People with diabetes visit the dentist less frequently despite link between diabetes and oral health

From medicalxpress.com

Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.
The study, published in The Journal of the American Dental Association, showed an overall decline in dental visits among adults with and without diabetes, but people with diabetes were consistently the least likely to obtain oral healthcare.
Research has shown a two-way relationship between diabetes and oral health. People with diabetes are at an increased risk for periodontal disease, a chronic inflammation of the gums and surrounding tissue and bone, while periodontal disease has an adverse effect on blood glucose control - which can contribute to the progression of diabetes. In fact, periodontal disease has been called the "sixth complication" of diabetes after issues like kidney disease, damage to the retina, and heart disease.
"For people living with diabetes, regular dental check-ups - paired with proactive dental and diabetes self-care - are important for maintaining good oral health. Regular dental visits provide opportunities for prevention, early detection, and treatment of periodontal disease, which can potentially help with blood glucose control and preventing complications from diabetes," said Bei Wu, PhD, Dean's Professor in Global Health and director of Global Health & Aging Research at NYU Meyers and the study's senior author.

Older studies have shown that individuals with diabetes had fewer dental visits than those without diabetes. In order to have an updated understanding of dental visits among people with diabetes, this study assessed the trends of annual dental visits from 2004 to 2014 in adults with diabetes, prediabetes, and without diabetes, and assessed racial and ethnic disparities in dental visits.
The researchers used data from the Behavioural Risk Factor Surveillance System, an annual telephone survey of U.S. adults during which respondents are asked whether or not they had a dental visit in the past 12 months and whether they were ever diagnosed with diabetes or prediabetes. The study sample included 2.5 million adults age 21 years and older, including 248,203 people with diabetes, 30,520 with prediabetes, and 2,221,534 without diabetes.
The researchers found that people with diabetes were the least likely to visit the dentist, followed by people with prediabetes. From 2004 to 2014, the proportion of annual dental visits declined from 66.1 percent to 61.4 percent among people with diabetes, 66 percent to 64.9 percent among people with prediabetes, and 71.9 percent to 66.5 percent among people without diabetes.
"This pattern is concerning, given that timely dental care is essential for good oral health, especially in individuals with diabetes. Those who need dental care the most seem to be the least likely to have it," said study author Huabin Luo, PhD, of East Carolina University.
Several factors may account for the underutilization of dental services by people with diabetes, according to the researchers. People may not be aware of the impact of diabetes on their oral health and vice versa. In addition, in a previous study, individuals with diabetes more frequently reported the cost of dental care as a reason for avoiding routine visits.
The researchers also observed racial and ethnic disparities in dental care. Black and Hispanic individuals were less likely to visit the dentist than were white people, and these disparities persisted over the decade studied. Males and single people were also less likely to regularly visit the dentist than females and married people.
While the study did not measure whether individuals had dental insurance, the researchers found substantial financial barriers to dental services for people with diabetes based comparing dental visits and income levels. The researchers assert that reducing these barriers and improving access to dental providers is needed, especially among people with diabetes and prediabetes.
"Healthcare providers and public health professionals should promote oral health in diabetes management and encourage people with diabetes to visit a dentist at least annually. Increasing access to dental services is vital to achieving this goal," said Wu, who is also co-director of the NYU Aging Incubator.

https://medicalxpress.com/news/2018-04-people-diabetes-dentist-frequently-link.html

Put your best feet forward, despite diabetes

From medicalxpress.com

"Diabetes is a multisystem disease," Dr. Ronald Lepow explained in a news release from the Baylor College of Medicine in Houston. "Circulation in the feet and legs may be diminished because there are problems with blood vessels that get narrowed or clogged as a result of the diabetes.
"A major cause of foot problems in diabetics is lack of blood flow," added Lepow, a professor of orthopedic surgery at Baylor.
This can cause calloused or injured areas on the feet to heal more slowly, which can lead to ulcers or infections.
Another problem is that diabetes-related nerve damage can affect the normal oil and moisture on the skin of the feet. That results in dry and cracking skin, which allows bacteria to get in and cause infections or ulcers, Lepow said.

