Making Diabetes UnLonely

From diatribe.org

Loneliness is a major public health issue that can increase a person’s risk for diabetes, as well as make managing diabetes more difficult. Dr. Jeremy Nobel, founder of The Foundation for Art & Healing and Project UnLonely, shares insights on loneliness and the work his organization does to combat it.

In 2023, U.S. Surgeon General Dr. Vivek Murthy released an advisory that called attention to the public health crisis of loneliness, isolation, and lack of connection in the country. Many Americans experience loneliness, and its impacts are catastrophic. 

In press conferences surrounding his advisory, Murthy cited research that likened the effects of loneliness to smoking 15 cigarettes a day. Studies have shown that for people experiencing chronic loneliness, physical health consequences include a 29% increased risk of heart disease, a 32% increased risk of stroke, and a 50% increased risk of developing dementia for older adults. 

Loneliness is a complex issue and becomes even more so for people living with a chronic health condition like diabetes. How exactly does loneliness affect diabetes? Is there anything we can do to solve this crisis? Here we explore all this and more. 

What is loneliness?

“It's really important that people understand loneliness is not the same thing as being alone,” said Dr. Jeremy Nobel, a primary care physician, public health practitioner, and award-winning poet. He’s also the founder and president of The Foundation for Art & Healing, which aims to harness the power of creative arts to improve personal and public health.

Nobel explained that being alone is an objective state that can be evaluated by the quality and number of social connections a person has. Loneliness, on the other hand, is a personal construction; you can think of loneliness as your body’s way of telling you it needs more human connection.

Loneliness is also more than just a feeling. Like stress, it can have damaging effects on the mind and body. Loneliness has been found to increase inflammation and the production of stress hormones like cortisol, while decreasing the production of “feel-good” hormones like serotonin and dopamine. In addition, it can make us more impulsive and less rational, as well as cause (or exacerbate) anxiety and depression. 

Loneliness can also make our immune systems less effective, and as mentioned earlier, raises the risk of heart problems, dementia, and even diabetes.

Loneliness and diabetes

The relationship between loneliness and diabetes is a two-way street. Experiencing high levels of loneliness has been shown to increase a person’s risk of developing type 2 diabetes, and having diabetes can put someone at greater risk of feeling lonely. 

This is because having a chronic health condition, especially one that is heavily stigmatized like diabetes, can make someone feel extremely isolated. If you have diabetes and are experiencing loneliness, it can make managing your condition that much harder. 

Feeling lonely can lower self-esteem and cause you to forgo health behaviours like checking glucose levels or taking medications. It can also cause you to withdraw socially from others – including your healthcare team. 

“As you become lonelier and detach both from the other people who care about you, as well as yourself, you're less likely to get the help you need when you need it,” said Nobel.

On the flip side, research shows that having strong social connections leads to better health outcomes and diabetes self-management.

How do we address loneliness?

Loneliness is clearly a problem that needs attention. The Foundation for Art & Healing is one organization working on implementing evidence-based strategies to raise awareness and combat loneliness with its Project UnLonely initiative. Nobel said that participating in creative and artistic expression can help reverse the damage done by loneliness. 

“The arts basically alter our brain physiology,” said Nobel. “The important thing to know is that how we make sense of the world, what psychologists call ‘social cognition,’ is personally constructed and shaped by our experiences, attitudes, and beliefs. That includes feeling lonely." 

"The great news is that anything that can be personally constructed in our mental image of the world, can also be personally reconstructed. That’s how we can move from being lonely to being unlonely,” he added. 

Studies have found that engaging in the arts can lower cortisol levels, boost dopamine, and increase our sense of connection to others. This can happen whether engaging in artistic expression alone or with others.

Nobel credits his unique background as a healthcare professional, public health expert, and poet for fueling his passion for this work. 

“I think it was the intersection of these three things that gave me some insight not just into the arts and how the arts can be such an important and vitalizing force, but specifically how it could help us be healthy and well,” he said.

