Madison Clinic Helps Young Diabetes Patients Manage Their Own Care

When children are diagnosed with type 1 diabetes­ – one of the most common chronic conditions of childhood – parents typically shoulder the burden of managing their care.  

This includes a rigorous daily routine of supervising what the child eats, checking blood sugar levels, administering insulin and keeping regular medical appointments. It’s a big job, and as children become independent adults, it’s one they must gradually take upon themselves. 

The Madison Clinic aims to improve the lives of patients and their families and to ease the burden of diabetes through compassionate and individualized management with emphasis on education, empowerment, and use of advanced technologies.

Visit the clinic’s website for more information.

This process of “transition” is important for maintaining optimal health, and it is highly influenced by socio-economic and cultural factors.

UCSF psychologist Diana Naranjo, PhD, an assistant professor of pediatrics, is particularly interested in how the health care transition occurs in ethnic minority families. Her work is part of a broad effort to smooth the transition process for all young adult patients at the Madison Clinic for Pediatric Diabetes at UCSF Benioff Children’s Hospital.

An Extra Developmental Challenge

Patients in the transitional age group­­ – 18 through 30 – face special challenges when it comes to managing their diabetes.

Diana Naranjo, PhD

“Young adults, who are still evolving decision-making skills, often feel ‘I’ve been dealing with this my whole life. I want it to go away,’” said Naranjo. 

An autoimmune disorder in which the body attacks the pancreas, type 1 diabetes requires that patients take over the metabolic balancing act that this organ performs in healthy individuals. That requires a daunting series of tasks that must be performed every day. If poorly controlled, the disease can cause serious short and long-term consequences.

Managing type 1 diabetes often conflicts with normal developmental behaviors, said Naranjo.

Experimentation with drinking alcohol, for example, has extra risks for youth with diabetes because it can affect blood sugars and impair judgment. Young people may also struggle with how to disclose the demands of their disease when starting an intimate relationship.

Guiding the Transition Process

The Madison Clinic is working to ease the transition process for all its young adult patients. These efforts are led by a team that includes pediatric diabetes specialists Saleh Adi, MD and Stephen Gitelman, MD, endocrinologist Roger Long, MD, and Megumi Okumura, MD, a specialist in chronic disease management.

Patients complete an annual survey that Naranjo and the team have developed that helps identify how much teen and young adult patients know about their disease – with questions about their knowledge of medical management, insurance, sex and drugs. 

Transition coordinator Marcela Arregui-Reyes sits down with every patient age 16 or older to complete the survey and prioritizes specific areas where more education is needed.  With most patients making four visits to the clinic each year, the goal is to fill in the most important educational gaps at each visit.

How Transition Differs for Minority Families

Ethnic minority patients in the transitional age group often wrestle with additional challenges, according to Naranjo.

As they reach adulthood and age out of public healthcare systems for children with chronic illness, some may be left uninsured or with very limited healthcare options.  This can lead to poor diabetes management and higher utilization of emergency room services.

Madison Clinic for Pediatric Diabetes at UCSF’s Mission

Bay campus

Naranjo, who is fluent in Spanish, has a special interest in cultural differences in patients’ perceptions about diabetes and its care.  

The Madison Clinic serves a higher-than-average percentage of minority patients with type 1 diabetes, making it a good site for researching these differences. Roughly 25 percent of the clinic’s families are Latino, and African-American families are proportionately higher than in the overall U.S. population of patients with diabetes.

Naranjo has gathered detailed information from 20 clinic families so far, using a combination of surveys and in-depth interviews with patients and family members.  One emerging pattern, according to Naranjo, is that Latino parents do not necessarily value transition in the same way that the medical world does.  The transition model used in medical settings is designed to help young adults take over monitoring their health, making their own appointments and interfacing with insurance companies or other agencies.  

“Latino parents often wonder ‘Why should I burden my child in that way?’” said Naranjo.  Many Latino families continue living together longer into adulthood than non-Latino families, and consequently, parents continue to play a big role in their young adult’s diabetes management.

