NEWSLETTER
MY
Spring 2012 Volume 39
It’s All About Prevention
Halting the Onset and Delaying the Progression of Diabetes and its Complications Dr. Edelman’s Corner
INSIDE Preventing Type 1 Diabetes Page 3
Bydureon Page 4
The Book of Perfect Is Not Available Page 6
Know Your Numbers Page 7
Preventing Type 2 Diabetes Page 8
Diabetes in Motion The Edelman Report Page 9
Ragnar Runners Give Back to TCOYD Page 10
Question of the Month Page 11
P
revention is the key to many chronic conditions. However, it is especially important for people who are at risk for getting diabetes and those who already have diabetes. If you are at risk for getting diabetes, your primary goal should be to hault the onset of the disease, and for those who already have it, the objective is to prevent or delay the progression of complications.
In this edition of our newsletter Dr. Juan Frias will discuss the prevention of type 2 diabetes and the value of several interventions including diabetes medications and lifestyle modifications for folks who are at high risk of developing type 2 diabetes. Dr. Jeremy Pettus will give us a snapshot of what is happening on the research front for preventing type 1 diabetes. What I
want to discuss in this Dr. Edelman’s Corner, however, is how to prevent the onset and delay the progression of the complications of diabetes. Diabetes complications are typically broken up into two categories: microvascular and macrovascular. Microvascular complications include eye disease or retinopathy, kidney disease or nephropathy and nerve disease or Prevention (continued on page 2)
Special Acknowledgements Medical Advisory Board Chair: Ingrid Kruse, DPM Veterans Affairs Medical Center Alain Baron, MD CEO, Elcelyx Therapeutics John Buse, MD, PhD University of North Carolina Jaime Davidson, MD Dallas, TX Mayer Davidson, MD Drew University Daniel Einhorn, MD Diabetes & Endocrine Associates Robert Henry, MD Veterans Affairs Medical Center Irl Hirsch, MD University of Washington
Board of Directors Steven V. Edelman, MD Founder and Director, TCOYD Sandra Bourdette Co-Founder and Executive Director, TCOYD S. Wayne Kay Margery Perry Terrance H. Gregg CEO, DexCom, Inc. Daniel Spinazzola President, DRS International Contributing Authors Jennifer Braidwood Steven Edelman, MD Juan P. Frias, MD Candis Morello, PharmD, CDE Christopher Mapes, PharmD Candidate 2013 Jeremy Pettus
TCOYD Team Steven V. Edelman, MD Founder and Director Sandra Bourdette Co-Founder and Executive Director Jill Yapo Director of Operations Michelle Day Director, Meeting Services Antonio Huerta Director, Latino Programs Roz Hodgins Director, External Affairs Jennifer Braidwood Manager, Outreach and Continuing Medical Education Jimm Greer Manager, Social Media David Snyder Manager, Exhibit Services
MyTCOYD Newsletter Editor: Jennifer Braidwood Assistant Editor: Jaci Frias Assistant Editor: Robyn Sembera Design: Hamilton Blake Associates, Inc.
MyTCOYD Newsletter is offered as a paid subscription of Taking Control Of Your Diabetes. All material is reviewed by a medical advisory board. The information offered is not intended to constitute medical advice or function as a substitute for the services of a personal physician. On the contrary, in all matters involving your health, TCOYD urges you to consult your caregiver. ©2012 All rights reserved.
