Shared doctor visits may help diabetes self-care


New York |
Thu Oct 10, 2013 3:14pm EDT

New York (Reuters Health) – Diabetes patients who agreed to attend group medical appointments at a Veterans Administration hospital showed health improvements similar to what most diabetes drugs would achieve, according to U.S. researchers.

Getting type 2 diabetes patients to take care of themselves and manage their disease daily is a challenge for healthcare providers, but shared doctor visits could be a useful tool, the study team says.

One way that hasn’t worked that well is to “lecture them,” according to senior study author Dr. Jeffrey Kravetz of the VA Connecticut Health Care System.

“People learn from each other and it is easier to learn from people who are in the same boat,” Kravetz said, adding that it is often more meaningful for people with diabetes to hear from a peer who understands the condition.

Type 2 diabetes can cause serious complications if it is not controlled by a combination of medication, diet and exercise. Healthcare providers agree the best way to approach this chronic condition is to educate patients to take care of themselves, but it’s tough to get people to be better self-managers.

Kravetz, together with pharmacist Alexander B. Guirguis and a team that included a nurse who specializes in diabetes, a registered dietitian and a health psychologist, tried a different approach: shared medical appointments, in which groups of three to 10 patients met in a 90-minute session every six to 12 weeks for a year.

About one quarter of the 8,000 veterans who are seen in the Firm A clinic of the West Haven VA have diabetes, Kravetz and his team write in the American Journal of Medicine.

Around 300 of those patients have exceedingly high levels of a blood protein known as A1C that indicates how well blood sugar has been controlled over the preceding several months. A1C levels greater than 9 percent are considered problematic.

For the study, selected patients with A1C around 9 percent or more were invited to join a shared medical appointment for diabetes management. Before their first visit, the patients agreed to sharing their medical results with the group, and were sent “report cards” with their blood test results.

The 90-minute appointments combined education and consultations with the medical team with peer support and education. The emphasis, according to team leader Guirguis, was to try to make the sessions more “patient interactive as opposed to provider led.”

The team would review patients’ blood test results openly and encourage patients to talk about their challenges and successes. The sessions usually ended with a question and answer session and brief talk by the dietician.

Of the sixty patients who signed up, 40 attended at least two group visits, 19 attended three or more visits and 15 attended four shared medical appointments over the year. And by the study’s end, some patients saw their A1C levels drop by as much as 1 percent, a change Kravetz says is about what would be expected from medication.

For instance, patients with A1C averaging 10.75 percent at the beginning of the study who attended two group appointments dropped to an average A1C level of 9.51 percent. Patients with lower starting levels of A1C – around 9.5 percent – dropped to an average of around 8.5 percent after attending three meetings.

In contrast, a comparison group of patients who were invited to participate but did not follow through had A1C levels that were unchanged or rose about a quarter of a percent over the year.

While these results mean the patients are still within the type 2 diabetes range (an A1C of 6.5 percent and above is considered type 2 diabetes), Kravetz considers them “pretty comparable to some major therapies.” He noted that at most a diabetes drug reduces the A1C by up to 1 percent and these patients are doing better than medication alone.

The team found that patients often shared similar experiences and could talk about how they overcame some of their obstacles to better self care: “We are trying to get people to talk about their barriers rather than lecture to them,” he told Reuters Health.

The majority of the behavior changes were diet and medication related. Guirguis recalls one patient who strongly identified with another patient’s story about setting up his insulin next to the coffee maker.

Another benefit of this kind of peer support is that patients who are leery of going onto insulin can observe peers who “are living perfectly normal lives” while on the medication regime, he said.

Helen Altman Klein, professor emeritus at Wright State University in Ohio, who has conducted extensive studies of diabetes self management education programs, considers this study “small scale in terms of medical research, but filling a very important niche in the field of diabetes education particularly when it comes to trying to help deliver services inexpensively.

“VAs have limited resources and need to serve a lot of people,” she said. “Sometimes with a VA, it’s no small thing for some people to sign up and even make an appointment.”