Latino children may also look at the transition process differently, particularly if their parents are uninsured and struggling to treat their own chronic health problems, such as high blood pressure or type 2 diabetes.

Naranjo will continue her research in the coming year. In the meantime, her findings suggest that health transition specialists may need to tailor the information they give to minority families to match different perceptions of living with a chronic disease.

Maintain, Don't Gain: A New Way To Fight Obesity | Duke Today

Durham, NC – Programs aimed at helping obese black women lose weight have not had the same success as programs for black men and white men and women.

But new research from Duke University has found that a successful alternative could be a “maintain, don’t gain” approach.

The study, which appears in the Aug. 26 issue of JAMA Internal Medicine, compared changes in weight and risk for diabetes, heart disease or stroke among 194 premenopausal black women, aged 25-44. They were recruited from Piedmont Health’s six nonprofit community health centers in a multi-county area of central North Carolina, which serves predominantly poor patients.

For the study, half of the participants — 97 women — were randomly placed in a primary care-based intervention program called Shape, while the other 97 received usual care from their physicians, generally weight-loss counseling.

The intervention program used software built by Duke researchers that personalized the intervention for each woman. Each woman received an individualized set of behavior-change goals for diet and physical activity. They tracked how well they were doing each week via automated phone calls, and had a personal health coach and a gym membership.

After 12 months, the intervention group stabilized their weight, while participants in the usual care group continued to gain weight. Sixty-two percent of intervention participants were at or below their weight at the onset of the program, compared to 45 percent of usual-care participants. After 18 months, intervention participants still maintained their weight while the usual care group continued to gain weight.

“Many people go to great lengths to lose weight when their doctor recommends it. They may try a series of diets or join a gym or undergo really complex medical regimens. The complexity of these treatments can make it difficult for many to lose a sufficient amount of weight,” said lead author Gary Bennett, an associate professor of psychology and neuroscience and global health at Duke who studies obesity prevention.

“Our approach was different. We simply asked our patients to maintain their weight,” Bennett said. “By maintaining their current weight, these patients can reduce their likelihood of experiencing health problems later on in life.”

The study, funded by a grant from the National Institute for Diabetes and Digestive and Kidney Diseases, cited other research showing that overweight and slightly obese premenopausal black women face far lower risks for many chronic diseases than do obese whites and other racial groups.

But by ages 40-59, black women have more than twice the prevalence of class 2 (moderate) obesity and three times the rate of class 3 (extreme) obesity than white women, the study said. This combination of rapid premenopausal weight gain and extreme obesity contributes to disproportionate chronic disease risk among black women, researchers said.

Preventing weight gain could reduce the odds of developing a host of health problems, such as high blood pressure, high cholesterol diabetes, cardiovascular disease, stroke and some cancers, the authors said.

A “maintain, don’t gain” approach could be particularly effective for this group for the following reasons:

— Compared to white women, black women are typically more satisfied with their weight and face fewer social pressures to lose weight, Bennett said. Consequently, they may be particularly receptive to intervention messages about maintaining their weight.

— Preventing weight gain is less intense than trying to lose it, so this approach could be achieved more easily.

“It’s true that there are some health risks for these overweight and slightly obese women,” Bennett said. “However, these health risks increase dramatically as women continue to gain weight, usually 2 to 4 pounds, year after year.  

“We could reduce these health risks if women simply maintained their current weight,” Bennett said. “Fortunately, it’s much easier to maintain weight than it is to lose it. We think this ‘maintain, don’t gain’ approach can help some women reduce their risk of obesity-related chronic disease.”                          