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Prevention (continued from page 1)
neuropathy. So, what ultimately causes eye, kidney and nerve diseases? It is well known from several large clinical trials that microvascular complications are a direct result of the duration and severity of high blood sugar levels, or hyperglycemia. This is why it is so important to try to get your glucose levels, and your A1c value, as close to normal as possible. The challenge is to get your glucose and A1c values down while, at the same time, avoiding hypoglycemia. There is also some research that suggests the ups and downs, or variability of glucose levels, may also contribute to the development of complications. In addition to glucose control, it turns out that making sure your blood pressure is within in the normal range is of extreme importance when it comes to preventing eye and kidney disease. High blood pressure puts a strain on the blood vessels and other vital structures of the eyes and kidneys. Avoiding drugs that can damage your kidneys and nerves is also part of prevention. Nerves can be affected by numerous factors including vitamin deficiencies, exposure to toxins and smoking, which makes the onset and progression of neuropathy less predictable than eye and kidney disease. Macrovascular complications include heart attacks and strokes, which remain the most common causes of death in all Americans, diabetic or not. People with type 2 diabetes are at the greatest risk for macrovascular complications because of
the high rate of cardiovascular risk factors associated with this condition: high blood pressure, abnormal cholesterol levels, propensity to form blood clots, inflammation and blood vessel abnormalities. The main ways we prevent heart attacks and strokes are to treat each of these risk factors directly: blood pressure medications, cholesterol drugs, anti-inflammatory agents and blood thinners, such as aspirin. Lifestyle modification is also very important. We need to be constantly aware of not only what we are eating, but, how much we are eating. It is also imperative to incorporate frequent aerobic exercise into our daily routines and to maintain the best body weight that we can possibly achieve. Diabetes is a treatable condition. One of the most important things to remember is, if you have diabetes you can prevent complications and if you are already experiencing complications you can delay their progression. The key issues to pay attention to and obtain control over are your glucose levels, blood pressure measurements, and cholesterol values. You should also consider a daily regimen of aspirin (only with the advice of your caregiver). It comes down to the ABCs of diabetes management: “A” for A1c and aspirin, “B” for blood pressure and “C” for cholesterol. Take control of your ABCs and enjoy a long and healthy life with diabetes.
Steven Edelman, MD Founder and Director Taking Control Of Your Diabetes
Preventing Type 1 Diabetes By Jeremy Pettus
T So what causes type 1 diabetes? Again, your genes do have something to do with it. However, if one identical twin gets the disease, there is about a 50% chance that the other twin will get it. In identical twins, every single gene in the body is the same. So that means that even if you have the same genes as somebody with type 1 diabetes, it is basically a coin flip as to whether or not you will get the disease. To put it another way, your genes can explain one half of why people get the disease, but what explains the other half? If it isn’t all in our genes, that means there is something in our environment causing the disease. Some researchers believe that a viral infection in childhood could trigger the disease. Others are looking into the effect of formula versus breast milk or the effect of vitamin D deficiency. There are many theories, but the bottom line is, we don’t know. One major research effort is The Environ-
he question of how to prevent type 1 diabetes is usually one that I hear from parents of kids who have the disease. As somebody with type 1 diabetes myself, I worry at times that I may pass the disease on to my children. So what are the facts? Well, type 1 diabetes definitely has a genetic component. To put things into perspective, if you have type 1 diabetes, there is about a 5% chance that your child or sibling will develop the disease. While this is a much higher risk than the general population, it is still a pretty low number (so breathe a sigh of relief!). This also means that the majority of people with type 1 diabetes (about 90%) are the only person in their family with the disease.