The Connecticut VA is planning to continue the group appointment program, including expanding into a multisite study. The team is also experimenting with peer-to-peer telephone support, and enrolling patients for the next study, according to Guirguis.

SOURCE: bit.ly/1czY0Xg American Journal of Medicine, online September 26, 2013.

Ban on diabetes drug leaves patients crippled

After the government imposed a ban on widely used anti-diabetes drug pioglitazone, city patients and diabetologists are in the dock.
The drug, which is quite popular with Type 2 diabetes patients, is consumed by about 10% of city’s population, claimed city diabetologist Dr Abhay Mutha at a press conference on Friday.

Chief diabetologist at Ruby hall Clinic, Mutha said, “The ban of pioglitazone came as a rude shock to us. It is one of the most prescribed medicines to our patients suffering from Type 2 diabetes. The medicine, being cheap and highly effective with minimum side effects is also used widely in western countries.”
Mutha said that the reasoning for the ban wasn’t clear and that government officials should consult the medical practitioners and reconsider the decision.

Diabetologist Dr Shrirang Godbole said that with the ban, the only available option that doctors have for the patients is to prescribe alternative medication or initiate the use of insulin. “I have been receiving frantic calls from my patients regarding the same,” he said.

There are other drugs available in the market with varying pioglitazone combination, but they are less effective, said Mutha.

Clinical trial aims to prevent type 2 diabetes through medication

diabetes finger prick

NIH

Above, a patient measures her blood sugar level. A clinical study will test whether certain medications can prevent diabetes, or slow the progression of the disease in newly diagnosed patients.

A clinical trial at the Veterans Affairs Puget Sound Health Care System and the University of Washington will address new approaches to prevent the development of type 2 diabetes or slow its progression. Participants will be treated with medications normally used for people who have had diabetes for at least one year. The study will enroll individuals who have prediabetes or have been recently diagnosed with diabetes, but who are not taking medications to treat the condition.

The Restoring Insulin Secretion, or RISE, Study will examine the effects of three such medication regimens.  Each will be administered for 12 months. The three regimens are: liraglutide plus metformin for 12 months; insulin for 3 months followed by metformin for 9 months; and metformin alone for 12 months. The expectation is that the use of these medications before diabetes has developed will preserve or enhance the body’s ability to produce insulin, the hormone that is crucial to maintain normal blood sugar levels.

The RISE study is a nationwide program looking at the effects of various treatments to preserve insulin secretion and thereby prevent the development of diabetes or its progression early in the disease. The UW and VA diabetes research group in Seattle is one of three recruiting adult patients for the medication trial, along with the University of Chicago and Indiana University in Indianapolis.

Dr. Steven Kahn, professor of medicine, Division of Metabolism, Endocrinology and Nutrition, at the University of Washington,  leads the Seattle clinical trial and is also chairs the national study.

“We hope to identify people who are at high risk of developing diabetes as they have mild elevations in their blood glucose as well as individuals who have had diabetes for less than a year and have not required medications,” Kahn said.

“The purpose of the study,” he explained, “is to determine whether aggressively treating such patients with medications used in diabetes can slow the disease process and prevent the loss of the ability of the pancreas to make and release insulin.”

The study, sponsored by the National Institutes of Health, is currently recruiting patients. To be eligible, patients must be between 20 and 65 years old, have prediabetes or self-reported type 2 diabetes for less than one year, and must not have taken any medications to treat diabetes in the past. Participants also must be considered overweight or obese. The investigators aim to enroll 85 patients who will participate in the trial for 21 months.

More details are available at the National Institute of Health’s ClinicalTrials.gov website, identifier: NCT01779362.

To participate in the RISE Study, interested individuals can call 206-764-2768.

Tagged with: , , , , , , ,

Curing ADHD: organic food is better than Ritalin

If ever there was a good reason to steer children away from processed foods, especially candy type snacks then ADHD is it. While studies have tried to connect certain food dyes, sugar, dextrose and high-fructose corn syrup with ADHD it seems that many other factors such as mineral deficiency are also to blame.

