Treatment | Diabetes Textbook

New Model Predicts Diabetes Complications and Treatment Outcomes

Researchers at the University of Chicago have developed a new model, DOMUS, that predicts the risk of complications and treatment outcomes for patients with type 2 diabetes. The model uses data from nearly 130,000 patients and takes into account various factors, including blood sugar levels, weight, cholesterol, and blood pressure.

Key Findings

Early treatment matters: The model shows that early treatment of diabetes can make a significant difference in preventing long-term complications.
Predicts 14 complications: DOMUS predicts the risk of 14 different complications, including heart attacks, kidney failure, and depression.
Models disease progression: The model predicts how risk factors such as weight, cholesterol, and A1C levels change over time.

Implications

The DOMUS model has the potential to inform clinical decision-making and policy decisions related to diabetes treatment and management. It can help clinicians and policymakers understand the potential benefits and costs of different treatment approaches and make more informed decisions about resource allocation.

Future Directions

The researchers are working on external validation of the model using different data sources and plan to apply it to study racial and ethnic disparities in predicted outcomes. The model has the potential to be used by insurers, policymakers, and public health agencies to guide decisions about diabetes treatment and management.

AI-Powered Diabetes Prevention Program Shows Promise

A recent study published in JAMA has found that an AI-powered diabetes prevention program (DPP) app can reduce the risk of diabetes in adults with prediabetes similarly to traditional human-led programs. The study, funded by the National Institutes of Health, compared the effectiveness of an AI-powered DPP app to human-led programs in over 368 participants.

Key Findings

Similar outcomes: Both the AI-powered DPP app and human-led programs achieved similar rates of diabetes risk reduction, with 31.7% and 31.9% of participants meeting the CDC-defined composite benchmark, respectively.
Higher initiation and completion rates: The AI-powered DPP app had higher rates of program initiation (93.4% vs 82.7%) and completion (63.9% vs 50.3%) compared to traditional human-led programs.

Implications

The study suggests that AI-powered DPPs could be an effective alternative to existing human-coached programs, especially for patients with logistical constraints. The AI-powered app’s ability to provide personalized interventions and always be available could extend its reach and make it a valuable tool in diabetes prevention.

Future Directions

The study team plans to explore how the AI app outcomes translate to broader, underserved patient populations and investigate patient preference, engagement, and costs associated with AI-led DPPs. This research has the potential to inform the development of more effective and accessible diabetes prevention programs.

The persistence of diabetes stigma

A recent study by Kyoto University researchers highlights the persistence of diabetes stigma among medical students and residents in Japan. Despite growing awareness, nearly half of the 921 respondents held misconceptions about diabetes, such as believing it’s always genetic or that people with diabetes have shorter life expectancy .

Key Findings

Awareness of diabetes stigma: 57% of respondents reported awareness of diabetes stigma, while 25.9% were aware of advocacy efforts.
Misconceptions: About half of medical students and residents held misconceptions about diabetes, with residents more likely to hold stigma-related beliefs.
Limited impact of clinical education: Clinical lectures increased awareness, but subsequent training had limited impact on reducing stigma.

Implications

The study suggests that medical education curricula need to be revised to address diabetes stigma and promote accurate knowledge. The researchers plan to conduct a follow-up survey to assess the effectiveness of their efforts.

Importance

Diabetes stigma can lead to social isolation, psychological distress, and poor disease management. By addressing these issues in medical education, future physicians can become agents of change, fostering environments where diabetes is understood accurately and without stigma.

Noninvasive On-Skin Biosensors for Diabetes Management

A recent review published by researchers from The University of Manchester and A*STAR’s Singapore Institute of Manufacturing Technology highlights the potential of noninvasive on-skin biosensors for real-time diabetes management. These biosensors analyze sweat and other skin biomarkers to provide continuous metabolic monitoring, eliminating the need for finger-prick blood tests.

Key Findings

Noninvasive skin biosensors offer a painless alternative: These biosensors can track glucose, lactate, cortisol, and inflammatory cytokines in real-time without blood draws.
Multimodal integration and AI-driven insights: The biosensors can combine biochemical markers with physiological signals, and machine-learning algorithms can convert multimodal data into personalized glycemic predictions and early warnings.
Innovative design and features: The biosensors use various sensor modalities, materials engineering, and microfluidics to ensure skin conformity and long-term wear.