mental Determinates of Diabetes in the Young study (TEDDY). This group is following about 8,000 children at risk for the disease and looking at what features in their environment might cause the disease. (http://teddy.epi.usf.edu/)
The bad news is that we still don’t know what exactly causes the disease. The good news is that we are getting better and better at predicting who will get the disease. Before the onset of symptoms, individuals with type 1 diabetes produce auto-antibodies in the blood that we can find and measure
with blood tests. These antibodies can appear years before the onset of the disease. For example, if you have two or more of these antibodies, your risk of developing type 1 diabetes in the next 5 years is between 25% and 50%. By screening family members of people with type 1 diabetes, researchers can identify those at high risk for developing the disease and attempt interventions to stop the disease. Unfortunately, no interventions to date have had any effect on delaying the disease. Again, as a person with type 1 diabetes, I ask myself, “Would I want to know if my child was going to develop the disease?” My answer is, Preventing Type 1 Diabetes (continued on page 11)
Taking Control Of Your Diabetes
3
Ask Your Pharmacist
Bydureon: The Curious Case of the Disappearing Injections By Candis M. Morello, PharmD, CDE & Christopher Mapes, PharmD Candidate
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n January 27, 2012, the Food and Drug Administration (FDA) approved Bydureon, the first once-weekly treatment for type 2 diabetes. Bydureon is an extended release version of another diabetes drug called Byetta which requires twice daily injections. While Bydureon and Byetta share the same ingredient, there are clear differences between the two drugs. Bydureon builds upon the proven benefits of Byetta such as improved glycemic control, less need for blood glucose testing and weight loss, but adds the convenience of a once weekly injection schedule.
What is Bydureon? Like Byetta, Bydureon contains the active ingredient called exenatide. Exenatide is a man made version of a hormone found naturally in the saliva of the Gila monster. A version of this hormone, called GLP-1, is also found in humans but it does not last very long in the body. Both hormones work by stimulating the pancreas to produce higher amounts of insulin when
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blood glucose concentrations are high. Luckily, exenatide can be used as medication because it is similar enough to GLP-1 to have biological activity, but different enough that it produces stronger and more lasting effects on the human body. Microsphere technology allows Bydureon to be a once-weekly medication. Each injection of Bydureon is comprised of tiny, biodegradable microspheres (like hollow balls that can be filled with medication) containing exenatide. These spheres are designed to be slowly broken down by the body over the course of seven days. This slow breakdown allows for a constant, controlled release of exenatide into the blood so that the correct amount of medication is always available for your body to use, whenever you may need it.
How Does Bydureon Work? The glucose lowering effect of Bydureon causes the pancreas to secrete insulin when blood glucose concentrations are elevated, such as just after a meal. If glucose concentrations go lower than normal,
Bydureon stops working. This effect is called glucose-dependent insulin secretion, and allows for increased glycemic control without the risk of hypoglycemia. In addition to directly affecting insulin levels, Bydureon has the ability to counteract a hormone that causes elevated glucose. This hormone, called glucagon, can further increase blood glucose concentrations even during times of hyperglycemia. As a bonus, Bydureon also slows down the rate that food empties out of the stomach. This means that the food you eat takes longer to be digested and absorbed into your blood. As a result, post meal glucose concentrations will not rise as quickly or as high. This effect also makes people feel full faster and longer, causing them to eat less and to even lose weight while taking Bydureon.
“Microsphere technology allows Bydureon to be slowly broken down by the body over the course of seven days.”
How is Bydureon Used? Bydureon is supplied as a single 2 mg subcutaneous injection given once every seven days at home. For convenience, every dose comes in its own tray (see picture). Each singledose tray contains 1 vial of exenatide powder, 1 vial connector, 1 prefilled diluent syringe (filled with a liquid that helps mix the exenatide powder), and 2 custom needles (1 provided as a spare—in case it’s needed). Four indi-
vidual trays are packaged together to create a one month supply. Administration of Bydureon is as easy as 1-2-3, or connect-shake-inject. Step 1: Connect all of the pre-supplied parts and mix the powder and liquid. Step 2: Shake the solution to obtain a well mixed suspension for injection. Step 3: Inject into the abdomen, thigh or the back of the upper arm. You may re-use the same general location for the next week’s dose; just be sure to not inject exactly into the same spot. Once the injection is complete, dispose of all used and unused parts of the tray. If you want to change your dosing day, you can. Your new dosing day must be at least 3 days after your last injection. Do not take 2 doses of Bydureon less than 3 days apart. Once you have selected a dosing day that is right for you, stay with it. It is not a good idea to change your dosing day often. As an unmixed powder, Bydureon should be protected from light and stored in the refrigerator (not frozen or in the hot sun) until use. If needed, you can keep
the sealed single dose tray at room temperature for up to four weeks, however, the suspension must be injected immediately upon mixing.