Nutrition is a vital part of our daily lives and an unhealthy diet leads to an unhealthy mind and body. Most people don’t realise that the majority of supermarket food, even the stuff labelled as healthy, is not.

Most drugs are only effective because of the natural elements they contain.

Wholesome, raw, natural foods are the best thing to eat as they are exactly as nature intended them. Eating organic food is a sure fire way to avoid developing food addictions which substances like sugar and MSG encourage.

One particular study of ADHD by Dr. Max Gomez follows the behavioural and eating patterns of seven-year-old Annabella Surovcik who was at the point of driving her parents insane.

Annie, as she is referred to by her parents, has an extreme form of Attention Deficit Hyperactivity Disorder with high impulsivity.

Greg and Dianne Marino-Surovcik, Annie’s parents fed her the same type of  things as most other kids and her behaviour was out of control. According to her mother she would hit, kick, bite and scratch people without the ability to restrain herself. Her impulses were overwhelming.

One consistent result from countless studies carried out into the cause of ADHD is the lack of evidence that food dyes and sugar lead to the condition.

Annie’s parents decided not to restrict her diet but instead chose therapy and medication as the way to cure her. The results were good in their opinion; she was settling down at school and her behaviour was much improved at home.

“Annie is doing tremendous, she is feeling confident,” her father said.

“Amazing, she’s amazing, her grades are good at school,” her mother added.

And Annie herself spoke of her improvement, “I feel happy because I stopped doing that stuff,” she said.

[adsense]Medication, while appearing to help Annie has hidden risks and is in fact a big slippery downward spiral which not only costs money but also health, whereas a healthier diet which excludes gluten (from bread, etc), milk, white rice, sugar, HFCS and food additives is a much better solution.

Consuming raw fruit and vegetables is the best possible basis for a healthy mind and body and also improves mood and general well being.

While the Food and Drug Administration explore options on food dyes and new anti-ADHD drugs – a notoriously slow process – think about adapting your child’s diet to include natural, organic food while cutting out candy and corn snacks. The health benefits will be massive and you also avoid the unpleasant side effects associated with drugs like Ritalin.

Please share your thoughts or experiences with ADHD by leaving a comment.

Read about how a raw vegan diet is also better than cancer tests and an artificial pancreas; juice fasting is great for digestion and detoxing; how a balanced vegetarian diet can combat obesity and Oprah Winfrey tries a raw diet.

images: thetechnologicalcitizen.com; londonhotelsinsight.com

 

Fantasia Barrino doing much better since suicide attempt

Weeks after trying to take her own life, Fantasia Barrino says she is doing “much better” now. Appearing at an event in Atlanta on Saturday to promote her new album, Fantasia told RadarOnline.com in an exclusive interview: “I’m doing much better now. I’ve got my strength. I’m OK.”

Fantasia was rushed to a North Carolina hospital after taking an overdose of pills in early August. News of her affair with married Antwaun Cook and a lawsuit against her by his wife for allegedly ruining the marriage had just broken, and she reportedly couldn’t deal with it.

Fantasia, who won ‘American Idol’ in 2004, overdosed on Aspirin and sleeping pills, and was disappointed when she woke up in hospital.

“I remember waking up in the hospital and thinking I’m still in this hell hole with all the drama going on,” the Examiner quotes her as saying.

Fantasia was set on committing suicide after deciding not to deal with her life anymore, and said she knew exactly what she was doing when she took all those pills.

“I didn’t have any fight in me. I didn’t care about anything. I just wanted out,” People quotes Fantasia as saying in her VH1 ‘Behind the Music’ interview. “At that moment, I wanted out. I wanted it to be over with – all of it, all of that [expletive].

“I just sat in the closet and looked at the mirror and took all the pills in the bottle. I wanted to go to sleep and just be at peace. I knew exactly what I was doing. You can’t accidentally take a whole bottle of pills.”