“I started the Foundation after 9/11 because I was very impressed with how effective certain types of creative expression were in helping people recover from the trauma of that event,” said Nobel. 

While it wasn't clear how exactly it worked at the time, Nobel said he discovered that these types of creative interventions were effective at treating trauma partially because they helped address loneliness and isolation.

Nobel and other researchers set out to understand this better with a pilot study that looked at how creativity circles impacted the quality of life for a small group of African American women with type 2 diabetes in Boston. Participants attended six, 2.5-hour supportive group sessions that combined creative arts and storytelling. The results were overwhelmingly positive, with mental health improvements largely attributed to the increased social connection.

As a result of pilot programs like this, the foundation launched Project UnLonely in 2016, which aims to raise awareness, destigmatize, and create programs to address loneliness. Right now, Project UnLonely is focused on four main audiences: older adults, college students, working populations, and individuals within at-risk or marginalized communities. While each program is different, each makes use of a few key components, namely, mindfulness, creative expression, and storytelling. 

Project UnLonely Films

In addition to loneliness programs, Project UnLonely curates a collection of films each year that highlight the challenges of loneliness and social isolation and how to overcome them. 

“That really is the power of our Project UnLonely Film initiative,” said Nobel. “Before you know it, not only do you no longer feel alone, but you feel connected.”

This year, The Foundation for Art & Healing announced that celebrated actor and director Steve Buscemi will be co-hosting the launch of Season 8 of Project UnLonely Films on June 2, 2024 at 7 p.m. ET. The event will feature the filmmakers and their thoughts in a special video montage and a handful of the award-winning films will be screened.

The virtual launch event is free and open to the public (you can RSVP here). If you can’t attend the event live, all the films (including those from previous seasons) will be available to stream online.

https://diatribe.org/mental-health/making-diabetes-unlonely 

The Surprising Link Between Diabetes and Dementia

From news.uams.edu

Studies show that having diabetes can increase your risk of dementia. There are several ways that diabetes contributes to dementia. Abnormal blood sugar levels, insulin resistance and other chronic diseases associated with diabetes can damage your brain over time.

• Abnormal blood sugar levels can affect your memory.

Stable blood sugar levels are crucial for clear thinking. However, with diabetes, frequent fluctuations in blood sugar can impair your ability to think clearly. Additionally, both high and low blood sugar levels can damage the blood vessels in your brain, making it difficult for oxygen to reach it. This damage can contribute to the development of dementia.

• Insulin resistance can cause brain cells to break down.

With diabetes, the body’s cells don’t respond as they should to insulin, the hormone that helps your body regulate blood sugar levels. This can lead to problems like inflammation or damage to brain cells, both of which can increase the risk of dementia.

• Health conditions associated with diabetes are also risk factors for dementia.
  Diabetes can lead to health conditions like high blood pressure, heart disease and kidney damage. These chronic diseases can all damage the brain and make dementia more likely.

The good news is that managing your diabetes can lower your chances of developing dementia.

By managing your diabetes with medication and lifestyle choices, you can keep your blood sugar levels stable, improve insulin resistance and help prevent other chronic diseases. Lifestyle choices that can reduce your dementia risk include:

• Getting 2.5 hours of cardio exercise per week, such as brisk walking, dancing or riding your bike
• Eating a balanced diet rich in fruits, vegetables, whole grains, lean proteins and healthy fats
• Keeping your mind active with activities like puzzles or learning new skills
• Staying connected with friends and family
• Getting 7-8 hours of sleep every night

Work closely with your health care team to create a diabetes plan that fits your needs. By effectively managing diabetes and adopting a healthy lifestyle, you can improve your overall health and potentially reduce your risk of dementia.

Sheldon Riklon, M.D., is an associate professor in the University of Arkansas for Medical Sciences (UAMS) Department of Family and Preventive Medicine and a co-investigator with the UAMS Institute for Community Health Innovation.

https://news.uams.edu/2024/05/28/the-surprising-link-between-diabetes-and-dementia/ 

How Can Patients With Diabetes and Obesity Lose Weight?