Is Bydureon Right for Me? Along with healthy eating and exercise, Bydureon is used to improve glycemic control in adults with type 2 diabetes, but should not be used as an initial treatment option. In clinical trials, Bydureon was shown to reduce HbA1c by 1.6 %, reduce blood glucose by an average of 25 mg/dL and reduce body weight by an average of five pounds after 24 weeks of continuous use. Bydureon is not a substitute for insulin and is not FDA approved for use in combination with insulin. Patients with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia should not use Bydureon due to an increased risk of thyroid c-cell tumors. In addition, patients who have experienced hypersensitivity to exenatide or have a personal history of pancreatitis, kidney impairment, severe gastrointestinal disease (gastroparesis), heavy alcohol use or triglycerides greater than 500 should also avoid Bydureon. Even though Bydureon does not cause low blood glucose, if it is given with medications that do, such as sulfonylureas, low glucose may occur and the dose of the sulfonylurea should be decreased. Women who are pregnant or may become pregnant should not use Bydureon due to the possibility of fetal harm. Nursing mothers
should use caution as the drug levels in breast milk have not been fully investigated. The most common side effects of Bydureon are nausea, diarrhea, headache, vomiting, constipation, itching and / or the formation of a small bump at the site of injection. Nausea associated with use of Bydureon may be worse at the start of treatment but should go away over time.
What if I am Already on Byetta? Prior treatment with Byetta is not required when initiating Bydureon therapy. Due to Byetta and Bydureon containing the same active ingredient, the two medications should not be used together. Therefore, if switching to Bydureon, you should discontinue use of Byetta. Upon switching to Bydureon, you may notice minor elevations of your blood sugar for the first few weeks.
The Bottom Line With the approval of Bydureon, patients with type 2 diabetes now have the potential to reach glycemic control with only one injection a week. Doing the math compared to using Byetta, this works out to avoiding 678 injections over the course of a year. Candis M. Morello, Pharm D, CDE, FCSHP, Associate Professor of Clinical Pharmacy at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, Clinical Pharmacist at VASDHS. Christopher Mapes, Pharm D Candidate 2013 at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences.
Taking Control Of Your Diabetes
5
Living Well
WHY IS BETTER SO GREAT? LIFE WITH DIABETES CAN’T BE PERFECT. MAKE IT BETTER. By Jennifer Braidwood
The Book of Perfect is Not Available
tional, more effective, attractive, more interesting and more fun. The goal for the designer is always… better.” Eichten was diagnosed with huck Eichten is a designer by type 1 diabetes in 1975 at the age trade who, in 1996, landed a of 13. His attitude toward living position as an apparel designer for Nike. In time, Eichten moved from with diabetes is very similar to the apparel design to brand design and way he approaches a profession, design or otherwise. A relationship began creating everything from with diabetes is constantly evolvbooks, posters and packaging to ing. Nothing about the disease is logos and retail space. Currently, ever static. A career is just like Eichten is the Design Director for the Department of Nike Archives. diabetes. There never comes a point when you can say, “Okay, I’m One of his primary responsibilidone! I’m just going to sit back, put ties is to gather and preserve Nike my feet up on my desk and enjoy a stories and find innovative and interesting ways to tell these stories. smooth ride from here on out.” Stories such as how the concept for the first best-selling Nike shoe “Diabetes management isn’t was based on a waffle iron, or how about trying to be perfect, Phil Knight, the founder of Nike, it’s about trying to be responded after he saw the iconic better.” Nike logo for the first time with the statement, “Well I guess I’ll get The fact that perfection and used to it.” Eichten observes, “The diabetes management will never go design job is to imagine how you can make things better, more func- hand in hand might be discourag-
C
6 My TCOYD Newsletter, Vol. 39
ing to some but, as Eichten muses, “diabetes management isn’t about trying to be perfect, it’s about trying to be better. Bad gets better, and good even gets better, too. People didn’t stop designing cars because the Pinto was a disaster. We knew we could do better than THAT and someone did. The first pair of pants ever designed was a pretty fantastic fashion design milestone but that didn’t keep anyone from trying to make the design of pants better.” Eichten recently published a book titled The Book of Better: Life With Diabetes Can’t Be Perfect– Make It Better. Eichten’s book isn’t your average book about diabetes management. In fact, it isn’t your average book at all. Each page stands out with large fonts, sunshine yellow pages, striking contemporary graphics and in-your-face diabetes management advice. You might spend the first hour just looking through the book and not even reading it, simply because it’s total eye candy.
