March 29, 2017

Medicare Putting More Diabetics at Risk

A new survey from the American Association of Diabetes Educators (AADE) found that Medicare’s Competitive Bidding Program (CBP) significantly reduced beneficiary choice and access to commonly used diabetes testing supplies. The lack of choice forces beneficiaries to switch to unfamiliar or unsuitable testing systems, and can have dire health consequences.

AADE’s survey is the latest in a continuous round of reports by AADE and others pointing out the inherent problems with the CBP. Last year, a National Minority Quality Forum report showed a direct link to increases in mortality and complications, inpatient admission and supplier costs. The unintended consequences from switching testing supplies results in diminished or ceasing altogether of blood sugar testing, leading to an increased risk for complications such as blindness, kidney damage, cardiovascular disease and lower-limb amputations.

The new survey reinforces AADE secret shopper surveys done in 2011 and 2013 showing the same downward trend in availability and access.

“Evidence continues to show that the competitive bidding process is failing people with diabetes and putting them at unnecessary risk,” said Kellie Antinori-Lent, a diabetes clinical nurse specialist at the University of Pittsburgh Medical Center. “Patient safety and choice must come first.”

Key findings from the survey include:
• The number of manufacturers making diabetes testing supplies (DTS) available under National Mail Order (NMO) has fallen 50 percent since the start of the Competitive Bidding Program (CPB)
• The number of diabetes testing systems available under NMO is less than half the number available in 2009 before the CPB started
• Many suppliers do not offer models covering 50 percent of the market share of the DTS
• Suppliers do not provide consistent information about inventory to customers

The Centers for Medicare and Medicaid Services (CMS) established the competitive bidding program for mail-order suppliers of diabetes testing equipment in January 2011. Soon after, widespread anecdotal reports suggested that the suppliers were denying access to the specific brands and types of equipment promised to be available on Medicare.gov. The most recent study showed some improvements, finding fewer discrepancies between the information provided on Medicare.gov and what is available to consumers.

To ensure beneficiary safety and well-being, a complete review of the program is necessary. AADE applauds the recent announcement by CMS to delay Round 2019 of the Competitive Bidding Program in hopes that the process can be overhauled to reflect evidence based data and best practices. Beneficiaries should have access to their preferred testing supplies, directed by their healthcare team.

March 28, 2017

Older Women Using Statins at Higher Risk of Diabetes

Even though this study is from Australia, it still applies to older women in the United States. According to a University of Queensland (UQ) study, older Australian women taking cholesterol-lowering statins face a significantly increased risk of developing diabetes.

UQ School of Public Health researcher Dr Mark Jones said women over 75 faced a 33 per cent higher chance of developing diabetes if they were taking statins. The risk increased to over 50 per cent for women taking higher doses of statins.

"We found that almost 50 per cent of women in their late seventies and eighties in the study took statins, and five per cent were diagnosed with new-onset diabetes," Dr Jones said.

"Statins are highly prescribed in this age group but there are very few clinical trials looking at their effects on older women.

"The vast majority of research is on 40- to 70-year-old men."

Statins, a class of drugs that lower cholesterol in the blood, are prescribed to reduce the incidence of cardiovascular events such as heart attacks and strokes.

"What's most concerning was that we found a 'dose effect' where the risk of diabetes increased as the dosage of statins increased.

"Over the 10 years of the study most of the women progressed to higher doses of statins," Dr Jones said.

"GPs and their elderly female patients should be aware of the risks.

"Those elderly women taking statins should be carefully and regularly monitored for increased blood glucose to ensure early detection and management of diabetes."

The research was based on prescription and survey data from 8372 women born between 1921 and 1926 who are regularly surveyed as part of the Women's Health Australia study (also known as the Australian Longitudinal Study on Women's Health).

The research is published in Drugs and Ageing.

March 27, 2017

Avoid Diabetes Scams

This FDA warning came a little late for me, but at least I deleted the attempts to put false information comments on one of my blogs. The person was claiming that he was cured of type 1 diabetes and was willing to provide the information for a “fee.” When it didn't post the first time, it was repeated exactly twice more and then he must have realized that comments were moderated and he stopped. The only thing I could conclude was that since I am using insulin, he must have felt that I was a type 1 and did not believe I was a type 2. I get this quite often from people that believe if you are using insulin, you must be a person with type 1 diabetes.

Next, he went to my profile page, emailed me the same message, and did asked why I would not approve any of his comments. This showed his arrogance as far as I was concerned and told me that he did not have type 1 diabetes to begin with and was just pushing a product to separate money from me. I may not always be the brightest bulb in the lot, but I am not stupid, and this joker really ticked me off.