###

CITATION: “Behavioral Treatment for Weight Gain Prevention Among Black Women in Primary Care Practice: A Randomized Controlled Trial,” lead author Gary Bennett, Perry Foley, Erica Levine, Sandy Askew, Dori Steinberg, Bryan Batch, Duke University; Jessica Whiteley, University of Massachusetts Boston; Mary Greaney, Dana-Farber Cancer Institute; Heather Miranda, Thomas Wroth, Marni Holder, Piedmont Health Services; Karen Emmons, Dana-Farber Cancer Institute and Harvard School of Public Health; Elaine Puleo, University of Massachusetts Amherst. JAMA Internal Medicine, online Aug. 26, 2013; DOI:10.1001/jamainternmed.2013.9263./////

Obesity Does Slow People Down, Study Confirms – WebMD

Obesity Does Slow People Down, Study Confirms

By Alan Mozes

HealthDay Reporter

FRIDAY, April 5 (HealthDay News) — Women who struggle with chronic obesity end up engaging in less and less routine physical activity, new research shows, confirming what may seem obvious to some.

The investigating team acknowledged that their observation so clearly aligns with conventional wisdom that it would be hard to describe it as “rocket science.” But they say theirs is the first study to rigorously establish what most scientists have long presumed to be the case: that obesity does indeed have a negative impact on an individual’s activity habits.

“An abundance of research has focused on factors that increase [the risk for] obesity, due to the many chronic diseases and conditions associated with it,” said study lead author Jared Tucker, currently a senior epidemiologist at the Helen DeVos Children’s Hospital in Grand Rapids, Mich. “And rightly so.”

“However, physical inactivity is also independently associated with many of the same chronic diseases, including cardiovascular disease and type 2 diabetes,” Tucker added. “But we don’t often think about factors that influence activity levels.”

Tucker was a graduate student when the research, reported online recently in the journal Obesity, was conducted.

“Our study suggests that obesity likely increases the risk of reducing physical activity levels in women,” Tucker said. “Therefore, it appears that physical inactivity and obesity may be involved in a feedback loop, in which lower levels of activity lead to weight gain, which then leads to lower levels of activity.”

To explore how obesity could depress activity levels among women, the authors focused on more than 250 middle-aged women living in the Mountain West region of the United States. Roughly half the participants were diagnosed as obese.

Rather than ask the women to self-report their activity routines — a study method that can undermine reliability — the team attached belt-strapped accelerometers to all the study participants. The small device measures movement of various accelerations and intensities. For a week, all the women were told to wear the straps throughout their day, except when exposed to water, such as while showering.

On average, the women wore the straps for nearly 14 hours out of the 15-hour daytime period (defined as 7 a.m. to 10 p.m.). This allowed the team to assess total time spent engaged in daily light, moderate or vigorous physical activity.

Body composition assessments were conducted just before the accelerometer monitoring began and again 20 months later. In turn, after the 20-month re-assessment, the women were again asked to wear the accelerometers for another week of activity monitoring.

The result: Among the obese participants, physical activity was found to drop by 8 percent overall over the course of the 20-month study period. This was equivalent to a loss of 28 active minutes per week, the researchers said.

Obesity Does Slow People Down, Study Confirms

obesity09235 Obesity Does Slow People Down, Study Confirms

By Alan Mozes
HealthDay Reporter

FRIDAY, April 5 (HealthDay News) — Women who struggle with chronic obesity end up engaging in less and less routine physical activity, new research shows, confirming what may seem obvious to some.

The investigating team acknowledged that their observation so clearly aligns with conventional wisdom that it would be hard to describe it as “rocket science.” But they say theirs is the first study to rigorously establish what most scientists have long presumed to be the case: that obesity does indeed have a negative impact on an individual’s activity habits.

“An abundance of research has focused on factors that increase [the risk for] obesity, due to the many chronic diseases and conditions associated with it,” said study lead author Jared Tucker, currently a senior epidemiologist at the Helen DeVos Children’s Hospital in Grand Rapids, Mich. “And rightly so.”

“However, physical inactivity is also independently associated with many of the same chronic diseases, including cardiovascular disease and type 2 diabetes,” Tucker added. “But we don’t often think about factors that influence activity levels.”

Tucker was a graduate student when the research, reported online recently in the journal Obesity, was conducted.

“Our study suggests that obesity likely increases the risk of reducing physical activity levels in women,” Tucker said. “Therefore, it appears that physical inactivity and obesity may be involved in a feedback loop, in which lower levels of activity lead to weight gain, which then leads to lower levels of activity.”