Potential Applications

Closed-loop therapeutics: Sweat-triggered microneedle patches and thermal drug-delivery films can be explored for automatic insulin or metformin release.
Digital health integration: The biosensors can transmit encrypted data to smartphones and cloud platforms for telemedicine and population-level analytics.

Challenges and Opportunities

Standardizing sweat-to-blood correlations: Overcoming sensor drift and ensuring equitable access to these biosensors remain key research priorities.
Regulatory pathways: Compliance with regulatory standards, such as ISO 20916 and FDA SaMD, is crucial for clinical translation.

The review provides a comprehensive guide for developing next-generation wearable biosensors that merge materials science, electronics, and AI to deliver painless, personalized diabetes care. These biosensors have the potential to transform daily diabetes management and improve patient outcomes.

New ‘smart insulin’ shows promise in reducing hypoglycemia bouts

Researchers at Indiana University School of Medicine have made a breakthrough in Type 1 diabetes treatment with a new “smart insulin” that combines insulin and glucagon into one molecule. This lab-designed protein has shown promise in reducing hypoglycemia bouts in rat studies. The protein works by mimicking the body’s natural response to insulin and glucagon, signaling the liver to adjust blood sugar levels accordingly. This could lead to a new treatment avenue for people with Type 1 diabetes, potentially simplifying the management of blood sugar levels and reducing the risk of hypoglycemia. The researchers aim to develop two types of “smart insulin”: a long-acting version for weekly injections and a short-acting version for use in insulin pumps. While the results are promising, further development is needed before the treatment can be cleared for public use.

Last Evening Meal and Insulin Sensitivity in Glucose Regulation

A recent study published in the Journal Nutrients highlights the importance of the last evening meal and insulin sensitivity in regulating glucose levels. Researchers from the Universitat Oberta de Catalunya (UOC) and US institutions found that the last meal of the day plays a crucial role in determining morning glucose levels, particularly in individuals with prediabetes.

Key Findings

Last evening meal impacts glucose regulation: The study showed that carbohydrate consumption and insulin sensitivity after the last evening meal affect morning glucose levels.
Insulin sensitivity is crucial: Individuals with lower insulin sensitivity may have a worse glycemic response to the last evening meal.
Meal timing matters: The timing of the last evening meal can impact glucose regulation, with later meals potentially leading to poorer glucose control.
Chronotype may play a role: The study suggests that an individual’s internal biological clock (chronotype) may influence glucose metabolism and fasting glucose levels.

Implications

The study’s findings have implications for dietary recommendations and glucose management in individuals with prediabetes. Personalized recommendations based on insulin sensitivity, meal timing, and chronotype may help prevent the onset of diabetes and improve glucose control.

New Technologies

The use of continuous glucose monitors, mobile apps, and artificial intelligence platforms can provide real-time monitoring of glucose levels and help patients make informed decisions about their diet and treatment. These tools may enable more personalized and adaptive glucose management, improving patient outcomes and quality of life.

Conclusion

The study highlights the importance of considering the last evening meal and insulin sensitivity in glucose regulation. By tailoring dietary recommendations to individual needs and using new technologies to monitor glucose levels, healthcare providers may be able to prevent or delay the onset of diabetes and improve glucose control in individuals with prediabetes.

The Connection Between Endometriosis and Diabetes

Endometriosis and diabetes are two distinct health conditions that can have a significant impact on a woman’s quality of life. Recent studies suggest that there may be a link between the two conditions, with women with endometriosis being more likely to develop insulin resistance and type 2 diabetes. In this essay, we will explore the connection between endometriosis and diabetes, and discuss the implications for women with both conditions.

Understanding Endometriosis

Endometriosis is a chronic gynecological condition characterized by the growth of endometrial tissue outside the uterus. This can cause pelvic pain, infertility, and other symptoms. Endometriosis affects approximately 1.5 million women in the UK, with an estimated economic burden of £8.2 billion per year.

Understanding Diabetes

Diabetes is a metabolic disorder characterized by high blood sugar levels. There are two main types of diabetes: type 1 and type 2. Type 1 diabetes is an autoimmune disease in which the body’s immune system attacks and destroys the insulin-producing beta cells in the pancreas. Type 2 diabetes is a condition in which the body becomes resistant to insulin, making it harder for glucose to enter the cells.