The FDA warning can be read here. I will quote a part of it:
Sound Too Good To Be True? Then it's probably a scam. Watch out for these and similar red flags:
  • "Lowers your blood sugar naturally!"
  • "Inexpensive therapy to fight and eliminate type II diabetes!"
  • "Protects your eyes, kidneys, and blood vessels from damage!"
  • "Replaces your diabetes medicine!"
  • "Effective treatment to relieve all symptoms of diabetes!" 
  • "Natural diabetes cure!"

As the number of people diagnosed with diabetes continues to grow, illegally marketed products promising to prevent, treat, and even cure diabetes are flooding the marketplace.

Products that promise an easy fix might be alluring, but consumers are gambling with their health. In general, diabetes is a chronic disease, but it is manageable. And people can lower their risk for developing complications by following treatments prescribed by health care professionals, carefully monitoring blood sugar levels, and sticking to an appropriate diet and exercise program.”

Even with the FDA monitoring things, people with diabetes will not listen, but will continue to believe in a miracle cure. Even recently, I had a fellow person with type 2 diabetes ask why the doctors continue to hide the cure. When I said the doctors are not the ones to blame, he snorted and said we can't expect them to expose the cure, because then they won't have patients to treat.

Yet, these are the people that will buy the scams and blame the doctors when they receive harm, even if their doctors warned them against the scam.

March 26, 2017

Sodium Use Rising in People with High BP

According to a study scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session, researcher say that despite recommendations to limit sodium intake to support a heart-healthy lifestyle, daily sodium intake significantly increased in Americans with high blood pressure from 1999-2012.

The study found people with high blood pressure consumed an average of 2,900 milligrams of sodium per day in 1999 and 3,350 milligrams per day in 2012, for an overall average daily sodium intake of 3,100 milligrams during the 14-year study period. That's more than twice the 1,500 milligram daily maximum recommended for people with high blood pressure in dietary guidelines issued by the U.S. Department of Health and Human Services and U.S. Department of Agriculture since 2005.

The increase appears to be driven by rising sodium intake among Hispanics and African-Americans, groups that historically showed lower sodium intake levels compared to whites but whose sodium consumption matched that of whites by the end of the study period. Groups with the lowest sodium intake included those with more advanced forms of heart disease such as a history of heart attack or stroke.

The researchers analyzed data from the National Health and Nutrition. Excess sodium consumption increases the risk of heart disease because it draws additional water into the bloodstream, raising the volume, and consequently, the pressure, of the blood as it flows through blood vessels. This increased blood pressure creates strain on the heart and cardiovascular system.

Elena Dolmatova, MD, a resident at Rutgers New Jersey Medical School and the study's lead author states, "We need to find a way to address this so that the message actually gets to people. People shouldn't wait until they have a heart attack before taking action to limit sodium."
Dolmatova and her colleagues extracted the records of 13,000 people participating in the survey between 1999-2012 who indicated they had been diagnosed with high blood pressure. People in the sample were an average age of 60 and slightly more than half were men.

The team then analyzed the sodium intake of these 13,000 study participants based on questionnaires that provided a snapshot of their daily food intake. The analysis revealed that daily sodium intake increased among people with high blood pressure by more than 14 percent overall from 1999-2012. Intake increased by 26 percent and 20 percent among Hispanic and African-American participants, respectively, compared to 2 percent in white Americans. White participants had the highest overall sodium intake across the study period and a markedly higher intake than other racial groups at the start of the study, but showed little change in sodium intake over time. All racial groups reported roughly the same daily sodium intake by 2012.

In general, men reported higher sodium intake than women, although both men and women increased their sodium intake over the course of the study at roughly the same rate.

Relative to all people with high blood pressure, those with the lowest sodium intake were people who had experienced a heart attack or stroke, were taking blood pressure medications, or who had diabetes, obesity or heart failure.

Although these findings suggest people with worse health conditions are likely more motivated to take dietary recommendations seriously, the researchers emphasized that reducing sodium intake is important for anyone with high blood pressure.

"For many diseases, lifestyle modification is the first and most effective step in treatment," Dolmatova said. "There are [many] medications for hypertension, but they all come at a cost and have side effects; we [the medical community] have to focus more effort on educating people to successfully implement these lifestyle modifications and thus decrease the use of medications."

U.S. dietary guidelines recommend a daily maximum of 1,500 milligrams of sodium for people with high blood pressure or a high risk of developing it, and a daily maximum of 2,300 milligrams (the amount in one teaspoon of table salt) for most other people. Since the majority of the typical American's daily sodium intake comes from prepared or processed foods, experts recommend cutting down on processed foods or switching to low-sodium or sodium-free products to reduce sodium intake. Other recommendations include selecting less salty items at restaurants, using less salt when cooking at home and tasting food before adding salt at the table.

