Could a Mediterranean diet be the secret to avoiding gestational diabetes?

From news-medical.net 

In a recent study published in the journal Nutrition & Diabetes, researchers investigate whether the Mediterranean diet (MedDiet) influences the risk of gestational diabetes mellitus (GDM).

GDM and MedDiet

GDM is a common disorder that occurs during pregnancy due to placental hormones that prevent effective insulin utilization. GDM can increase the risk of several short- and long-term adverse outcomes for both the mother and child; therefore, it is crucial to control blood glucose levels during pregnancy through medical and nutritional interventions.

Several studies have suggested that preventing GDM through lifestyle and dietary interventions in pre-pregnancy or early pregnancy stages could significantly reduce the risk of neonatal diseases and congenital disabilities, as well as improve the mother’s health. Typically, increased consumption of saturated fatty acids, carbohydrates, cholesterol, and total fat increases the risk of developing GDM.

MedDiet is associated with consuming higher amounts of whole grains, vegetables, legumes, and foods rich in monounsaturated fatty acids (MUFAs) and reduced intake of processed and red meat. Although it is important to understand how individual food components affect GDM, assessing overall dietary patterns like the MedDiet could be more beneficial in managing this condition.

Several studies have indicated that adherence to the MedDiet reduces the risk of GDM. Although many studies have equivocally highlighted the benefits of MedDiet in lowering the risk of GDM, a systematic review and meta-analysis are needed to summarise the findings of the available research.

                                                             Image Credit: Olga Gavrilova / Shutterstock.com

About the study

For the current systematic review and meta-analysis, all relevant literature published until August 2023 was obtained from PubMed, Web of Science, Google Scholar, and Scopus databases. Duplicate, animal, and ecological-based research, short communications, and non-English language studies were excluded.

Ten articles published between 2012 and 2023 were ultimately considered for the analysis, which included two case-control and eight cohort studies. These studies were conducted in different countries, including the United States, the Mediterranean countries, Australia, Iran, Spain, and Greece. The participants of these studies were pooled and totalled 32,959,909, with ages ranging between 18 and 45.

MedDiet adherence was assessed through a Mediterranean Diet Adherence Screener (MEDAS) score, higher quartiles of alternate MED (AMED) score, and a Mediterranean-Style Dietary Pattern Score (MSDPS). GDM outcomes were determined using the National Diabetes Data Group criteria, fasting or postprandial blood sugar levels, or glucose challenge test using the Obstetricians and Gynaecologists (HSOG) criteria.

Study findings

Seven of the ten reviewed indicated that higher adherence to the MedDiet reduces the risk of GDM. Moreover, the pooled analysis identified a significant correlation between adherence to MedDiet and a reduced risk of GDM. Across all studies, these results were heterogeneous, which could be due to differences in study design or period of dietary assessment.

Although case-control studies reported a more significant 75% reduction in the likelihood of GDM in women with greater adherence to the MedDiet, cohort studies revealed a moderate 20% reduction in the risk of GDM. A significantly higher reduction in GDM risk in case-control studies could be attributed to recall biases that are difficult to validate, which may lead to an overestimation of the risk ratio.

A subgroup analysis found that the association between adherence to the MedDiet and reduction of GDM risks was true for both Mediterranean and non-Mediterranean countries. Thus, the MedDiet appears to benefit both Mediterranean and non-Mediterranean populations.

Greater adherence to the MedDiet leads to higher consumption of whole grain products, fruits, vegetables, extra virgin, nuts, olive oil, and legumes with regular fish and seafood intake. A higher intake of antioxidants and vitamins through this diet reduces oxidative stress and systemic inflammation, both of which are crucial factors in the development and advancement of chronic diseases.

The high polyphenol content in fruits and vegetables also significantly reduces GDM risk through several mechanisms, such as inhibition of glucose absorption in the gastrointestinal tract, anti-inflammatory effects, modification of microbiota, and increased antioxidant capacity.

Obesity and insulin resistance, both common risk factors for GDM, are inversely related to the MedDiet. One previous meta-analysis revealed that greater adherence to the MedDiet reduces the risk of obesity or overweight by 9%.