But what made her want to end it all? Was it just the affair with Antwaun Cook?

“I was tired of people doing me wrong, constantly, over and over again, dealing with my family – my father, dealing with men and their s*** – I was tired,” she said. “My head was hurting me. I was over it.”

Fantasia claims a nurse in hospital gave her the motivation to keep going, which has seen her make appearances, perform and promote her album several times in the weeks following her suicide attempt.

And, despite her low point being only a few weeks ago, she seems to have recovered and learnt a lot about what it means to be in such a dark place.

“I realized how people end up in the grave. Because that one moment [snaps her fingers] of just breaking or feeling like I can’t, I can’t go on, it’s too heavy. That was somewhere I don’t ever want to go again.”

Read about Fantasia Barrino’s overdose.

Other celebrities who have had recent overdoses include Jennifer Capriati and Shawn King.

Other celebrities who have recently been in hospital for other reasons include Katy PerryCheryl Cole and Pink.

Images: PR Photos

Decongestants help lower the risk of preterm delivery

In a recent study scientists have claimed that decongestant use during pregnancy can lower the risk of preterm birth.  The study was conducted by a panel of researchers at the Boston University School of Public Health (BUSPH).

According to www.sciencedaily.com, expecting mothers who take over the counter decongestants during the second and third trimesters are at lesser risk of premature delivery by 58 percent, as compared to those who do not take the medication.

As reported by www.physorg.com, the research study also states that this revelation would help the researches to further delve and decode preterm birth.

Speaking about the study, lead author Rohini Hernandez, who is also a doctoral candidate in epidemiology at BUSPH, stated that: “Medication use is a major concern for pregnant women and generally, when medications are found to have effects on the fetus, they’re usually found to have adverse effects.”

She added: “This was surprising in that a potentially beneficial effect was found. During the study, researchers analysed 3,271 deliveries in Massachusetts out of which 6 percent women delivered premature kids. It was found that out of these 6 % women who had preterm deliveries, 4.2 % women took decongestants whereas others did not.

The study appeared in the online journal Birth Defects Research Part A: Clinical and Molecular Teratology.

Celebrities whose pregnancies we have reported on include Miranda KerrCeline DionKelly Preston andMariah Carey.

Images: http://www.sxc.hu/photo/601552,

http://www.sxc.hu/photo/708160

Breakthrough in AIDS treatment- two drugs identified to treat the condition

Two new drugs have been identified by the researchers to provide effective treatment for HIV, says a report published in www.physorg.com. The research has been done by the researchers at University of Minnesota Academic Health Center on drugs Decitabine and Gemicitabine, which are currently used to treat cancer.

The researchers used mice to find out the effectiveness of the above mentioned drugs that are already FDA approved. The combination of these two drugs had a direct effect on the AIDS virus and in the process; the virus mutated itself to death. The researchers are hopeful that the drugs will work in the same manner in humans and will offer hope to the patients.

The findings of this study have been published in the Journal of Virology, says the report in www.sciencedaily.com. The process, by which the AIDS virus mutates itself due to the drugs, has been named as lethal mutagenesis by the researchers. In the new research, the mutation rate of the virus has been increased. This makes the virus to act against itself. No toxic side effects were noticed in the research.

The researchers are now doing further studies and finding ways to convert the drugs into suitable form that can be taken orally by the patients.

Find out more about HIV/AIDS.

Celebrities who have suffered from AIDS include Magic Johnson and Liberace.

Images: http://www.sxc.hu/photo/1111307,

http://www.sxc.hu/photo/1115701

New morning after pill to be available in U.S. soon

New morning after pill Ella has been approved by the Food and Drug administration as a prescription only drug. Hailed as the most effective and best morning after pill to be available, Ella can prevent unwanted pregnancies from occurring up to five days after intercourse.

Ella has already been on the market in Europe since last year, where it carries the name EllaOne.