To explore how obesity could depress activity levels among women, the authors focused on more than 250 middle-aged women living in the Mountain West region of the United States. Roughly half the participants were diagnosed as obese.

Rather than ask the women to self-report their activity routines — a study method that can undermine reliability — the team attached belt-strapped accelerometers to all the study participants. The small device measures movement of various accelerations and intensities. For a week, all the women were told to wear the straps throughout their day, except when exposed to water, such as while showering.

On average, the women wore the straps for nearly 14 hours out of the 15-hour daytime period (defined as 7 a.m. to 10 p.m.). This allowed the team to assess total time spent engaged in daily light, moderate or vigorous physical activity.

Body composition assessments were conducted just before the accelerometer monitoring began and again 20 months later. In turn, after the 20-month re-assessment, the women were again asked to wear the accelerometers for another week of activity monitoring.

The result: Among the obese participants, physical activity was found to drop by 8 percent overall over the course of the 20-month study period. This was equivalent to a loss of 28 active minutes per week, the researchers said.

Non-obese women, on the other hand, showed no drop in their physical activity routines.

“This finding,” Tucker said, “highlights the importance of maintaining an active lifestyle and a healthy weight in order to prevent the start of this potential cycle of increasing risks.”

Lona Sandon, a registered dietitian and assistant professor of clinical nutrition at the University of Texas Southwestern in Dallas, said the viciousness of this cycle means this is often easier said than done.

“What we do know is that obesity is clearly related to more sedentary behavior,” Sandon said. “But is it that they move less and become obese, or because they’re obese that they move less?”

Sandon said there are many reasons an obese woman would stop being active.

“Certainly, when you become obese it’s just harder to move your body, and you become winded or easily fatigued with very little activity,” she said. “S you would just plain avoid it for that reason.”

Psychological issues also come into play, Sandon said.

“Being obese gets tied to emotion and body image. You don’t want people watching you. You don’t feel comfortable going to a gym or a fitness class because people may be staring,” she said. “Low self-esteem, poor body image and depression also oftentimes go along with obesity. There’s a lack of confidence that they can lose the weight, and that in trying to do it they’ll just bring unwanted attention to themselves.”

The cycle of obesity and inactivity “is a very complicated and difficult situation,” Sandon said.

More information

For more on physical activity recommendations, visit the U.S. National Heart, Lung, and Blood Institute.

HEALTHDAY Web XSmall Obesity Does Slow People Down, Study Confirms

Chinese herbs help cut diabetes symptoms

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The study involved a controlled clinical trial of 800 type 2 diabetic adults, comparing the anti-diabetic drug Glibenclamide as a stand-alone treatment and treatment with Glibenclamide in conjunction with traditional Chinese medicine.

Results show patients treated with traditional Chinese medicine were more than a third less likely to experience hypoglycaemia—dangerously low levels of blood sugar—than those treated with Glibenclamide only.

Straight from the Source

Read the original study

DOI: 10.1371/journal.pone.0056703

“They were also less likely to experience other symptoms of diabetes, including fatigue, hunger, and palpitation,” says Sanjoy Paul of the University of Queensland.

“Traditional Chinese medicine has long been used to treat diabetes in China and around the world but until now there has been a lack of evidence regarding its safety and efficacy. This absence of scientific understanding has caused skepticism and criticism about traditional Chinese medicine.”

More studies are needed to interpret just how traditional Chinese medicine works to reduce hypoglycaemia, but the new study, published in the journal PLOS ONE, highlight its potential to reduce the treatment gap in developing countries where diabetes is at epidemic proportions, Paul says.

“A vast majority of people in developing countries depend on herbal medicine for basic health care. The findings of this study may improve the safe delivery of effective health care to people who may otherwise be unable to access treatment.”

The study is the largest scientifically designed clinical trial evaluating the safety and efficacy of traditional Chinese medicine on glycaemic control in patients with type 2 diabetes.

Lilong Ji, professor at Peking University, contributed to the study.