The Link Between Endometriosis and Diabetes

Research suggests that women with endometriosis may be more likely to develop insulin resistance and type 2 diabetes. This may be due to the chronic inflammation associated with endometriosis, which can lead to insulin resistance and metabolic dysfunction. Additionally, hormonal imbalances, particularly estrogen, may play a role in the development of insulin resistance and diabetes.

Implications for Women with Both Conditions

Women with both endometriosis and diabetes may experience a range of symptoms and complications, including:

Increased risk of infertility: Both endometriosis and diabetes can affect fertility, making it more challenging for women to conceive.
Worsening symptoms: Diabetes can exacerbate the symptoms of endometriosis, such as pelvic pain and inflammation.
Medication interactions: Women with both conditions may need to manage multiple medications, which can lead to interactions and complications.
Slower healing: Diabetes can impair wound healing, which can be a concern for women with endometriosis who may require surgery.

Managing Both Conditions

Managing both endometriosis and diabetes requires a comprehensive approach that includes:

Lifestyle modifications: Eating a balanced diet, maintaining a healthy weight, and engaging in regular physical activity can help manage both conditions.
Stress management: Stress can exacerbate both endometriosis and diabetes symptoms. Techniques like mindfulness, yoga, and meditation can help manage stress.
Medication management: Women with both conditions should work closely with their healthcare providers to manage their medications and prevent interactions.
Regular monitoring: The healthcare provider should regularly monitor blood sugar levels and adjust treatment plans as needed.

The connection between endometriosis and diabetes is complex and multifaceted. While the exact mechanisms are not fully understood, research suggests that women with endometriosis may be more likely to develop insulin resistance and type 2 diabetes. Women with both conditions require a comprehensive treatment plan that addresses their unique needs and health status. By understanding the connection between endometriosis and diabetes, healthcare providers can develop effective treatment plans to manage symptoms and improve quality of life.

Initiation of SGLT2 inhibitors in patients hospitalised for heart failure

The DAPA ACT HF-TIMI 68 trial showed that starting dapagliflozin in hospitalised heart failure (HF) patients did not significantly reduce short-term cardiovascular death or worsening HF compared with placebo. However, when combined with other trial data on SGLT2 inhibitors, the evidence suggests a meaningful benefit.

Background

HF hospitalisation is the leading cardiovascular cause for admission and is linked to high mortality and complications shortly after discharge.
Therapy optimisation during hospital stays could improve outcomes, but data on initiating SGLT2 inhibitors in this setting are limited.
Dapagliflozin (an SGLT2i) was tested for safety and efficacy in reducing early adverse outcomes when started during hospitalisation.

Study Design

Type: Double-blind, placebo-controlled randomised trial.
Sites: 210 centres in USA, Canada, Poland, Hungary, Czech Republic.
Patients: 2,401 adults (median age 69; 33.9% women) hospitalised with HF and fluid overload.
Intervention: Dapagliflozin 10 mg daily vs. placebo, started 24 hours–14 days post-admission.
Primary outcome: Composite of cardiovascular death or worsening HF over 2 months.

Results

Primary outcome:
- Dapagliflozin: 10.9%
- Placebo: 12.7%
- HR 0.86 (95% CI 0.68–1.08; p=0.20) → not statistically significant.
Components:
- Cardiovascular death: 2.5% vs. 3.1% (HR 0.78)
- Worsening HF: 9.4% vs. 10.3% (HR 0.91)
All-cause mortality: 3.0% vs. 4.5% (HR 0.66; 95% CI 0.43–1.00)
Safety: Slightly higher rates of symptomatic hypotension (3.6% vs. 2.2%) and worsening kidney function (5.9% vs. 4.7%) with dapagliflozin.