Several studies have also shown that the consumption of whole grains reduces the risk of developing type 2 diabetes. Furthermore, nuts contain MUFAs and polyunsaturated fatty acids (PUFAs) that can regulate blood glucose levels and reduce appetite.

Observational studies have indicated that long-term red meat consumption increases GDM risk, which may also contribute to the reduced risk of GDM in individuals who follow the MedDiet.

Conclusions

The current systematic review and meta-analyses presented a robust association between high adherence to the MedDiet before gestation or during pregnancy and reduced GDM risk. Thus, MedDiet should be recommended to women of reproductive age to prevent the development of GDM and other adverse pregnancy outcomes.

Nevertheless, future studies are needed to analyse the interaction of the MedDiet, genetic, and lifestyle risk factors of GDM to develop more effective preventive strategies.

https://www.news-medical.net/news/20240725/Could-a-Mediterranean-diet-be-the-secret-to-avoiding-gestational-diabetes.aspx

More Adults with Diabetes are Using Cannabis Despite Potential Risks

From drugtopics.com

From 2021 to 2022, the prevalence of adults with diabetes who used cannabis increased by 33.7%

There has been a significant increase in the use of cannabis among adults with diabetes in the United States despite the drug’s unclear impacts on health outcomes, according to recent data published in the journal Diabetes Care. The authors said that the findings support the use of screening and education about potential risks.

Cannabis use in the US is now prevalent and increasing due to many states legalizing medical and recreational use. Adults with diabetes are no exception, despite a potential increased risk of diabetic ketoacidosis and negative impacts on metabolic factors. However, despite some research pointing to adverse effects, the impact of cannabis use in patients with diabetes is not well understood.

“The increased use of cannabis in the US for managing health-related symptoms has led to its increased use among individuals with chronic diseases, including millions of people with diabetes,” the authors wrote. “However, due to the difficulties of conducting studies with cannabis, including the number of cannabinoids and various routes of administration, as well as federal restrictions, there is limited research on its effect on glucose metabolism, lipid profiles, and cardiovascular risk for people with diabetes.”

      More Adults with Diabetes are using Cannabis Despite Potential Risks / S.Price - stock.adobe.com

Investigators from the University of California San Diego School of Medicine conducted a study to estimate the most recent national prevalence of cannabis use among adults with diabetes and delineate characteristics. Data for the study was gathered from the 2021 to 2022 National Survey on Drug Use and Health, which is conducted by the Substance Abuse and Mental Health Services Administration.

The study cohort included 6816 adults with a lifetime diagnosis of diabetes. Patients who reported cannabis use were compared to those who reported not using it. Cannabis use within the past month was gauged by asking about the use of cannabis products that are smoked, vaped, dabbed, ate, drank or applied via a lotion. CBD and hemp products were excluded. Covariates included sociodemographic characteristics, past-year all-cause emergency department (ED) use, past-year major depression, past-month misuse of opioids and/or stimulants, and binge drinking.

Investigators found that 9% of adults with diabetes were estimated to have used cannabis in the past month. From 2021 to 2022, the prevalence of users increased by 33.7%, rising from 7.7% to 10.3%. Over 48% of people with diabetes who reported using cannabis in the last month were under the age of 50.

Additionally, factors associated with higher-odds of using cannabis in the past month included living in a state where cannabis is legal, having a history of hepatitis, experiencing a major depressive episode in the last year, as well as using tobacco, binge drinking, or misusing opioids in the last month.

Study limitations include that the data did not distinguish between diabetes type or type of cannabis product used, a reliance on self-reporting, and that samples were only gathered from the noninstitutionalized population.

“[C]linicians must discuss with their patients with diabetes the potential harms of cannabis use on diabetes-related outcomes without a clear understanding of its benefits,” the authors concluded.” Further, screening for and education about the potential risks of its use and other psychoactive substances must be done with all patients with diabetes and discussed in the context of managing and monitoring their diabetes.”