Source: University of Queensland

Futurity.org – Obesity and type 2 diabetes link identified

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There are an estimated 371 million people with diabetes in the world and around 90 percent of these cases are type 2 diabetes. By 2030, there will be some 550 million with the condition based on current trends.

Cases of diabetes have more than doubled since 1980, with 70 percent of the trend due to aging populations worldwide and the other 30 percent estimated to be due to increasing prevalence of risk factors including obesity.

Straight from the Source

Read the original study

DOI: 10.1016/j.cmet.2013.02.019

New research published in Cell Metabolism identifies a key mechanism in the immune system involved in the development of obesity-linked type 2 diabetes. The findings open up new possibilities for treatment and prevention of this condition, which is becoming increasingly prevalent worldwide.

The association between obesity and diabetes has long been recognized but the molecules responsible for this association are unclear.

Lead author Jane Howard and her colleagues from King’s College London studied mice genetically engineered to lack T-bet, a protein that regulates the differentiation and function of immune cells. They found that the mice had improved insulin sensitivity despite being obese.

“When T-bet was absent this altered the relationship between fat and insulin resistance; the mice had more intra-abdominal fat but were actually more sensitive to the glucose lowering effects of insulin,” says Howard. “As fat accumulation in the abdomen is typically associated with worsening insulin resistance and other features of the metabolic syndrome, the findings seen were both unusual and unexpected.”

It turned out that the intra-abdominal fat of these mice contained fewer immune cells and was less inflamed than that of normal mice. The researchers then went on to discover that by transferring immune cells lacking T-bet to young, lean mice they were able to improve insulin sensitivity. “It appears that T-bet expression in the adaptive immune system is able to influence metabolic physiology,” adds Professor Graham Lord.

Although human obesity is often associated with insulin resistance and diabetes, this is not always the case.

“Our data suggests that obesity can be uncoupled from insulin resistance, through the absence of T-bet,” says Howard. Several of the main drugs currently used to treat type 2 diabetes work by improving insulin sensitivity.

Further studies are needed to identify other molecules in the pathway of action of T-bet which could pave the way for future drug development in the treatment of type 2 diabetes. The administration of specific immune cells as immunotherapy to improve insulin resistance may also one day become a therapeutic possibility.

“This is just the start,” says Howard. “The idea that the immune system can impact on metabolism is very exciting, but more research needs to be done before we can bring this work from the bench to the bedside for the benefit of patients.”

The UK Medical Research Council funded the study.

Source: King’s College London

Futurity.org – Obesity gene linked to skin cancer risk

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New research shows that people with particular variations in a stretch of DNA within the FTO gene, called intron 8, could be at greater risk of developing melanoma.

Variations in a different part of the FTO gene, called intron 1, are already known to be the most important genetic risk factor for obesity and overeating. These variants are linked to Body Mass Index (BMI)—a measure of a person’s shape based on their weight and height.

Straight from the Source

Read the original study

DOI: 10.1038/ng.2571

Having a high BMI can increase the risk of various diseases including type 2 diabetes, kidney disease, womb (endometrial) cancer, and more.

But this research is the first to reveal that the gene affects a disease—melanoma—which isn’t linked to obesity and BMI.

The results, published in Nature Genetics, suggest that FTO has a more wide-ranging role than previously suspected, with different sections of the gene being involved in various diseases.

“This is the first time to our knowledge that this major obesity gene, already linked to multiple illnesses, has been linked to melanoma,” says study author Mark Iles, Cancer Research UK scientist at the University of Leeds. “This raises the question whether future research will reveal that the gene has a role in even more diseases?

“When scientists have tried to understand how the FTO gene behaves, so far they’ve only examined its role in metabolism and appetite. But it’s now clear we don’t know enough about what this intriguing gene does.

“This reveals a hot new lead for research into both obesity-related illnesses and skin cancer.”

The researchers examined tumor samples in more than 13,000 melanoma patients and almost 60,000 unaffected people from around the world.

Malignant melanoma is the fifth most common cancer in the UK with around 12,800 new cases and around 2,200 deaths each year.

