Developments in diabetes prevention & treatment
A1C TARGET GUIDELINES
If you have diabetes, keeping blood glucose levels under control is critical to preventing complications and maintaining overall good health.
The question is, what constitutes under control? What is the ideal target for A1C (the average measure of blood glucose levels over two to three months)?
Diabetes experts had recommended that most people with type 2 diabetes strive for an A1C level between 6.5 percent and 7 percent. People without diabetes typically have A1C levels of 5.7 percent or below; prediabetes is diagnosed when levels fall between 5.7 percent and 6.4 percent.
But in Spring 2018 the American College of Physicians (ACP) issued new guidance, published in the Annals of Internal Medicine, recommending that people with type 2 diabetes be treated to achieve A1C levels between 7 percent and 8 percent, based on research showing that using medicine to reach lower targets did not reduce heart attacks, stroke or death but did result in harm to the individual (such as causing low blood sugar and making treatment more expensive).
The ACP has called for personalizing A1C goals to balance the benefits and harms of drug therapy, patient preferences, a patient’s general health and life expectancy, the treatment burden and the cost of care.
THREE MEALS ARE BETTER THAN SIX
Eating a high-energy breakfast and just three meals a day promotes weight loss, improves diabetes control and reduces the need for insulin in obese people with type 2 diabetes, according to an Israeli study presented at ENDO 2018, the 100th annual meeting of the Endocrine Society in Chicago, IL.
The study found that eating three meals a day, consisting of a big breakfast, an average lunch and a small dinner, was better than eating six small meals evenly distributed throughout the day. The three-meal plan resulted in more weight loss, better blood glucose control, less hunger and less need for patients to use insulin, the authors reported.
“The hour of the day — when you eat and how frequently you eat — is more important than what you eat and how many calories you eat,” noted lead study author Daniela Jakubowicz, MD, professor of medicine at Tel Aviv University, in a press release published by the Endocrine Society. “Our body metabolism changes throughout the day. A slice of bread consumed at breakfast leads to a lower glucose response and is less fattening than an identical slice of bread consumed in the evening.”
The study followed 11 women and 18 men, all of whom had obesity and type 2 diabetes and were being treated with insulin. The average age was 69 years old. Patients were randomly assigned to the three-meal or six-meal diet, each containing an equal number of calories, for three months. At the end of the study, the three-meal group lost 11 pounds, whereas the six-meal group gained three pounds.
Even before weight loss, those on the three-meal diet exhibited better blood glucose control than the other group, suggesting that meal timing and frequency played a significant role in diabetes management.
RED MEAT LINKED TO NON-ALCOHOLIC FATTY LIVER DISEASE
A growing body of evidence suggests that consuming a lot of red and processed meat is related to the development of chronic diseases such as cancer, type 2 diabetes and heart disease. A study published in the Journal of Hepatology links having this type of diet to non-alcoholic fatty liver disease, a range of liver conditions unrelated to alcohol consumption.
Non-alcoholic fatty liver disease is the most common form of chronic liver disease in the United States. It affects an estimated 80 to 100 million people, mostly in their 40s and 50s, who are overweight and at risk for heart disease and type 2 diabetes. It is closely linked to metabolic syndrome.
This cross-sectional study of 800 people in Israel, ages 40 to 70, found that those who ate a lot of red meat — especially fried or grilled to a well-done state — were more likely to have non-alcoholic fatty liver disease and insulin resistance.
The authors recommend against low-carb diets that are high in red meat, cautioning that meat should be eaten in moderation. They recommend substituting chick, turkey or fish and steaming food over cooking it at high temperatures on the grill.
LIVER ENZYME MAY BE KEY TO NEW DIABETES TREATMENT
Researchers have long understood that when fat deep in the belly becomes inflames, it can lead to insulin resistance and type 2 diabetes. A new study of obese mice, by researchers at Columbia University Irving Medical Center (CUIMC), has shown that one of the causes for this inflammation is an enzyme produced in the liver.
The enzyme, DPP4, travels through the blood to fat in the abdomen, helping to activate inflammatory cells. But researchers were able to turn off DPP4 production in the mice, soothing that inflammation. While the mice remained obese, turning the enzyme off improved their insulin resistance.
If this effect can now be reproduced in humans, it could lead to a promising new treatment for diabetes.