American Diabetes Association. With the FDA now mandating cardiovascular safety evaluation be included in trials for new antihyperglycemic agents, VERTIS CV looked at the long-term renal and cardiovascular effects of Ertugliflozin in patients with type 2 diabetes. 

This randomized, placebo-control trial aimed to show that ertugliflozin was non-inferior to placebo concerning the study‘s primary endpoint. This study’s primary endpoint was a composite of MACE, including death from cardiovascular causes, nonfatal MI, or nonfatal stroke. The critical secondary endpoints were a composite of HF hospitalization and death by cardiovascular causes and the composite renal outcome, including renal replacement therapy, serum creatinine doubling, or death from renal causes. A test for superiority was to be conducted for the critical secondary endpoints if non-inferiority was proven in the primary endpoint. To be included in the study, patients with type 2 diabetes (A1c between 7 and 10.5%) had to be ≥ 40 years of age with atherosclerotic cardiovascular disease. Patients were excluded if they had an eGFR < 30 mL/min/1.73m2, a history of diabetic ketoacidosis, or type 1 diabetes. 

Patients were randomized 1:1:1 into study arms receiving either 5 mg or 15 mg of ertugliflozin or placebo on top of the patient‘s standard diabetes therapy. Baseline characteristics were balanced in all three of the arms. The mean duration of the study was 3.0 years, with the mean follow-up period being 3.5 years. 

A total of 8246 patients were enrolled in the trial, 5499 patients in the combined ertugliflozin arms, and 2747 patients in the placebo arm. MACE’s primary endpoint was reached in 11.9% of patients in the combined ertugliflozin arms and 11.9% in the placebo group (HR 0.97; 95.6% CI 0.85 – 1.11; p<0.001), demonstrating non-inferiority. In the composite secondary endpoints analysis, patients in the ertugliflozin group had a 12% lower risk of death by cardiovascular cause or hospitalization for heart failure, though not significant (HR 0.88; 95.8% CI, 0.75 – 1.03; p=0.11). A 19% lower risk of the composite renal outcomes was also seen in the combined ertugliflozin arms, though not significant (HR: 0.81, 95.8% CI 0.63-1.04). Of the remaining secondary endpoints, the risk of hospitalization for heart failure was 30% lower in the combined ertugliflozin arms though it was not tested for statistical significance (95% CI 0.54-0.90). At week 18, patients taking ertugliflozin had a lower mean reduction in A1c than patients in the placebo arm. A mean difference of -0.70% and -0.72% was seen in the 5 mg ertugliflozin and 15 mg ertugliflozin arms, respectively, and a difference of -0.22% was seen in patients who received placebo. Adverse events leading to death or permanent discontinuation of the trial regimen did not differ significantly between the groups. Rates of urinary tract infections and genital mycotic infections in both males and females were significantly higher in patients taking ertugliflozin as compared to placebo (p=0.03, p <0.001 and p <0.001, respectively) 

Ertugliflozin was found to be non-inferior to placebo concerning MACE. Still, it did not show superiority to placebo in risk reduction of composite renal outcomes or the composite cardiovascular outcomes of hospitalization for heart failure or death by cardiovascular cause. Potential explanations of why ertugliflozin did not reach significance in the critical secondary outcomes include the increased intensity of secondary preventive strategies over the past few years and differences among the SGLT-2 class agents. Though the composite renal outcomes were not met, for other agents in this class, each trial had different definitions for their renal endpoints. Further analysis could be done by modifying the renal endpoints to compare the outcome to other SGLT-2 inhibitors better.  

Practice Pearls: 

• Ertugliflozin was non-inferior to placebo in its effects on MACE, including death from cardiovascular causes, nonfatal MI, or nonfatal stroke. 
• There was no difference in the critical secondary outcomes in the combined ertugliflozin and placebo arms. 
• Further study can be done to better compare VERTIS CV renal outcomes to that of other SGLT-2 inhibitors. 

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