“These are fascinating early findings that, if confirmed in further research, could potentially provide new targets for the development of drugs to treat melanoma,” says Julie Sharp, Cancer Research UK’s senior science information manager.

“Advances in understanding more about the molecules driving skin cancer have already enabled us to develop important new skin cancer drugs that will make a real difference for patients,” continues Sharp.

“But it doesn’t detract from the importance of reducing your risk of the disease by enjoying the sun safely on winter breaks abroad and avoiding sunbeds. Getting a painful sunburn just once every two years can triple the risk of melanoma.”

Source: University of Leeds

Overactive immune system triggers chronic bladder infections

The best thing to do if you want to prevent from getting a bladder infections is an age old idea: keep warm, wear socks and make sure your pelvic area doesn’t get cold. When cold, the natural defense system of the mucus membranes decreases strongly, allowing bacteria, like E. Coli from the intestines, to enter the urinary tract and the bladder.

Women are much more likely to suffer from bladder infections than men. The reason is anatomical, as the urethra, vagina and anus are much closer to each other in the female body, which makes it much easier for bacteria to enter the travel. While some females are able to overcome a bladder infection easily, it can become a chronic condition in others.

Recent research conducted at the Washington University in St. Louis however claims that it isn’t a weak immune system that leads to these chronic infections, but rather an overactive one.

Experiments with mice that were purposefully infected with the most common urinary tract and bladder infection pathogens. Those mice with the most active immune systems were particularly susceptible to chronic infections. A receptor named TLR4 and a group of white blood cells are reportedly to blame for this. According to the researchers’ experiments, those mice who were given medication to suppress these, and those mice who were genetically altered, did not have chronic infections.

Researchers also found that those animals that were susceptible to these chronic infections were also likely to develop new infections much more often.

Apparently it is difficult for the body to find a perfect balance by which the immune system combats the infection, the researchers write in an article published in PLoS Pathogens.

The reaction needs to be strong enough to eliminate and destroy the bacteria, but it mustn’t harm tissue or mucus membranes. If the immune system reacts too strong to this infection and tissue is damaged, it allows the bacteria to travel, hence paving the way for chronic infections, and new infections that can grow in severity.

If this is true in humans as well, researchers say there could be a simple test by which a woman can determine whether she is susceptible to chronic infections. An infection indicator called IL-5 was present in increased levels in the mice 24 hours after infection. A simple blood test in women could determine whether this indicator is present in their bodies too.

Find out more about urinary tract infections, interstitial cystitis and natural remedies for bladder infections.

Images: http://www.sxc.hu/photo/1159174,

http://commons.wikimedia.org/wiki/File:Normal-pelvis-001.jpg, Author: RadsWiki

Exercise and optimism can help fight chronic diseases, study finds

According to a study conducted by Centers for Disease Control and Prevention (CDC), almost half of the American population currently suffers from chronic diseases. These numbers, MSNBC reports, have risen staggeringly with the high presence of obesity in society. The percentage of adult Americans living with heart diseases, obesity and diabetes is 18.4 percent which is almost double the results of a 1984 study, according to the statistics provided by Centers for Disease Control and Prevention.

And while many think ageing means becoming frail and ill, they are mistaken, researchers say. Margaret Moore of the CDC says: “I think the old myth was somehow after age 60, 65, there’s just nothing you can do anymore. But really there are lots of things you can do to improve your function [and] and your health well into older age.”

According to alive.com, regular exercise can help maintain body hormones and oxygen functioning, which is essential to build muscle strength in humans.

But exercise isn’t our only fountain of youth: apparently a good amount of optimism and cheer keeps us healthy and feeling better longer too, the research suggests.

Carmel Dyer, geriatrician at the University of Texas Medical School, said: “I’ve been practicing geriatric medicine for almost 20 years, and I’ve notice that my patients who sort of make the best of everything, when there’s lemons they make lemonade…they seem to live longer and happier lives. I think if you’re more optimistic, you’re more positive, you’re going to do better, you’re going to feel better.”

Another recent study has found overweight elderly people live longer.

Image: http://www.sxc.hu/photo/1099505