Know Your Numbers
Eichten says that he published the book partly because his design gene told him to, and partly to try and make a better book about diabetes, a book that is maybe a little more effective, more fun and more interesting. Most importantly, though, he wrote and designed the book because he absolutely believes that the only way to deal with diabetes is to push it kicking, screaming and excruciatingly slowly toward better. In a moment of unbridled honesty, which seems to happen a lot when talking to Eichten, he stated, “I’ve done a lot of idiot things trying to deal with diabetes. And I’ve done a few smart things. But good or bad, I learned something from all of them. Eventually, they made me a little better and that, any designer will tell you, is just what we need, something a little bit better.” The Book of Better: Life With Diabetes Can’t Be Perfect–Make it Better is available at all major booksellers and online at Amazon. com. Visit www.bookofbetter.com for more information!
By Steven Edelman, MD
T
his logbook is from a 58 year old male named John who has a strong family history of diabetes, obesity and heart disease. Both his parents and several uncles and aunts have type 2 diabetes and are well above their ideal body weights. John’s father died of a heart attack at the age of 55 and his sister just had a stroke at the age of 59. John’s two kids are heavy and look just like their dad. His doctor recommended occasionally testing his blood sugar levels at home. Testing with a home glucose meter is more practical and realistic than using a formal oral glucose tolerance test (OGTT). OGTT consists of fasting overnight and then swallowing 75 grams of glucose. Blood glucose levels are taken just before and two hours after the ingestion of the sweet syrup. As you can see from John’s logbook his morning, or fasting, values are between 100 and 126mg/dl and his post dinner values are typically above 140mg/ dl but not above 200mg/dl. John eventually got an A1c value and it was 5.8%. His diagnosis is “pre-diabetes” (see question of the month).
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Taking Control Of Your Diabetes
7
Preventing
diabetes or prediabetes with a blood glucose or hemoglobin A1C test if you are overweight and have any of the risk factors mentioned above, or starting at age 45. If the test shows By Juan P. Frias, M.D. that you do not have diabetes, it should be repeated every 1-3 years, The good news is, if you depending on the results of the initial have type 2 diabetes, you can test and your risk factors.3 avoid or significantly reduce the A fast and simple Type 2 Diaberisk of developing complications by tes Risk Test was recently developed controlling your glucose, blood pres- by the American Diabetes Associasure and cholesterol levels.3 If you tion. It can be found on-line at www. have prediabetes, clinical studies stopdiabetes.com. By answering a few have proven that there are ways simple questions, it helps inform you to significantly reduce your risk of of your risk of type 2 diabetes. You developing type 2 diabetes.4 should discuss your Risk Test results with your healthcare provider, who How do you know if you are may then check you for diabetes or at increased risk of develop- prediabetes with a blood test. ing type 2 diabetes? If you are found to have prediaThere are a number of factors betes, there is a relatively new blood that may put you at an increased test called the PreDx® Diabetes risk of type 2 diabetes. These risk Risk Score (Tethys Bioscience, Inc., factors include being overweight Emeryville, CA), which can tell you or physically inactive, age (higher your risk of developing type 2 diaberisk with increasing age), having tes within the next 5 years.6 The test high blood pressure or abnormal results are provided on a scale of 1 to cholesterol levels, having immedi10—the higher your score, the higher ate family members with type 2 your risk for type 2 diabetes within diabetes, having had gestational 5 years. If you have prediabetes, you (pregnancy-related) diabetes, being and your healthcare provider may of a certain ethnic group (Latino, find this test useful when planning African American, Native Ameriyour diabetes prevention program. can, Pacific Islander, Asian American), and/or having blood glucose If you have prediabetes, what levels that are higher than normal, can you do to reduce your risk but not yet high enough to classify of type 2 diabetes? you as having diabetes (so-called As mentioned above, if you have “prediabetes”).5 prediabetes, there are definitely The American Diabetes Associ- actions you can take to significantly ation recommends that your healthPreventing Type 2 Diabetes (continued on page 12) care provider screen you for type 2