From medscape.com

BERLIN — What is the best way to help patients with diabetes, heart problems, and obesity lose weight and improve their outcomes? Is it exercise or medication (such as glucagon-like peptide 1 or gastric inhibitory polypeptide receptor agonists)? This was the focus of a "Battle of Experts" at the 2024 Diabetes Congress in Berlin.

Benefits of Exercise

"Exercise is 'omnipotent,'" said Christine Joisten, MD, general, sports, and nutrition physician at the Sports University in Cologne, Germany. She pointed out that exercise not only helps with weight loss but also improves overall fitness, body composition, eating habits, cardiometabolic health, and quality of life, listing the benefits of exercise.

In a conversation with the Medscape German edition, Stephan Kress, MD, a diabetologist at Vinzentius Hospital in Landau, Germany, and first chair of the German Diabetes Society's Diabetes, Sports, and Exercise Working Group, referred to a study by Pedersen et al. that examined the effect of exercise on 26 conditions. It indicated that exercise had moderate to strong positive effects on disease progression. The benefits of exercise extended beyond metabolic, cardiological, pneumological, and musculoskeletal diseases to neurological and psychiatric conditions.

The so-called myokines, which are "good" cytokines released by muscles, could play a role in this process, according to a presentation by study author Bente Klarlund Pedersen, MD, of Rigshospitalet in Copenhagen, Denmark.

For example, exercise could elevate mood in patients with depression and reduce inflammation in individuals with chronic inflammatory diseases, said Kress. Many patients, including those with diabetes, could benefit from physical activity even if their HbA1c levels do not decrease as desired.

Exercise As a Snack

Fat loss can be achieved with prolonged activity or with "short and intense" sessions if followed by refraining from eating immediately afterward, Joisten explained during the expert battle at the Diabetes Congress.

Different recommendations exist regarding how much exercise is necessary. According to the World Health Organization's (WHO) recommendation, "Every step counts." "As sports physicians, we consider physical activity to be any form of energy expenditure achieved through muscle activity," said Joisten.

This means that even occasional standing up, walking around, climbing stairs, and everyday activities are a start. They help motivate stigmatized, discouraged patients with obesity. Joisten highlighted a clear advantage of exercise over the "weight loss injection." "You can promise your patients that when they start or resume physical activity, they will experience the greatest increase in fitness and health right from the start."

Just 500 more steps per day can decrease cardiovascular mortality by 7%, while a daily increase of 1000 steps reduces overall mortality by 15%, according to a recent meta-analysis. For movement in a confined space, such as a home office, one can engage in "exercise snacks." To do this, one interrupts sedentary activities throughout the day with short bursts of movement, said Joisten.

Kress agreed with this introductory concept. "With lower intensity and longer duration, you can achieve even more than with short, intense exercise sessions," he told Medscape Medical News. For starters, he recommended "walking without panting," such as walking or jogging at a pace that allows for conversation.

Even the first walk improves the condition of coronary arteries, Kress explained. Fragmented exercise sessions, such as three times for 10 min/d, benefit circulation and fitness, the expert emphasized. Moderate aerobic training also ensures effective fat burning and prevents lactic acid build-up.

The Next Step

Gradual progression can lead to longer or brisker walks. The goal does not always have to be 10,000 steps per day, as shown in a meta-analysis presented by Joisten. In individuals aged < 60 years, 8000-10,000 steps significantly reduced mortality. For those aged > 60 years, 6000-8000 steps were sufficient.

More exercise is even better. The WHO recommends 150-300 min/wk of exercise for adults, including seniors, equivalent to 30-60 min/d for 5 days a week. Additionally, strength training is recommended on 2 days a week — or for seniors, 3 days of combined training sessions with strength and balance components.