Meta-Analysis

Combining DAPA ACT HF-TIMI 68 with two other SGLT2i trials (empagliflozin, sotagliflozin) in 3,527 patients showed:
- Reduced early cardiovascular death or worsening HF (HR 0.71; p=0.012)
- Reduced all-cause mortality (HR 0.57; p=0.001)

Conclusion

Dapagliflozin alone: Did not significantly improve early outcomes in hospitalised HF patients.
Across SGLT2i trials: Strong evidence supports early in-hospital initiation to reduce cardiovascular and all-cause mortality.
Clinical implication: While dapagliflozin’s individual effect was not statistically significant, the collective trial data argue for the broader use of SGLT2 inhibitors during HF hospitalisation.

The Link Between Diabetes and Celiac Disease

Diabetes and celiac disease are two distinct medical conditions that can have a significant impact on an individual’s quality of life. While they may seem unrelated, research has shown that there is a link between the two conditions. In this essay, we will explore the connection between diabetes and celiac disease, and discuss the implications for individuals who have both conditions.

What is Celiac Disease?

Celiac disease is an autoimmune disorder that causes the immune system to react to gluten, a protein found in wheat, barley, and rye. When individuals with celiac disease consume gluten, their immune system damages the small intestine, leading to malabsorption of nutrients and a range of symptoms, including diarrhea, abdominal pain, and fatigue [1].

The Link Between Diabetes and Celiac Disease

Research has shown that individuals with diabetes are at a higher risk of developing celiac disease. Studies have found that the prevalence of celiac disease is higher in individuals with type 1 diabetes, with some estimates suggesting that up to 10% of individuals with type 1 diabetes may also have celiac disease [2]. The exact reason for this link is not fully understood, but it is thought to be related to the shared genetic and environmental factors that contribute to both conditions.

Shared Genetic Factors

Both diabetes and celiac disease are autoimmune disorders, and research has identified several genetic variants that are associated with an increased risk of developing both conditions. For example, the HLA-DQ2 and HLA-DQ8 genetic variants are strongly associated with celiac disease, and individuals with these variants are also at a higher risk of developing type 1 diabetes [3].

Implications for Individuals with Both Conditions

Individuals who have both diabetes and celiac disease face unique challenges in managing their conditions. A gluten-free diet is essential for managing celiac disease, but it can also impact blood sugar control and insulin dosing. Individuals with both conditions need to work closely with their healthcare provider to develop a personalized treatment plan that takes into account their dietary needs and glucose management goals.

Managing Both Conditions

Managing both diabetes and celiac disease requires a comprehensive approach that includes [4]:

Gluten-free diet: A strict gluten-free diet is essential for managing celiac disease and preventing complications.
Blood sugar monitoring: Regular blood sugar monitoring is crucial for managing diabetes and adjusting insulin doses as needed.
Dietary planning: Individuals with both conditions need to work with a registered dietitian or healthcare provider to develop a personalized meal plan that takes into account their dietary needs and glucose management goals.
Regular follow-up: Regular follow-up with a healthcare provider is essential for monitoring the progression of both conditions and adjusting treatment plans as needed.

The link between diabetes and celiac disease is complex and multifaceted. While the exact reason for the connection between the two conditions is not fully understood, research has shown that individuals with diabetes are at a higher risk of developing celiac disease. Individuals who have both conditions face unique challenges in managing their conditions, but with a comprehensive treatment plan and close follow-up with a healthcare provider, they can manage their conditions and prevent complications.

References

National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Celiac Disease.
Journal of Clinical Gastroenterology. (2019). Prevalence of Celiac Disease in Patients with Type 1 Diabetes.
Nature Reviews Disease Primers. (2020). Celiac Disease.
Academy of Nutrition and Dietetics. (2020). EatRight: Gluten-Free Diet.

How the COVID pandemic affected the management of diabetes

The COVID-19 pandemic has significantly impacted the management of diabetes, affecting patients’ ability to access healthcare services, maintain regular glucose monitoring, and adhere to treatment plans. The pandemic’s far-reaching consequences on diabetes care have been multifaceted, influencing various aspects of disease management.

Disruptions in Healthcare Services

One of the primary challenges faced by individuals with diabetes during the pandemic was the disruption in healthcare services. Many healthcare providers shifted to telehealth services, which, while necessary, presented several limitations. Patients experienced difficulties in accessing regular check-ups, glucose monitoring, and medication management. A study published in The Lancet Diabetes Endocrinology found that the pandemic led to significant decreases in utilization and testing rates and the likelihood of meeting A1C guidelines, primarily driven by missing A1C tests.