One limitation of this retrospective study is that it relied on self-reporting by participants to measure both high blood pressure and dietary intake. In addition, because authors analyzed the data during the 12-year period from 1999 to 2012, the study does not reflect any dietary changes that might have occurred since the latest U.S. dietary guidelines were released in 2016.

Dolmatova will present the study, "Dietary Sodium Intake among United States Adults with Hypertension, 1999-2012," on Sunday, March 19, at 12:30 p.m. ET at the Prevention Moderated Poster Theater, Poster Hall C at the American College of Cardiology's 66th Annual Scientific Session in Washington. The meeting runs March 17-19.

March 25, 2017

Celiac Disease, Watch for Lymphoma

Gluten-free foods are in the news more and more lately. I have written blogs about the dangers of gluten-free foods. For people with celiac disease, which is an autoimmune disease, they have to consume gluten-free foods. This article really scares me, as often the people that develop lymphoma have been ignored by doctors because the doctors did not believe in celiac disease and believed that they maybe had stomach problems only.

Celiac disease affects approximately 3 million U.S. adults, or roughly 1 percent of the healthy adult population in the country. The disease is an inherited autoimmune condition. For people with celiac disease, the consumption of gluten - a protein found in cereal grains such as wheat, rye, and barley - causes their immune system to attack the small intestine.

If left untreated, celiac disease may lead to complications such as osteoporosis, infertility, some brain disorders, and even additional autoimmune conditions. In some rare cases, undiagnosed or untreated celiac disease may also cause cancer. A team of researchers at the Leiden University Medical Center (LUMC) in the Netherlands has recently shown that the body's immune cells triggered by the consumption of gluten in patients with celiac disease may also lead to a rare form of lymphoma.

The findings were published in the journal Proceedings of the National Academy of Sciences.

For a small number of people living with celiac disease, a gluten-free diet is not enough to stop the otherwise severe symptoms. These patients are classified as having refractory celiac disease (RCD), which usually affects between 2 and 5 percent of celiac disease patients.

In one type of RCD called RCDII, the white blood cells found in the wall of the small intestine divide and multiply in excessive numbers. In approximately half of the RCDII patients, these cells, called lymphocytes, go on to develop into a particularly rare form of lymphoma.

This rare and very aggressive form of white blood cell cancer is called enteropathy-associated T-cell lymphoma.

The body's T cells - a type of immune cell that controls the body's reaction to gluten, among other things - have a very strong inflammatory reaction to gluten. When they detect the protein, they produce cytokines, which in turn stimulate other immune cells. This leads to the extremely inflammatory and painful response typical of celiac disease, but in some rare cases, it also leads to
cancer.

Researchers have known that the onset of this rare form of lymphoma depends on the cytokine IL-15, which makes malignant cells multiply. In this latest research, however, scientists in the Netherlands have now shown that three other cytokines - TNF, IL-2, and IL-21 - can also cause malignant cell proliferation.

These findings serve to further clarify how the body's immune system responds to gluten and how this can stimulate the growth of cancerous cells in RCDII.

Dr. Lara Bennett, science communications manager at Worldwide Cancer Research, comments on the significance of the findings: "This is another great example of the importance of early-stage, discovery research. This is a rare type of cancer, but the findings could be of real benefit to this small but important group of patients with refractory celiac disease."

LUMC researcher and Worldwide Cancer Research scientist, Dr. Jeroen van Bergen, explains why the next important step in this research is identifying where exactly in the development of lymphoma these three cytokines get involved.

"It is likely that at the time of lymphoma diagnosis, the patient has already experienced decades of intestinal inflammation," Dr. van Bergen says. "We need to determine the extent to which it would actually help to block these newly discovered growth factors with targeted drugs at the time of diagnosis. In the meantime, we have tested a large number of potential drugs in the laboratory, and two of them seem promising. But this is only interesting in terms of a new treatment if these growth factors still have a role to play in the growth and development of the lymphoma after diagnosis."

That 2 to 5 percent of celiac patients that develop lymphoma is still scary and the doctors that ignore this, need his/her license revoked.

March 24, 2017

Dog Haters

No, don't ever accuse me of this, as I love cats and dogs equally. This last week has been a real test of my will and having a judge that was willing to listen to someone without legal qualifications. I will only say that the person bringing the lawsuit against the owner of a mobility service dog almost got away with it.