In a network meta-analysis, the following exercise regimens were compared for overweight or obese individuals:

• Interval training (very high intensity, 2-3 d/wk, averaging 91 min/wk)
• Strength training (2-3 d/wk, averaging 126 min/wk)
• Continuous endurance training (moderate intensity, 3-5 d/wk, averaging 176 min/wk)
• Combined training (3-4 d/wk, averaging 187 min/wk)
• Hybrid training (high intensity, such as dancing, jumping rope, ball sports, etc., 2-3 d/wk, averaging 128 min/wk).

Participants in the combined training group (which included the longest weekly training times) performed the best in all five endpoints: Body composition, blood lipid levels, blood sugar control, blood pressure, and cardiorespiratory fitness. However, hybrid training also produced good results.

First, Visit the Doctor

Patients who wish to exercise and have not done so in a while or who have cardiac-respiratory or orthopaedic conditions should first undergo a medical check-up, Kress told Medscape Medical News.

In most cases, a test on a stationary bicycle at the primary care physician's office would be sufficient. If higher athletic goals are sought, a sports physician or a cardiologist should be consulted.

However, when looking at weight loss alone, exercise may not go very far, said Joisten. Approximately 1.5-3.5 kg of body weight can be lost, as shown in a meta-analysis. Of this amount, about 1.3-2.6 kg is fat mass. Only 330-560 g of this total is visceral fat, which matters the most.

A Direct Comparison

Matthias Blüher, MD, an endocrinologist and diabetologist at the University Hospital Leipzig in Leipzig, Germany, represented the pro-injection position. He initially focused on body weight and presented a highly publicized study by Lundgren et al., which showed that treatment with 3.0 mg/d liraglutide was significantly more effective in terms of weight loss than moderate to intensive physical activity. After 12 months, patients who received the injection lost 6.8 kg, while those who exercised lost only 4.1 kg. "The injection wins in a direct comparison," said Blüher.

The diabetologist also pointed out the risk for injury associated with exercise. Patients may become less active after a sports injury, he noted.

The LOOK-AHEAD study investigated whether a lifestyle program involving exercise and dietary changes brought cardiovascular benefits. In the long run, it did not. Patients regained weight after some time, and the combined cardiovascular endpoint did not differ between the group with an active, healthy lifestyle and the inactive control group. The study was discontinued.

The SELECT study compared the effect of treatment with once-weekly semaglutide 2.4 mg and placebo on cardiovascular events in patients with cardiovascular conditions and overweight or obesity (n = 17,604). Patients in the semaglutide arm had significantly fewer cardiovascular events over nearly 3 years than the comparison patients receiving placebo (6.5% vs 8.0%). Although the study participants did not have diabetes, they had relatively high baseline HbA1c levels; two thirds of the patients (n = 11,696) had prediabetes, with an HbA1c level ≥ 5.7%. Semaglutide significantly delayed the onset of diabetes in these patients, said Blüher.

A review in which Blüher was involved showed that treatment with 2.4 mg semaglutide or 15 mg tirzepatide over 12 months was more effective than many older medications (including orlistat) but not as effective as bariatric surgery. Participants in the Exercise and Nutrition study performed even worse than with the older medications.

Combination Therapy

Blüher and Joisten agreed that the combined prescription and use of exercise and incretin-based medications yields the best results for relevant endpoints such as weight loss and blood sugar control.

For example, data from the Lundgren study mentioned previously showed that participants in the combination group with liraglutide plus exercise lost an average of 9.5 kg of body weight. In addition, the HbA1c level, insulin sensitivity, and cardiorespiratory fitness of the participants in the combination group improved significantly over the course of the study.

The suggestion of an interval therapy (alternating between exercise and injections) enjoyed widespread approval during the audience discussion. Kress also supported the idea of interval therapy with incretin-based injections because it minimizes costs and could enhance insurance companies' acceptance of this therapy.

But exercise should not be interrupted, he said, and perhaps patients would not want to take breaks either, hoping that "once someone has lost weight (for example, even under injection therapy) they gain new motivation to move and achieve more."