Type 2 Diabetes
C
hances are, you know someone who has type 2 diabetes, or is at an increased risk of developing the disease. Today, it is estimated that over 26 million American adults have diabetes (90-95% have type 2 diabetes and 5-10% have type 1 diabetes), and another 81 million—one out of every 4 people over 18 years old —have what is called prediabetes, a condition that puts them at increased risk of developing type 2 diabetes.1 In fact, type 2 diabetes is one of the fastest growing chronic diseases worldwide and, if not well cared for, can lead to serious medical complications, such as eye, kidney and heart disease.2
8 My TCOYD Newsletter, Vol. 39
TCOYD in Motion
Dedicated to Health By Jennifer Braidwood
I
t has been a great start to the 2012 conference season. The communities of people with diabetes in Washington, DC and Sacramento, CA welcomed TCOYD with opened arms this past February and March. Both cities gave us record on-site registration numbers and over 1,200 participants at each event. Our Making the Connection continuing medical education program for healthcare professionals sold-out completely in both cities. Our Health Fairs encompassed an eclectic mix of exhibitors ranging from Sahaja Meditation to Early Alert K-9s in addition to our generous sponsors from the pharmaceutical and medical device
companies. Needless to say, there was something for everyone and a little extra. “This TCOYD conference has meant the world to me. The difference between life and death.” - 2012 Conference Attendee
It’s not every day that you get to see more than one thousand people spending an entire day dedicated to their health. Not to mention, witnessing healthcare providers and people with diabetes coming together throughout the day in order to express their concerns and work together for a
common cause, living well with diabetes. After all the planning, meetings and conference calls, after all the set-up, traveling and layovers, the thing we all love here at TCOYD more than anything is to hear the feedback from conference attendees. It truly makes all the effort and energy we put into each event so incredibly rewarding. We hope to see you at our next conference. “This was a fantastic, exceptional, heart warming and educational day for me.” - 2012 Conference Attendee
B
e sure to tune in to The Edelman Report! Each week Dr. Edelman brings you up to date information, tips, personal rants, and opinions on diabetes and health management. Visit www.tcoyd.org and find the latest Edelman Report under the “What’s Happening Now” section of our homepage. You can also subscribe to our TCOYD1 YouTube channel or like us on Facebook and be automatically notified when the next Edelman Report is available!
Taking Control Of Your Diabetes
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Giving Back
Ragnar Runners Give Back to TCOYD By Jennifer Braidwood
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egin in Huntington Beach, a city on the outskirts of Los Angeles, and head south along the pacific coast toward Anaheim. Pass through the scenic beachside towns of Carlsbad, Del Mar and La Jolla and ultimately end up on the beautiful island of Coronado. This is Ragnar, a two-day, onenight, 200-mile relay race through some of the most beautiful areas in Southern California. Ragnar isn’t your average relay or your standard marathon, it’s an intense test of physical strength and endurance. It’s the ultimate team building activity, a memory that will last a lifetime, the ultimate slumber party without sleep or deodorant. On April 21st, Barbara Laskaris and her team of 11 other runners will take on the Ragnar adventure. TCOYD will be the proud and honored recipient of the proceeds that her team raises from the race. Laskaris has enjoyed fitness and running for a number of years and has participated in many races. When she learned about Ragnar (www.ragnarrelay.com) and the challenge it presented she thought it was a great opportunity to give back and to collaborate with a group of
10 My TCOYD Newsletter, Vol. 39
On April 21st, Barbara Laskaris and her team of 11 other runners took on the Ragnar adventure. TCOYD will be the proud and honored recipient of the proceeds that her team raised from the race.