Key Takeaways

• Cannabis use among adults with diabetes in the US increased by 33.7% from 2021 to 2022, with 9% of diabetic adults using cannabis in the past month.
• Cannabis use in diabetic patients may pose risks such as diabetic ketoacidosis and adverse metabolic effects, although comprehensive research on these impacts is limited.
• Healthcare providers should discuss the potential harms of cannabis use with diabetic patients, emphasizing the importance of screening and education about the risks associated with cannabis and other psychoactive substances.

https://www.drugtopics.com/view/more-adults-with-diabetes-are-using-cannabis-despite-potential-risks

Diabetic Retinopathy: Causes, Prevention, and Treatment

From diatribe.org

Key takeaways: 

• Screening for diabetic retinopathy is important as many people do not show symptoms until the disease has progressed. 
• New technology, like artificial intelligence, may make screening for diabetic retinopathy easier. 
• Treatment for diabetic retinopathy may involve eye injections, laser therapy, or surgery to remove leaking fluid. 

Diabetic retinopathy is the most common eye disease among people with diabetes and the main cause of blindness in American adults. According to the National Eye Institute, more than half of people with diabetes will develop retinopathy over time. 

Often, the symptoms of DR do not appear until it has progressed to the point of severe vision loss. Read on for valuable advice on screening, how to prevent retinopathy, and a glimpse into current and future treatments. 

What is diabetic retinopathy?

Diabetic retinopathy is a diabetes complication that occurs when blood vessels in the retina of the eye are damaged or swollen, or begin to grow irregularly. It has four stages: mild, moderate, severe, and proliferative retinopathy. 

At first, diabetic retinopathy may cause no symptoms. If left untreated, however, it can cause severe vision loss or even blindness.
A retinopathy diagnosis may mean the presence of other diabetes-related complications occurring elsewhere in the body. For instance, a 2021 study found that people with diabetic retinopathy are twice as likely to develop heart disease compared to people without it. Likewise, diabetic retinopathy is also linked to a higher risk of chronic kidney disease. 

What causes diabetic retinopathy?   

Anyone with type 1 or type 2 diabetes is at risk of developing diabetic retinopathy, which is caused by high blood sugar over time – typically, many years. Chronic high blood sugar levels can lead to damage and blockage of the tiny blood vessels in the retina, diminishing blood supply. 

When this blood supply is cut off, the eye develops new blood vessels. However, these new blood vessels don’t develop properly and can easily leak fluid, causing vision loss. The longer a person lives with diabetes, the more likely he or she is to develop retinopathy.

How to prevent diabetic retinopathy

To answer this question, we spoke to Dr. Ivan Suñer, an ophthalmologist and retinal surgeon at Retina Associates of Florida, and Mike Ellis, a person who was diagnosed with diabetic retinopathy at age 63.

Suñer emphasized that monitoring and controlling blood sugar, blood pressure, and cholesterol are key steps to preventing diabetic retinopathy. A1C levels also have a direct relationship with the risk of developing diabetic retinopathy – maintaining an A1C of less than 6.5% is associated with a decreased risk, according to the American Diabetes Association.

Regular exercise also decreases the risk of diabetic retinopathy and other long-term complications. Suñer also pointed out that limited research suggests smoking cigarettes increases the risk for diabetic retinopathy if you have type 1 – but not type 2 – diabetes.

The most critical piece of information Suñer shared was that people with all stages of diabetic retinopathy often have no symptoms until they are at extremely high risk for vision loss. Thus, he strongly emphasized the importance of regular screening with a comprehensive eye examination.

Our conversation with Ellis taught us the same lesson. Ellis hadn’t seen a doctor in years when he started losing his vision, and only when he started having trouble doing the things he loved, including fly fishing and working on cars, did he see a doctor. 

His physician diagnosed him with type 2 diabetes and diabetic retinopathy at the same appointment. He had no reason to believe that he had diabetes – while a majority of people with type 2 diabetes are overweight, he had been fit and active his entire life. Thus, the number one piece of advice he wanted to share was to see a doctor regularly and get screened.

Screening for diabetic retinopathy 

Because early detection of diabetic retinopathy is key to preventing vision loss, people should be screened through a dilated eye exam by an ophthalmologist or optometrist. An eye exam performed by a primary care doctor (without eye dilation) does not replace a full exam done by an eye doctor. 

The ADA recommends that anyone with type 1 diabetes receive an initial dilated eye examination within five years of being diagnosed with diabetes. Anyone newly diagnosed with type 2 diabetes should receive a dilated eye exam by a specialist immediately after diagnosis. 