This story was translated from the Medscape German edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

https://www.medscape.com/viewarticle/how-can-patients-diabetes-and-obesity-lose-weight-2024a10009yz?form=fpf 

The subtle warning sign of diabetes you might notice when you stand up – YEARS before other symptoms strike

From the-sun.com

IF you catch yourself feeling dizzy or faint when you stand up, you could be a risk of diabetes in the future, a new study suggests.

Dizziness can be triggered by neuropathy, a type of nerve damage that can occur if you have diabetes.

Hungarian researchers estimated that people at risk of type 2 diabetes are up to six times more likely to have neuropathy.

They also found that patients can show subtle signs of this damage years before their diabetes becomes fully developed.

Professor Anna Körei, from Semmelweis University, said: “Our aim is not just to identify individuals with carbohydrate metabolism disorders, but to detect those at risk as early as possible."

The scientists claim their findings could be used to track signs of neuropathy in patients at risk of diabetes and then either slow or prevent the nerve damage from occurring.

Neuropathy is one of the long-term complications of diabetes.

High blood sugar levels associated with the disease can injure nerves throughout your body.

Over the long term, this can lead to nerve damage and different symptoms depending on the nerves affected.

2

Many people have type 2 diabetes for years without realising it because the early symptoms tend to be general

It commonly results in peripheral neuropathy, which causes numbness, tingling, burning sensations, aching, cramps, and weakness in the feet and hands.

This condition can eventually spread to the entire limb. 

More than five million Brits are thought to be living with diabetes, of which an estimated 850,000 are unaware they have the condition. 

And two million Brits are believed to be at high risk of developing the disease in the next five years, according to Diabetes UK.

New research from the charity found that diagnoses of type 2 diabetes have risen at an alarming rate in people under 40, scientists say.

The study, published in the journal Frontiers in Endocrinology,  looked at signs of neuropathy in people with normal blood sugar levels who had a higher risk of developing diabetes.

Those most likely to develop the condition have known diabetes risk factors, such as being overweight or older.

Diabetics are urged to monitor their sugar levels and if you're diabetic it's likely you will have been given a device so you can do this at home.

You will be told what your average blood sugar level is and this is referred to as your HbA1c level.

While they differ for everyone, the NHS says that if you monitor your levels at home then a normal target is 4 to 7mmol/l before eating and under 8.5 to 9mmol/l 2 hours after a meal.

If it's tested every few months then a normal HbA1c target is below 48mmol/mol (or 6.5% on the older measurement scale).

What should my blood sugar be?

They compared the health test results of 44 people at high risk of developing diabetes and 28 healthy controls.

The participants had their heartbeat measured and tested on how their bodies reacted to sensations such as aching, burning pain, and numbness.

They found people at increased risk of diabetes had 5.9 higher odds of having a type called parasympathetic neuropathy when compared to healthy people.

There is no cure for neuropathy linked to diabetes, however drugs are available to combat the symptoms it causes.

What Is Diabetes? Plus The 10 Warning Signs To KnowPlus, the 10 warning signs to know

What is diabetes? Plus, the 10 warning signs to know

Diabetes is a condition that happens when your blood sugar (glucose) is too high

It develops when your pancreas doesn’t make enough insulin or any at all, or when your body isn’t responding to the effects of insulin properly.

There are 2 main types of diabetes:

• Type 1 diabetes – a lifelong condition where the body's immune system attacks and destroys the cells that produce insulin
• Type 2 diabetes – where the body does not produce enough insulin, or the body's cells do not react to insulin properly

Type 2 diabetes is far more common than type 1. In the UK, over 90 per cent of all adults with diabetes have type 2.

High blood sugar that develops during pregnancy is known as gestational diabetes. It usually goes away after giving birth.

The 10 warning signs to know

Visit your GP as soon as possible if you experience the main symptoms of diabetes, which include:

1. Feeling very thirsty/dry mouth
2. Peeing more frequently than usual, particularly at night
3. Feeling very tired
4. Dark skin patches
5. Frequent infections
6. Wounds taking longer to heal
7. Weight loss and loss of muscle bulk
8. Itchy skin
9. Itching around the penis or vagina, or frequent episodes of thrush
10. Blurred vision

Type 1 diabetes can develop quickly over weeks or even days.