like-minded friends and colleagues. Laskaris’ father has type 1 diabetes and is nearly blind as a result of his the one thing that everyone has poorly controlled condition. A few in common is a passion for health. years ago, Laskaris attended a Taking “This is our first Ragnar,” Laskaris Control of Your Diabetes Confersaid, “but some of us have found ence and Health Fair in San Diego connections with others that have with her father and has held that raced, and everyone we have talked experience close to her heart. In an to says it’s an amazing experience. interview I conducted with Laskaris I expect to have a great race, enjoy on March 21st, only one month time with my friends and most before the race, she said, “I feel so importantly raise money for an strongly about the great things Dr. incredible organization.” Edelman is doing to empower people Taking Control of Your Diabewith diabetes to take control of their tes extends a huge thank you and health. I truly feel very privileged to warm wishes to Barbara Laskaris support TCOYD.” and The Ambulance Chasers for Laskaris’ team of runners is their support! It is people like you a very unique mix of members that allow us here at TCOYD to from the legal, insurance, forensic continue our mission of diabetes witness, medical and technology advocacy and education! industries. Ragnar teammate Michael Geatz is another who, as the Director of GiantBiosensor, a manufacturer of a low blood sugar alarm, has ties to the diabetes community. The teammates have varying degrees of athletic ability, from six-minute milers to those who are in The Ragnar Runner Photo features (left to right) Roz Hodgins, the double digits. However, Barbara Laskaris, Steve Edelman and Michael Geatz.
Question of the Month
Preventing Type 1 Diabetes (continued from page 3)
I would only want to know if there was something I could do about it. So what can you do about it? There are many ongoing trials that are testing ways to prevent type 1 once these auto-antibodies develop. If you are interested, check out the TrialNet website at www.diabetestrialnet.org. This is a group of researchers dedicated to exactly this purpose. They are looking for relatives of people with type 1 diabetes who are at risk for developing the disease. Alternatively, the Juvenile Diabetes Research Foundation (JDRF) is an excellent resource. You can enter your information and they will tell you about trials in your area. Check them out at: https://trials.jdrf.org/patient/. I honestly believe with our new ways of identifying people at risk, we will be able to identify the environmental factors that lead to type 1 diabetes and, ultimately, prevent it. However, it will also take the effort of people with the disease and their family members getting involved and volunteering for some of the ongoing research. So get informed, get involved, and together we can work toward the common cause of finding a cure!