What to do?
Lepow says it's important for anyone with diabetes to wash and dry their feet and inspect them for scratches, blisters, injuries, cuts and bruises every day. Once feet are dry, apply a cream that's at least 20 to 40 percent urea.
Proper footwear is also crucial for people with diabetes. Because of the special needs, Lepow suggests seeing a podiatrist for help.
For instance, you'll need a wide and deep toe box. That will allow free movement of your toes and reduce friction and pressure. Also important are a solid sole and cushioning in areas that store-bought shoes typically do not have, he said.
Podiatrists also can recommend different types of custom shoe inserts, Lepow said.
Also, wear socks that don't cause friction or pressure. Cotton socks are recommended. People whose feet sweat a lot should wear moisture-wicking socks. And, Lepow said, everyone should wear thicker socks in the winter.

https://medicalxpress.com/news/2018-04-feet-diabetes.html

8 Amazing Breakthroughs in Diabetes Research That Are Giving Us Hope

From sciencealert.com

According to recent research, we're not entirely sure how many diseases the label 'diabetes' covers. But no matter what causes our bodies to struggle with their blood sugar levels, it's a serious condition that requires daily care.
Scientists have been working hard to find cures, new treatments, and better management techniques for the millions of people worldwide dealing with diabetes.
Here are some of the latest developments you need to know about.

1. Insulin producing implants made from stem cells
Clinical trials began last year for testing for ViaCyte's PEC-Direct device; a credit-card sized implant containing insulin-producing cells derived from stem cells.
Previous research had shown the implants could mature and function inside patients. Together with a cohort of volunteers who started testing in January, the new research should tell us soon whether the technology can help people with type-1 diabetes.

2. Brand new beta cells
Type 1 diabetes develops when a person's immune system wipes out insulin-producing beta cells in the pancreas.
But it turns out that another type of immature beta cell has been hiding in our pancreases all along, and scientists think it might be possible to use these 'virgin beta cells' to restore the functionality of the pancreas.

3. A common blood pressure medication
A drug on the World Health Organisation's list of essential drugs could have another purpose; blocking a molecule implemented in the autoimmune response that can give rise to type-1 diabetes.
Called methyldopa, the compound already has an important job treating high blood pressure in pregnant women and children. It's left to be seen if it could help reduce the incidence of diabetes in some way, but the fact it's already being used - rather than being stuck in the lab - makes for a promising find.

4. A unique transplant
One woman with severe type 1 diabetes has spent a year without insulin injections thanks to an experimental transplant.
Doctors implanted insulin-producing cells into a fatty membrane in the stomach cavity, and the success of the operation is paving the way towards more people receiving artificial pancreases.

5. An extreme diet
A clinical trial conducted on just 298 volunteers in the UK last year found an intensive weight management program could put type-2 diabetes into remission for those who lose a significant amount of weight.
The subjects were limited to roughly 850 calories a day for three to five months, consuming mostly soups and health shakes, before having more food introduced.
A similar study conducted on rats last year in the US also showed low calorie diets might help those who can stick to it reverse their condition.

6. Glucose-monitoring contact lenses
Until we can nail down a cure, there will always been a need to monitor those messy blood glucose levels.
Checking your tears for glucose using a smart contact lens, or monitoring your sweat with colour changing ink, could be a whole lot less invasive than drawing blood.
They're not new ideas, but constant improvements in miniaturising technology could mean these kinds of devices aren't too far off.

7. Loneliness could make us prone
While we can list a variety of genetic and lifestyle factors that affect a body's growing resistance to insulin, there's still a lot to learn.
A study published late last year involving nearly 3,000 subjects aged 40 to 75 found there seems to be a significant relationship between social isolation and type-2 diabetes.
It's not clear what the link might be, but having a few housemates or a local social group could make all the difference.