Weight loss is common in people with type 1 diabetes when it first develops and before it's treated, but it's less common in people with type 2 diabetes.

Many people have type 2 diabetes for years without realising it because the early symptoms tend to be general or there are no symptoms at all.

How can I prevent it?

There are no lifestyle changes you can make to lower your risk of type 1 diabetes.

You can reduce the risk of type 2 diabetes through healthy eating, regular exercise and achieving a healthy body weight.

You may be more at risk of type 2 diabetes if you:

• Are living with overweight or obesity
• Do not have a healthy diet
• Have a family history of type 2 diabetes
• Are of Asian, Black African or African Caribbean origin
• Take certain medicines such as steroids for a long time
• Have high blood pressure
• Have had gestational diabetes during pregnancy

Metformin is a medicine used to treat type 2 diabetes and gestational diabetes. It's also used to help prevent type 2 diabetes if you're at high risk of developing it.

https://www.the-sun.com/health/11450288/warning-sign-diabetes-neuropathy-standing-up/ 

Early blood sugar management for people with type 2 diabetes has lifelong benefits

From diabetes.org.uk

Treating type 2 diabetes as early as possible helps to reduce risk of future complications, show new findings from a 40-year landmark study that began with funding from Diabetes UK.

Scientists from the Universities of Oxford and Edinburgh analysed data spanning more than four decades from the UK Prospective Diabetes Study (UKPDS) - one of the longest ever type 2 diabetes studies.

The latest results reveal the lasting legacy of early treatment to get blood sugar levels to target range straight after a type 2 diabetes diagnosis to minimise the risk of complications and help people live longer, healthier lives. 

Starting early treatment with insulin or sulphonylurea tablets led to 17% fewer heart attacks, 26% fewer complications, such as kidney failure and vision loss, and 10% fewer deaths.

Early treatment with metformin led to 31% fewer heart attacks and 20% fewer deaths, compared to managing type 2 diabetes with diet.

Changing diabetes care for good

The UKPDS began in 1977, with our support. It ran for 20 years and when its ground-breaking findings were announced in 1998, they completely transformed type 2 diabetes guidelines worldwide.

They showed, for the first time, that keeping blood sugar and blood pressure levels within a target range was key to managing diabetes and avoiding complications. 

A legacy effect

The UKPDS team continued to study participants’ health after the 20-year trial had ended to monitor the long-term impact of early treatment.

Ten years later, they saw that people who had started medications (metformin, sulphonylureas or insulin) straight after they’d been diagnosed with type 2 diabetes continued to experience fewer diabetes complications, compared to those who had managed their blood sugar levels with diet.

The team’s latest analysis now shows these protective effects last for up to 42 years. The researchers think that getting blood sugar levels to target early on creates a "memory" in the body that helps protect against complications for years later, even if blood sugar levels creep up further down the line.

The findings reinforce the importance of getting an early diagnosis for type 2 diabetes. The earlier the condition is diagnosed, the sooner people can be treated to get blood sugar levels to target.

Professor Rury Holman, the founding Director of the University of Oxford Diabetes Trials Unit and Chief Investigator of the UKPDS, said:

“These remarkable findings emphasise the critical importance of detecting and treating type 2 diabetes intensively at the earliest possible opportunity.

“People may have type 2 diabetes for several years before being diagnosed as they may have few symptoms until their blood sugars become substantially elevated.”

Professor Amanda Adler, Director of the Diabetes Trial Unit, said:

“This shows that treating type 2 diabetes early and thoroughly is crucial. Playing catch-up with blood glucose control is not sufficient.”

The 24-year follow-up of the UKPDS is published in The Lancet.

https://www.diabetes.org.uk/about-us/news-and-views/early-blood-sugar-management-people-type-2-diabetes-has-lifelong-benefits