By Steven Edelman, MD
Defining Diabetes
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ow is diabetes defined and what steps are taken to determine if an individual has diabetes? How can medical professionals tell what type of diabetes a person has? Answer: The following blood glucose numbers show how we define normal, pre-diabetes, and diabetes, primarily based on the levels at two different times. The fasting blood glucose level, measured first thing in the morning after an overnight fast (nothing to eat for approximately 8 hours), should be less than 100 mg/dL. If the fasting value is 126 mg/ dL or greater, that is within diabetic range. An individual is at risk for developing diabetes, often times referred to as pre-diabetes, if the fasting blood glucose value is greater than 100 and less than 126 mg/dL. The medical phrase for a diagnosis of pre-diabetes that is based on the morning fasting glucose value is ‘impaired fasting glucose’ (IFG). Another important time to measure the glucose value in order to diagnose pre-diabetes is 2 hours after drinking 75 grams of a very sweet substance. This test is called the ‘2-hour oral glucose tolerance test’ (OGTT) and it is primarily used for research purposes. The medical phrase for pre-diabetes based on the 2-hour value is ‘impaired glucose tolerance’ (IGT). These criteria are used to screen potential research volunteers for the prevention trials. One thing that is somewhat new is that pre-diabetes and diabetes can also be diagnosed from a HgbA1c or A1c value. This allows screening for diabetes to be relatively more simplistic. A1c values can be determined from a simple blood test that does not require fasting or ingesting glucose. An A1c between 5.7% and 6.4% defines someone with pre-diabetes and 6.5% and above is full blown diabetes. The way we define diabetes as described above does not tell us what type of diabetes is present. Determining the type of diabetes such as type 1 versus type 2 and gestational diabetes (this one is pretty obvious!) comes from other blood tests and historical questions.
Taking Control Of Your Diabetes
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TCOYD Conferences & Health Fairs 2012 Schedule February 11 Washington, D.C. March 3 Sacramento, CA April 14 Honolulu, HI April 15 Maui, HI May 19 Raleigh, NC June 23 San Ysidro, CA - Latino September 8 Missoula, MT September 15 Sacramento, CA - Latino September 22 Des Moines, IA October 27 San Diego, CA November 3 Oceanside, CA - Latino December 1 Austin, TX
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Preventing Type 2 Diabetes (continued from page 8)
reduce your risk of developing type 2 diabetes. Most important on the “to-do list” are healthy eating and increased physical activity. Several research studies in patients with prediabetes have shown that losing 5-10% of your body weight (about 10-20 pounds in someone weighing 200 pounds), maintaining a healthy diet, and getting about 30 minutes a day of moderate physical activity (like brisk walking) can reduce the risk of developing type 2 diabetes by almost 60%!4,7 Also, depending on your risk and other factors, your healthcare provider may recom-
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My TCOYD Newsletter, Vol. 34
terol, risk of heart disease, and will mend starting a medication, such likely have many other benefits! as metformin or pioglitazone, to help reduce your risk of developing Juan P. Frias, M.D. diabetes. Your individual diabetes Chief Medical Officer, Tethys Bioscience, Inc. prevention plan should be discussed Clinical Assistant Professor of Medicine, University of California San Diego and developed with your healthcare Important disclosure: Dr. Frias serves as Chief Medical Officer of Tethys Bioscience, Inc., the manufacturer of the PreDx Diabetes provider. Risk Score. To wrap-up, since prediabetes References: 1. American Diabetes Association. Diabetes Statistics. Alexandria, is so common (81 million AmeriVA: American Diabetes Association. http://www.diabetes.org/diabetes -basics/diabetes-statistic/. cans) and its progression to type 2 2. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and diabetes is preventable, it is very prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and important to find out if you have Prevention, 2011. 3. American Diabetes Association. Standards of Medical Care in Diabeprediabetes. If you do, you should tes – 2012. Diabetes Care. 2011; 34(Suppl 1):S11-S61. 4. Diabetes Prevention Program Research Group. Reduction in the discuss a diabetes prevention plan incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346:393-403. with your healthcare provider – 5. American Diabetes Association. Diabetes Statistics. Alexandria, VA: American Diabetes Association. http://www.diabetes.org/diabeteswhich will include a healthy diet, basics/prevention/risk-factors/. 6. Kolberg JA, Gerwien RW, Watkins SM, et al. Biomarkers in type 2 increased physical activity, and diabetes: improving risk stratification with the PreDx® Diabetes Risk Score. Expert Rev Mol Diagn. 2011; 11:775-92. achieving a healthy weight. Most 7. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired importantly, this plan will also help glucose tolerance. N Engl J Med. 2001; 344:1343-1350. improve your blood pressure, choles-