Impact on Glucose Control

The pandemic also affected glucose control in individuals with diabetes. Studies have shown that lockdowns and social distancing measures led to changes in lifestyle habits, such as reduced physical activity and altered dietary patterns, which can negatively impact glucose control. A study published in Diabetes Care found that patients with diabetes experienced a small absolute increase in A1C levels during lockdowns compared to before lockdowns.

Telehealth and Diabetes Management

Despite the challenges, telehealth has also presented opportunities for innovative diabetes management. Telehealth services have enabled healthcare providers to remotely monitor patients glucose levels, adjust treatment plans, and provide education on diabetes self-management. A study published in the Journal of Diabetes Science and Technology found that telehealth services can be effective in managing diabetes, particularly for patients with limited mobility or those living in remote areas.

Disparities in Care

The pandemic has also highlighted disparities in diabetes care, particularly among vulnerable populations. Patients who identified as racial or ethnic minorities, had Medicaid or no insurance, and had no encounters or all telehealth encounters were less likely to meet optimal A1C guidelines during the pandemic. These disparities underscore the need for healthcare systems to develop targeted interventions to ensure equitable care for all patients with diabetes.

Strategies for Mitigating the Impact

To mitigate the impact of the pandemic on diabetes management, healthcare systems can implement several strategies:

Increase access to telehealth services: Expand telehealth services to reach more patients, particularly those with limited mobility or living in remote areas.
Develop targeted interventions: Develop targeted interventions to address disparities in care, particularly among vulnerable populations.
Enhance patient education: Provide patients with education on diabetes self-management, including glucose monitoring, medication management, and lifestyle modifications.
Improve communication: Foster effective communication between healthcare providers and patients, ensuring that patients receive timely and accurate information about their care.

The COVID-19 pandemic has presented significant challenges to diabetes management, disrupting healthcare services, impacting glucose control, and highlighting disparities in care. However, the pandemic has also accelerated the adoption of telehealth services, which can be effective in managing diabetes. By implementing targeted interventions and strategies to mitigate the impact of the pandemic, healthcare systems can ensure that patients with diabetes receive high-quality care and achieve optimal health outcomes.

AI, full automation could expand artificial pancreas to more diabetes patients

Researchers at the University of Virginia Health System have published a review on the future of automated insulin delivery (AID) systems, such as the artificial pancreas. While AID systems have improved blood sugar management for millions of people with type 1 diabetes, limitations remain, including the need for user input for meals and exercise. The researchers aim to fully automate AID systems, making them easier to use and more accessible to a wider range of patients, including older adults and pregnant women. To achieve this, researchers are testing systems that use artificial intelligence to detect meals and deliver insulin doses without user interaction. The goal is to simplify the use of AID systems, improving access for the millions of people with diabetes who do not yet have access to this technology.

Untangling glucose traffic jams in Type 2 diabetes

Researchers at the Indian Institute of Science (IISc) have made a breakthrough in understanding Type 2 diabetes. They discovered that in people with Type 2 diabetes, the molecular traffic system that manages glucose levels in pancreatic β-cells is impaired. Specifically, glucose transporters (GLUTs) that help glucose enter the cells are not functioning properly, leading to reduced insulin release.

The team used advanced live-cell imaging to track GLUTs in healthy and diabetic cells, finding that in diabetic cells, fewer GLUTs reach the cell membrane and their cycling is impaired. This slows down glucose entry and reduces insulin granules docking to the cell membrane, weakening the body’s ability to regulate blood sugar.

The study suggests that restoring proper GLUT trafficking could be a new therapeutic approach to treating Type 2 diabetes. In fact, the researchers have previously identified a plant-derived molecule, Pheophorbide A, that can boost insulin release by interacting with glucose transporters. This new understanding could lead to personalized therapies based on a patient’s metabolic state.

New Study Highlights Potential for Early Detection of Diabetes through Household Analysis

A recent study presented at the European Association for the Study of Diabetes (EASD) Annual Meeting in Vienna, Austria, suggests that analyzing electronic health records of people living in the same household as individuals with prediabetes can help identify those at high risk of developing type 2 diabetes. The study, led by Dr. Tainayah Thomas from Stanford University, used electronic health record (EHR) and administrative data to identify household members of adult patients with prediabetes and evaluate their diabetes risk factors.