The store owner from the town that my friend used for training mobility service dogs, my friend, and I were present for all four days of the trial. On the evening of the second day of the trial, my friend brought in another person with a mobility service dog. The judge and two local sheriff department officers knew of this and all three were ready for action. The person behind the lawsuit was not aware and the city police were not aware because they were holding the first dog and would not let it be brought into the courtroom at the request of the person.

The person with the mobility service dog entered the store and as soon as the store owner realized this, he removed the person and went to remove the dog. He did not realize that the judge and two sheriff department officers had slipped into the store and were waiting to see what would happen. As suspected, the store owner had a whip and was using it on the dog. At that point, they moved in and arrested the store owner and the judge asked the store owner if this is what he had done to the first dog. He of course denied this and the sheriff deputies were ordered to take him to the sheriff office and confine him for the night and report to the city police department with a local veterinary.

When they arrived, the chief of police would not release the dog they had, but did allow the veterinary to examine the dog. The dog had lost the sight in one eye and still had several large welts on its head and back. At that point, the judge called the sheriff and had him come and arrest the chief of police and several police officers for animal cruelty and not following court orders. The next day, when everyone was in the courtroom, the judge handed out sentences for the police officers and the chief of police.

Next, the judge addressed the store owner and asked him why when the dogs did him no harm, had he taken after them with a whip. All he would say was that the dogs were not allowed in his business and he could do what ever he wanted to trespassers.

Unknown to even us, the judge had asked a representative from the American Kennel Club (AKC) to be present. The judge asked my friend and me to take the injured dogs through the test for good citizenship. When the store owner saw the first dog, he pulled the whip out if his shirt and struck out at the dog. He was taken down by the sheriff officers and removed from the courtroom. My friend then started the test with the second dog and the AKC tester said that the dog passed the test. Then I brought the first dog to the front and started the test. When I completed the test, the AKC tester said that even with only one eye, the dog passed the test. The AKC tester said he had been make aware of the happenings and still these dogs could pass the test. He went down to one knee, invited both dogs to him, and petted both. Next he talked to my friend and asked if this was something we encountered on a regular basis.

My friend said no, but we no longer have a regular tester as that individual has passed and we now have to travel longer distances to have our dogs tested. I was then asked for my role in this. I explained that the dog that I tested was the first dog I had taken through the AKC test. I was an assistant to my friend and had worked several summers for him and with the dogs.

The AKC tester then addressed the judge and said for the abuse both dogs had been exposed to, they still were safe for their role as mobility dogs. My friend spoke up and said that if the current owner did not mind, he would like to replace the dog with one eye. The judge asked the current owner and he said that he would like to think about this, but was in no hurry, as he wanted to have the dog heal first.

The judge asked that both dogs be returned to the court room the following day and asked the sheriff officers to bring in the local store owner in the morning.  In the morning, the judge said that his lawsuit was dismissed and he would be sentenced to seven years in jail for animal cruelty. On top of this, add five more years for bribery of the city police officers.

Under federal law of not allowing the customers with service dogs to stay in the business, the judge added another year. This brought a complaint and a question about his rights as business owner. The judge said that under the American Disabilities Act, customers could not be denied access with service dogs. Under the circumstances and your lawsuit, be satisfied I did not add several years to the total sentence, because I could add four years for each officer bribed.

In addition, there has been nothing said about you being sued for the damages done to the service dogs, so be prepared to pay for any damages. At that point, my friend was asked about the cost of replacing each dog and the judge ordered him to place that cost into an escrow fund with the court, plus an amount for the veterinary fees, plus the costs for the witnesses and court costs for the case you lost.

We had a joyous trip home. The store owner asked my friend how he came up with the trap for the dog hater. He said that he had not, but had been in the meeting with the judge when the trap was hatched. He said the judge had asked many questions to insure that this would not be entrapment. When it was suggested that two sheriff officers be present to prevent the city police from being involved, that was when the judge agreed. The judge was also happy that no one was accusing anyone, but felt the store owner needed to be tested.

My friend said that once the store owner showed his true self and the veterinary was allowed to see the dog held by the city and explain the injuries to the judge, that is when the whole scheme broke down.

March 23, 2017

Another Reason to Avoid Fast Food

Most of us with type 2 diabetes have been warned about consuming fast food because of the added sugars and high carbohydrate content. Now we have an even more important reason- new research suggests that the packaging it comes in might be harmful as well. The study, which took place at the Silent Spring Institute in Newton, Massachusetts, found that the wrappers and boxes in which fast food is typically served are often sources of dangerous chemicals that can leach into your food.