However, because there are a limited number of eye specialists in the U.S., screenings are not always easy for everyone with diabetes to do as directed by the ADA. 

Historically, the images taken during screening were interpreted by an ophthalmologist. However, this might change in the future with the development of artificial intelligence. Eyenuk’s EyeArt AI Screening System gained FDA approval in 2023 and AEYE Health’s AEYE-DS received FDA approval in 2024; both systems provide AI-based detection of diabetic retinopathy. AI-based screening could be especially useful for people who live in rural areas or places with limited access to eye doctors. 

Research suggests that a considerable proportion of people with type 2 diabetes have some level of retinopathy at the time of diagnosis – up to 16%, according to a 2023 study. The recommended frequency of screenings depends on the stage of retinopathy. People with mild retinopathy may need to be screened once a year; people with more severe disease may need eye exams on a more frequent basis. 

The silver lining of Ellis’ diagnosis was that it served as a “wake-up call” to his younger siblings. After he was diagnosed with diabetic retinopathy, he encouraged them all to get tested for diabetes. It turned out that they all had blood sugars in the prediabetes range. This information gave them the opportunity to proactively change their lifestyles, potentially preventing the onset of type 2 diabetes and its complications.

How is diabetic retinopathy treated?

Treatment options depend largely on the severity of the disease. Mild or moderate retinopathy may not require immediate treatment; managing blood sugar can usually slow the progression of the condition. It’s also important to manage blood pressure and cholesterol levels. 

For people with more advanced stage diabetic retinopathy, treatment options include:

1. Injections

Anti-VEGF drugs, such as Lucentis and Eylea, can help slow down or reverse early-stage disease. They are given by a healthcare provider as a monthly eye injection for people who do not yet need surgery. Anti-VEGF drugs block a protein that causes damage to blood vessels in the eye. According to Suñer, as many as 40% of people with diabetic retinopathy see significant improvements after using these drugs.

Newer and more powerful medications, like higher-dose Eylea, have the potential to reduce the frequency of injections. Other medicines, called corticosteroids, can help reduce swelling and inflammation. 

2. Laser treatment

For people who do not see improvement after injections, focal laser treatment allows doctors to shrink abnormal blood vessels through a laser procedure. According to the National Eye Institute, focal laser treatments can reduce the risk of vision loss by 50%.

3. Eye surgery

If blood vessels in the eye have significant bleeding, a surgical procedure called a vitrectomy may be performed. In this procedure, vitreous gel containing leaked blood is removed from the eye as well as any scar tissue. Laser treatment is also performed to help prevent the recurrence of new blood vessels and bleeding. 

When Ellis was diagnosed, he started receiving Lucentis injections as a treatment. Fortunately, these injections helped him regain his vision within a year. He has regained the ability to do all the activities he loves again, including fishing and tutoring children at his local church. According to his doctor, he likely would have lost his vision completely had he not caught the symptoms when he did (and if this treatment hadn’t been available to him). Although he said it’s certainly not comfortable to get injections in his eyeballs every month, it’s a small price to pay for maintaining his vision. 

Surgical interventions like focal laser treatment and vitrectomy often slow or stop the progression of diabetic retinopathy, but they are not cures. Regular eye exams are thus necessary to continue monitoring diabetic retinopathy.

The future of diabetic retinopathy treatment

Along with advancements in screening for retinopathy, treatments are ever-evolving as well. Here’s a look at what may be coming in the future.

New medications

Researchers are investigating medications such as fenofibrate, an oral drug traditionally used to lower cholesterol. For instance, a 2022 study of nearly 150,000 participants found that using fenofibrate was linked to a lower risk of proliferative retinopathy and vision-threatening retinopathy. Additional research suggests that fenofibrate may slow the progression of the disease. 

Implant devices

Researchers are investigating eye implants that release a drug (e.g. Lucentis) over a prolonged period of time, instead of regular, frequent injections. With eye implants, patients would need to refill the device less frequently (i.e., potentially every six or eight months). Susvimo, an eye implant, has been approved for patients who have wet age-related macular degeneration. Clinical trials are currently underway to investigate Susvimo in people with diabetic retinopathy without diabetic macular edema. 