8. Mexican cavefish evolved to be diabetic
While developing a resistance to insulin is bad news in humans, the pale, eyeless animal known as a Mexican cavefish evolved a new version of the insulin receptor that makes it harder for the hormone to bind.
This isn't exactly a problem for the fish, which have also evolved other features to help it compensate. Studying its biology might help shine a light on how diabetes evolved in humans, and maybe even lead to new treatments.

https://www.sciencealert.com/new-breakthroughs-diabetes-research-treatments-2018

Book Review: Yoga for Diabetes

From asweetlife.org

Admittedly, I am one of those people who has a hard time following through with things. This is true in both my personal and professional lives, and is something that I struggle with on a daily basis. I tell you this to explain how much Yoga for Diabetes, by Rachel Zinman, is changing my life.
I’ll briefly take you back to my first experience with yoga: I had been running fairly consistently for about eight months, training for a 5K. I am not a runner, and even when I was running, I knew it wasn’t really my thing. I ended up with a twisted sacroiliac joint and Achilles tendonitis.
Enter: yoga. My best friend and I stumbled upon a new yoga studio while we were shopping for running shoes. They had a beginner’s course coupled with a free membership, and we promptly signed up. That is where my love story begins. I was hooked from day one, and for about three years I practiced yoga at that studio 3 – 4 times per week. I even had a job there cleaning, and checking people into class. I was fully immersed.

Then I moved, and basically stopped practicing yoga. And I missed it, which is why I was so happy to receive Yoga for Diabetes. It has helped me remember that my own journey with fitness and diabetes is just that: my own.
Yoga for Diabetes guides you through finding out how yoga fits into your life and your goals. I appreciated how easy it was to read the book and not focus on diabetes, but yet have all my questions answered. You won’t find dose adjustment recommendations or blood sugar goals, but what you will find are the deep benefits of yoga on our lives with diabetes.
My favourite part of Yoga for Diabetes, circling back to my annoying personality trait of never following through with anything I plan to do, is that it’s helping me find validation for the way that I function. Rachel encourages us to find our dosha. She describes our dosha as an individual constitution made up of environmental, societal, and genetic factors. In yoga, your dosha is made up of a combination of elements. For example, the Vata dosha is a combination of space and air.  Everything from your skin type to how often you are thirsty to your speech pattern is accounted for when identifying the dosha that is strongest in you.
The second half of the book includes yoga poses. There are pictures of each pose and clear, easy to understand descriptions of how your body should feel, as well as the benefits that each pose will provide you. Although I already had a fairly solid understanding of how to do these poses, I found the explanations about the benefits extremely helpful. Sometimes I forget how great my back feels from stretching my legs. (For the poses that are difficult, variations are included.)
Rachel gave me some amazing suggestions on how to fit yoga into my life in a way that will truly benefit me. She suggested I set up a yoga “studio” in my house that is a permanent space, because a barrier I have to practicing is that I prioritize other things, then I don’t feel like putting in the effort to get my mat, blocks, etc. organized, and I skip it all together.

I have never doubted the benefits of yoga in my life, so when I read this book, it wasn’t because I needed to be convinced to do yoga, but, rather, I needed some guidance on how to fit it back into my routine. I am a better person when I’m practicing yoga regularly. My emotions, sleep, and blood sugars all benefit. My weight is more stable, my body feels more comfortable to me, and I know it’s great for my long term health. Rachel’s book has been the light I needed to get back into a practice that I’ve been needing so badly.
I signed up for a year of yoga online. I have my mat and blocks in the living room. My goal is to find a routine that involves regular practice 2-3 times per week, and I know that I’ll be able to get there. Understanding and integrating yoga on the level that Rachel walked me through in her book was the first step back on a journey I know and love.

https://asweetlife.org/book-review-yoga-for-diabetes/?utm_source=ASweetLife.org+List&utm_campaign=7eb896ee68-ASweetLife+Weekly+Update++-+Nov.+14%2C+2017&utm_medium=email&utm_term=0_5125b14cf8-7eb896ee68-413392997

Smart socks aim to catch diabetic foot problems early

From 6abc.com

SAN FRANCISCO (WPVI) --

For the millions of Americans living with diabetes, a new tech product offers early warning against the threat of losing a foot or a leg to the disease.