Key Findings

The study identified nearly 30,000 adults with type 2 diabetes and almost 50,000 with prediabetes living in the same households as index cases with prediabetes. The researchers found that [1]:

65% of adult household members had diabetes risk factors, including overweight or obesity, hypertension, abnormal blood fats, or cardiovascular disease.
32% of adult household members had an abnormal blood sugar profile, indicating prediabetes.
20% of adult household members had prediabetes laboratory results, and 12% had blood test results showing full-blown type 2 diabetes.

Implications for Diabetes Prevention

The study’s findings highlight the potential for early detection and prevention of diabetes by analyzing household members of individuals with prediabetes. By identifying high-risk individuals within households, healthcare providers can target prevention efforts and promote lifestyle changes to reduce the risk of developing type 2 diabetes.

Future Directions

The researchers plan to further investigate household members, including assessing follow-up care, diagnosis of diabetes or other conditions, enrollment in lifestyle interventions, and prescription of glucose-lowering medications. This study’s approach could be used by health systems to identify and tailor diabetes prevention messaging and programs to entire households instead of just individuals.

This study demonstrates the potential for using electronic health records to assess household diabetes risk and identify high-risk individuals. By targeting prevention efforts at the household level, healthcare providers may be able to reduce the incidence of type 2 diabetes and improve health outcomes for individuals and families.

The Importance of Breakfast for Individuals with Diabetes

Breakfast is a crucial meal for individuals with diabetes, as it helps to regulate blood sugar levels and provide energy for the day ahead. A well-balanced breakfast can help individuals with diabetes manage their condition and reduce the risk of complications.

Nutritional Requirements for Breakfast

Individuals with diabetes should aim to include a balance of protein, healthy fats, and complex carbohydrates in their breakfast. This can help to [1]:

Regulate blood sugar levels: Complex carbohydrates, such as whole grains, fruits, and vegetables, can help to regulate blood sugar levels and provide sustained energy.
Provide satiety: Protein and healthy fats can help to provide satiety and reduce the risk of overeating.
Support overall health: A balanced breakfast can provide essential vitamins, minerals, and antioxidants that support overall health.

Best Breakfast Foods for Diabetes

Some of the best breakfast foods for individuals with diabetes include [2]:

Oatmeal: Oatmeal is a complex carbohydrate that can help to regulate blood sugar levels and provide sustained energy.
Eggs: Eggs are a good source of protein and can help to provide satiety.
Avocado: Avocado is a healthy fat that can help to provide sustained energy and support heart health.
Berries: Berries are rich in antioxidants and fiber, and can help to regulate blood sugar levels.
Whole grain toast: Whole grain toast is a complex carbohydrate that can help to regulate blood sugar levels and provide sustained energy.

Breakfast Ideas for Diabetes

Some healthy breakfast ideas for individuals with diabetes include [3]:

Oatmeal with fruit and nuts: Cook oatmeal with milk or water and top with fruit and nuts for added fiber and protein.
Avocado toast: Toast whole grain bread and top with mashed avocado, eggs, and a sprinkle of red pepper flakes.
Greek yogurt with berries: Mix Greek yogurt with berries and a sprinkle of granola for added crunch and fiber.
Smoothie bowl: Blend together Greek yogurt, frozen berries, and spinach, then top with granola, nuts, and seeds.

Foods to Avoid at Breakfast

Some foods that individuals with diabetes may want to avoid at breakfast include [4]:

Sugary cereals: Sugary cereals can cause a spike in blood sugar levels and provide little nutritional value.
Refined grains: Refined grains, such as white bread, can cause a spike in blood sugar levels and provide little nutritional value.
Processed meats: Processed meats, such as bacon and sausage, can be high in sodium and saturated fat.

Breakfast is an important meal for individuals with diabetes, and choosing the right foods can help to regulate blood sugar levels and provide energy for the day ahead. By including a balance of protein, healthy fats, and complex carbohydrates in their breakfast, individuals with diabetes can help to manage their condition and reduce the risk of complications.