Ella works very differently to and more effective than Plan B, an over-the-counter emergency contraception drug which has been available to the American female population for years. While Plan B is comprised of levonorgestrel, a progestin hormone which is used in low doses in many birth control pills, Ella is a non hormone-based product that contains ulipristal, which blocks the effects of important hormones that are necessary for conception, WebMD explains.

Also, Plan B is only effective up to 72 hours after sex, while Ella can still work over a period of five days.

Pregnancy statistics in the United States are as follows: according to the New York Times, studies have proven that “more than one million woman who do not want to get pregnant are estimated to have unprotected sex every night in the U.S., and that more than 25,000 become pregnant every year after being sexually assaulted. Half of all pregnancies in the United States are unintended.”

The FDA’s approval of the drug has sparked outrage with anti-abortion groups, while obtaining praise from abortion rights activists. The controversy surrounding termination of pregnancies will undoubtedly forever continue, but for some a drug like Ella comes as a huge relief.

Celebrities whose pregnancies we have reported on include Celine DionKelly PrestonCourteney Cox Arquette and Marcia Cross.

Images: http://www.sxc.hu/photo/1054533,

http://www.sxc.hu/browse.phtml?f=search&w=1&txt=medication&p=7

Police link Corey Haim to illegal drug ring

After being suspected of passing away from a prescription drug overdose, Corey Haim has now been linked to a large investigation into an illegal drug ring. RadarOnline reports that investigators found prescriptions in Corey’s name on stolen and “unauthorized” prescription pads during an ongoing investigation. California Attorney General Jerry Brown is now investigating the link between Corey, his death and the illegal drug ring, involving stolen doctor’s identities to obtain prescription pads. So far 5,000 fake prescriptions have been uncovered.

Corey, who has previously battled addictions to prescription medication, is suspected to have died of a drug overdose. While the Los Angeles Coroner confirms that four prescription medication bottles where found at his home, it is unclear whether these were legit prescriptions, or from the illegal drug ring, PEOPLE reports.

And while the exact cause of Corey’s, 38, death is to be determined from toxicology tests, the situation already seems clear to Jerry Brown, who told RadarOnline: “Corey Haim’s death is yet another tragedy linked to the growing problem of prescription-drug abuse. This problem is increasingly linked to criminal organizations, like the illegal and massive prescription-drug ring under investigation. It’s a serious public health problem.”

Corey Haim died on Wednesday in Los Angeles after collapsing at his mother’s home.

Other celebrities who died surprisingly in the last year include Brittany MurphyAdam Goldstein,  Michael Jackson and Alexander McQueen.

Image: PR Photos.com

Australian study casts doubts over ADHD medications

A study performed in Western Australia investigated just how effective ADHD medications (like Ritalin and dexamphetamine) really are.

According to The West Australian, 131 children between the ages of five and 14 were followed throughout the study, which claims that those children taking ADHD medication were 10 times as likely to be classified as “performing below average” by their teachers than children with ADHD who were not taking medication. In fact, the study shows that students taking ADHD medication performed significantly worse than children with ADHD who were not on medication.

The children taking the medications were also found to have “significantly” higher diastolic blood pressure, something that could affect their hearts in the long run.

“While these differences were small, the results suggest that doctors should look at a child’s cardiovascular risk symptoms before starting treatment with stimulant medication,” study co-author and researcher Lou Landau told The West Australian.

Lou Landau also told the AAP, as quoted by the Sydney Morning Herald, that he was not expecting such negative results. “Yes, we weren’t anticipating that significant effect … or the significant lack of effect of the medication,” he said.

The researchers found medications also did not improve social or emotional wellbeing, the West Australian reports, nor did it improve the children’s academic work.

Overall, the study concluded there was “little long-term benefit of stimulant medication” for children with ADHD.

Celebrities with ADHD include Jim Carrey, Ty Pennington, Will Smith, Michael Phelps and Jamie Oliver.

Image: http://www.sxc.hu/photo/1160103