"I have very little sensation on the bottom of my feet," explained Marc Fairman, who's type 1 diabetic.

Fairman will never take his feet for granted again. In 2012, he developed a foot ulcer that got out of control.

"I sought several opinions -- surgeons and podiatrists -- and several told me i would probably lose my foot," he said.

For 30 million Americans with diabetes, UCSF surgery professor Michael Conte said it's a very real danger.

"You can imagine if you had a pebble in your shoe, you'd take one step and stop," Conte said. "But if you don't have sensation, you're going to keep walking until you've created a hole in the bottom of your foot."

Fairman opted for months of gruelling treatment, and managed to save his foot. Now, his doctor has him beta testing a new product for diabetic foot health: smart socks.
"I don't think I've ever worn white socks with dark pants before," Fairman said.

Experiencing pain in your feet and toes? When you have diabetes, you may experience pain because of a condition called diabetic neuropathy. 

The socks are the brainchild of Ran Ma, who studied biomedical engineering at Johns-Hopkins University while working in a wound care clinic. She learned one of the earliest ways to spot a foot ulcer before it breaks through the skin is a "hot spot" on the bottom of the foot.

As the body tries to heal itself, the area around the wound becomes inflamed, causing a very localized spike in temperature. Doctors can pick it up with a large infrared thermometer by routinely testing six spots on the bottom of the foot -- and Ma's socks -- called Siren Diabetic Socks -- have invisible sensors woven into the fabric in precisely those six spots.

"When there is a significant temperature difference, you'll see a red spot," Ma said, pointing to the mobile app that shows a diagram of the patient's feet and also gives push alerts whenever the socks sense something out of the ordinary.

Though diabetic patients are told to check their feet every day, that can sometimes be tough.
"Many of these patients, not only do they not feel their feet well, but they also have problems with vision," Conte said. "They may not be able to inspect their feet easily."

Conte said though the socks haven't undergone clinical trials yet, they show promise as a useful tool for early warning -- especially for tech-savvy patients like Fairman, who showed us his new insulin pump, wirelessly linked to a continuous blood glucose monitor.

When they launch later this year, Siren socks will be sold by subscription: $20 a month for ten new pairs of socks a year. They're machine washable and dryable, and contain a small battery that never needs to be charged.

As for Fairman's fashion complaint, Ma says Siren is working on new colours and styles, including crew socks, knee high socks and ankle socks.

http://6abc.com/health/smart-socks-aim-to-catch-diabetic-foot-problems-early/3286591/

What it takes to reduce your risk of diabetes

From bizjournals.com

Staying at a healthy weight, eating healthy and physical activity is often associated with a healthy lifestyle, but these are also recommendations to help ward off Type 2 diabetes —  the most common.

More than 29 million U.S. adults have diabetes, according to the Centres for Disease Control and Prevention. Of those affected, 25 percent, or one in four, don’t even know they have diabetes.

If left unmanaged, diabetes could lead to complications such as kidney disease, lower limb amputations, adult-onset blindness and heart disease and stroke.

In addition, 86 million U.S. adults have prediabetes and 90 percent are unaware.

Prediabetes is a condition where insulin produced in the body is no longer used effectively, leading to slightly elevated blood glucose levels. The risk of complications associated with diabetes is thought to begin in prediabetes.

When people with prediabetes participate in healthy lifestyle changes, they tend to reduce their chance of developing Type 2 diabetes by as much as 60 percent.

Healthy eating involves consuming nutritious food choices and appropriate-sized portions to improve your overall health.