References

American Diabetes Association. (2022). Standards of Medical Care in Diabetes. Diabetes Care, 45(Supplement 1), S1-S212.
Evert AB, et al. (2019). Nutrition therapy for adults with diabetes or prediabetes: A consensus report. Diabetes Care, 42(5), 731-754.
Franz MJ, et al. (2019). Medical nutrition therapy for type 2 diabetes: An update. Diabetes Spectrum, 32(3), 249-258.
Sheard NF, et al. (2019). Dietary carbohydrate (amount and type) in the prevention and management of diabetes: A statement by the American Diabetes Association. Diabetes Care, 42(5), 755-763.

Big gains in type 1 diabetes glucose-control management in recent years

A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health reveals significant improvements in blood sugar management among individuals with type 1 diabetes over the past 15 years, driven by the widespread adoption of continuous glucose monitoring (CGM) and insulin delivery devices.

The study analyzed nearly 200,000 de-identified electronic health records from 2009 to 2023, tracking the use of CGM and insulin pumps alongside blood sugar control (measured by HbA1c levels). Key findings include:

Improved Glucose Control: The percentage of children under 18 with optimal HbA1c levels (<7%) rose from 7% (2009–2011) to 19% (2021–2023)—a 171% increase. Among adults, optimal control increased from 21% to 28% (33% increase).
Surge in Technology Use:
- CGM adoption skyrocketed from 4% to 82% in youths and 5% to 57% in adults.
- Insulin pump use rose from 16% to 50% in youths and 11% to 29% in adults.
- Concurrent use of both devices jumped from 1% to 47% in youths and 1% to 22% in adults.

Despite progress, disparities persist, with non-Hispanic white patients and those with commercial insurance showing higher rates of technology adoption and glucose control. For example, only 12% of non-Hispanic Black youths achieved optimal control in 2021–2023, compared to 21% of non-Hispanic white youths.

The researchers emphasize the need for better access to diabetes technologies to reduce these gaps. While the advancements are promising, most patients still do not meet optimal glucose targets, indicating room for further improvement.

Published in JAMA Network Open (August 11), the study highlights how modern diabetes technologies have transformed care, with future research planned to examine long-term complications like heart and kidney disease in type 1 diabetes patients.

Key Takeaways:

Technology Drives Improvement: CGM and insulin pumps have significantly enhanced blood sugar management.
Disparities Remain: Racial and insurance-based gaps in access and outcomes need addressing.
Ongoing Challenges: Most patients still lack optimal control, calling for further innovation and policy changes.

DASH Diet Modified for Diabetes Lowers Blood Sugar Levels in Clinical Trial

A recent clinical trial led by researchers at Johns Hopkins Bloomberg School of Public Health found that a modified version of the DASH diet, called DASH4D, is effective in lowering blood sugar levels in adults with type 2 diabetes. The DASH4D diet is similar to the original DASH diet but is lower in carbohydrates and higher in unsaturated fats, with reduced potassium levels to improve safety for individuals with chronic kidney disease.

The study, published in Nature Medicine, involved 89 participants with type 2 diabetes who ate prepared meals at a clinical research center for 20 weeks. The results showed that when participants consumed the DASH4D diet, they had a clinically meaningful reduction in average blood glucose level and an increase in average time spent with blood glucose in the recommended range compared to when they consumed a standard diet.

Specifically, the study found that:

Participants on the DASH4D diet had blood sugar levels that were on average 11 mg/dL lower than when eating the standard diet.
Participants on the DASH4D diet stayed in the optimal blood glucose range for an extra 75 minutes a day.
Larger improvements were seen in participants who had higher blood glucose levels at the start of the trial, with those with HbA1c above 8% experiencing an increase in time in the optimal blood glucose range by about three hours per day.

The researchers hope that the results will lead to incorporating the DASH4D diet into clinical guidelines and improving type 2 diabetes management in the broader population. The study’s findings suggest that the DASH4D diet can be a sustainable and effective approach to managing type 2 diabetes, with potential benefits for population health.

Phase 3 study supports use of canagliflozin for type 2 diabetes in children and adolescents

A recent phase 3 clinical trial published in Annals of Internal Medicine supports the use of canagliflozin for treating type 2 diabetes in children and adolescents. The study involved 171 participants aged 10-18 years with inadequate glycemic control, who received either oral canagliflozin or a placebo for 52 weeks.