For the study, more than 400 packaging samples were obtained from restaurants across the United States. An analysis of the material showed that 46 percent of the paper wrappers and 20 percent of the paperboard boxes contained fluorine. Fluorine - the most reactive nonmetallic element, a pale-yellow, corrosive, toxic gas that occurs combined, especially in fluorite, cryolite, phosphate rock, and other minerals.

Fluorine is a compound used in a number of chemicals including perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), and polytetrafluoroethylene (PTFE) which were added to fabrics, carpeting, furniture, and more for many years to increase their stain resistance, and cookware to make it non-stick. While American manufacturers began to phase them out as of 2011, some countries have not. And clearly, from the results of this study, they are still being used in fast food packaging due to their ability to limit the spread of the grease from the food.

People think it is great that the chicken nuggets and French fries will not leave a grease stain on the seat of the car or on your clothes, but the problem is that these chemicals are absorbed into our bodies. We are exposed to them regularly, as we breathe them in our air and drink them in our water. They also leach into our food through contact with these wrappings and boxes.

Fluorinated chemicals have been detected in blood samples of approximately 98 percent of adults and children, and even in umbilical cords. They have been linked to such conditions as kidney cancer, testicular cancer, thyroid disease, fertility problems, arthritis, and immune system disorders. Plus, these toxins are known to remain in our bodies for several years. Needless to say, it seems pretty obvious that we now have one more excellent reason for eliminating fast food from our diets, as well as one more excellent reason for regularly detoxing.

Don't let yourself fall into the trap of saying you’ll only have fast food every once in a while. After all, it’s so convenient, with drive-throughs practically on every corner and pizza places that deliver dinner to your doorstep. But you just have to think ahead so you won’t have to fight the urge to give in.

If your issue is a certain night or two of the week that you’re extra busy and don’t have time to cook, make a plan. You can cook a double batch of food the evening before and have leftovers ready. Or buy easy-to-prepare items you can throw together for a quick meal that’s still nutritious such as a salad with veggies, nuts, and hard-boiled eggs or wraps with strips of vegetables and chicken. For those nights when you think you’ll be too hungry to wait until you get home, keep a baggie of homemade trail mix in your car to get you over the hump.

If, on the other hand, you opt for fast food sometimes because you just love the taste of it, try to make healthier versions of your favorites at home. You can make pizza with a whole-grain dough or cauliflower crust, fresh veggies as tasty toppings, and keep the mozzarella to a minimum. If it’s a burger and fries you crave, make a turkey or chicken burger using organic meat. It may not offer the same greasy consistency as a fast food beef burger, but if you top it off with onion slices, lettuce, and tomato, you’ll still enjoy plenty of flavor. And you can slice up sweet potatoes, season them with paprika or a little cayenne pepper, and bake them for a lower-calorie, more nutritious side dish.

March 22, 2017

What Role Will Rare Sugars Play?

Rare Sugars? Where did they come from? And the study was done using rats and not humans.

In an era when the label "natural" hits a sweet spot with consumers, some uncommon sugars emerging on the market could live up to the connotation. Preliminary animal studies have suggested that allulose and other low-calorie, natural rare sugars could help regulate glucose levels. Now, researchers are investigating how they might exert such effects. They report their findings in ACS' Journal of Agricultural and Food Chemistry.

It is unfortunate that only one rare sugar is mentioned and the only rare sugar even considered.

Sucrose is the natural sweetener most labels refer to when sugar is on the ingredient list. It's abundant, and manufacturers figured out long ago how to extract it on a large scale from sugar cane and other sources. Allulose, which is 70 percent as sweet as sucrose, and other rare sugars also can be found in fruits and vegetables but in very small amounts.

Recently, however, researchers discovered an industrial way to produce allulose in large quantities from high-fructose corn syrup, which contains about equal parts glucose and fructose. Some studies have suggested that allulose can help control weight gain and glucose levels, but no one knew why. Tomoya Shintani and colleagues wanted to confirm that allulose - and potentially other rare sugars - yield these results and to take a step toward understanding why.

To investigate, the team of scientists gave three groups of rats plain water, water with high-fructose corn syrup, and water with rare-sugar syrup (RSS) containing glucose, fructose, allulose, and other rare sugars for 10 weeks. The rats drinking RSS-infused water gained less weight, had less abdominal fat, and had lower blood glucose and insulin levels compared to the high-fructose corn syrup group.

The study also showed that the liver cells' nuclei in the RSS rats exported to the cytoplasm higher amounts of glucokinase, an enzyme that reduces blood-sugar levels by helping convert glucose to its stored form, glycogen.

Although further testing is needed, the researchers say, the findings suggest that rare sugars could be a good alternative sweetener.

The authors acknowledge funding from the Matsutani Chemical Industry Co. and Meijo University.