Studies show that regular physical activity provides a variety health benefits and may prevent or delay prediabetes and Type 2 diabetes. It’s recommended that physical activity is increased gradually with a moderate intensity activity such as walking. The recommended minimal physical activity is 30 minutes, five times a week.

A weight loss of as little as 7 percent of body weight may prevent or delay the development of prediabetes and Type 2 diabetes.

The combination of healthy eating and increased physical activity will naturally promote a gradual weight loss to help prevent diabetes.

Healthy lifestyle goals will constantly evolve and change. It’s important to identify barriers that may potentially delay achievement of your goals.

Resources such as the YMCA, local gyms, weight loss programs, diabetes education programs and your health care professionals are available to navigate you towards achievement of your long term goals.

https://www.bizjournals.com/atlanta/news/2018/04/01/what-it-takes-to-reduce-your-risk-of-diabetes.html

NHS Mandate pledges diabetes commitment

From diabetestimes.co.uk

A commitment to improving the management and care of people with diabetes has been laid out in the recently published NHS Mandate.
The document reaffirms the commitment of the Government and NHS England to ‘Healthier You’, the NHS Diabetes Prevention Programme.
Additionally, it ensures that local areas will be held to account through the CCG Improvement and Assessment Framework.
An NHS England spokesperson said: “This mandate continues the approach set out for 2016-17 and then carried forward through 2017-18. It maintains the direction already set and defines annual deliverables for 2018-19 that will keep us on track for meeting our 2020 goals.”
Page 14 of the document laid out targets, which included the pledge that by July 2018, the results of the CCG improvement and assessment framework for 2017-18 would be published.
The document stated: “This will continue to include an independent assessment of CCG performance for each of cancer, dementia, maternity, mental health, learning disabilities and diabetes.
“With NHS Improvement, ensure commissioners and providers deliver their 2018-19 operational plans, which will deliver year two of locally agreed STPs.”

Diabetes-related overall 2020 goals include:

• Measurable reduction in child obesity as part of the Government’s childhood obesity plan.
• A total of 100,000 people supported to reduce their risk of diabetes through the NHS Diabetes Prevention Programme.
• Measurable reduction in variation in the management and care for people with diabetes, including improving the achievement of the NICE recommended treatment targets whilst driving down variation between CCGs.
• With support from Public Health England, contribute to the reduction of preventable illness and associated hospital admissions through the implementation of tangible, preventative interventions in the NHS.

The diabetes-related deliverables for 2018-19 include:

• Deliver NHS England’s contribution to the Government’s childhood obesity plan in 2018-19.
• At least 60,000 people referred to the Diabetes Prevention Programme.
• Fund, and deliver with Public Health England, a programme from April 2017 to March 2019, that will support the implementation of identified preventative interventions at scale by the NHS, in collaboration with local health and care partners.

The mandate also states that the NHS will receive an additional £2.8 billion overall between 2017-18 and 2019-20, taking funding to over half a trillion pounds from 2015 to 2020.
But Secretary of State for Health and Social Care Jeremy Hunt said the extra money comes with a “clear responsibility for the NHS to minimise waste and make the best use of its resources”.
Robin Hewings, head of policy at Diabetes UK, said: “The NHS mandate reaffirms the commitment of the Government and NHS England to continue reducing variation in diabetes services and Healthier You, the NHS Diabetes Prevention Programme. On top of this, local areas are being held to account through the CCG Improvement and Assessment Framework.
“This is good news because the NHS in England has made a strong start in changing services since diabetes was made a priority for NHS England. The prevention programme is on track to hit its very ambitious target of reaching 100,000 people a year by 2020, while many local NHS areas are also making big improvements to diabetes services.
“These changes are tangibly improving the lives of people with diabetes, as well as making the NHS sustainable in the long term by helping people with diabetes to avoid serious, life-changing and costly complications.”
To read the mandate in full, click here.

http://diabetestimes.co.uk/nhs-mandate-pledges-diabetes-support-and-more-funding/