Combination therapies

Other researchers are investigating the effectiveness of combining multiple therapies for diabetic retinopathy earlier in treatment. For instance, laser therapy at the start of treatment, rather than beginning with injections and then performing surgery later on. While this research is in its early stages, Suñer has seen that combination therapy can lead to better outcomes and fewer treatments down the road.

The bottom line

Being screened for diabetic retinopathy is the most important action that people with diabetes can take to prevent severe vision loss and blindness. 

Improving blood sugar levels by getting regular exercise and eating a nutritious diet can prevent diabetic retinopathy and even reverse it in its early stages. However, since symptoms may not appear until the disease is more severe, the only way to know if you are at risk is to get regular eye screenings from your eye doctor. 

https://diatribe.org/diabetes-complications/diabetic-retinopathy-causes-prevention-and-treatment 

Sleeping different amounts each night may be linked to higher diabetes risk

From medicalnewstoday.com

• The link between sleep and the risk of developing obesity or type 2 diabetes is unclear but is expected to be bidirectional.
• Sleeping different amounts each night could be linked to diabetes risk, research has shown.
• A new analysis of UK Biobank data shows increased variance in sleep duration is associated with an increased risk of diabetes, particularly for those who slept for longer and those with a lower genetic risk score for diabetes.

Irregular sleep has been linked to type 2 diabetes risk, though this effect was reduced when data was adjusted for obesity, comorbidities, and lifestyle factors.

Researchers from Boston, M.A., and Manchester, the U.K, found that individuals with the most variability in how much they slept each night, were 59% more likely to develop diabetes over a 7.5-year follow-up than those whose sleep pattern was the most consistent.

Risk increases as sleep becomes more inconsistent

To investigate the link between irregular sleep and diabetes risk, researchers used UK Biobank data, gaining permission to use the data of 84,421 participants for this study. Sleep data was available as participants had been invited to wear an accelerometer, a device that captures activity levels, much like a fitness watch, for seven days, at some point between 2013–2015.

The participants had a mean age of 62 and researchers also used genetic data held on individuals by the Biobank to calculate polygenic risk scores for diabetes, using known genetic risk variants for the condition.

The researchers discovered that participants with a sleep duration deviation of between 31 and 45 minutes from their average, had a 15% increased risk of diabetes compared with those whose sleep duration deviated by 30 minutes or less. Those with the most variability, with a sleep duration deviation of 91 minutes or more had a 59% increased risk, after adjusting for age, sex, and race.

The researchers also analysed differences in sleep duration of over and under 60 minutes and found a 34% increased risk for those who had a difference of over 60 minutes, but this decreased to 11% when data was adjusted for lifestyle, comorbidities, environmental factors, and adiposity.

The cohort was 97% white, and over 45% had a college degree, both of which are unrepresentative of the U.K. population as a whole.

How sleep affects hormones 

The authors did not look at the mechanisms underpinning the link they discovered in this prospective cohort study but explained it may be due to irregular sleep patterns disrupting circadian rhythms. They suggested this unstable circadian cycle could interfere with glucose metabolism and lead to reduced insulin sensitivity.

They looked at the effect of sleep variation on diabetes risk as there is increasing evidence sleep variation can have an impact on metabolic health. Sleep duration, sleep quality, and other sleep disturbances have been linked to diabetes risk in previous studies.

Sudha Tallavajhula, MD, neurologist, and sleep medicine physician at UTHealth Houston who was not involved in the research, told Medical News Today:

“In both clinical and research goals, we see that sleep disorders change hormonal pathways. During sleep, the whole endocrine axis, that is the pathway that encompasses all hormonal function, undergoes a cyclical change. Hormones that are not required during sleep, because of low activity, for example, insulin and steroids are usually reduced. Their levels rise in the mornings, to meet demand for activity. Impaired sleep contributes to poor utilization of glucose and fat.”

It wasn’t clear if one caused the other and the issue could be bidirectional, she explained.

“There is a substantial amount of research that links both obesity and diabetes to sleep disorders. From a larger perspective, sleep disorders are linked to the overall metabolic inefficiency that underlies both diabetes and obesity. The relationship is multifactorial and goes both ways, meaning that sleep disorders can increase the risk of diabetes and obesity. These two conditions can also contribute to sleep disorders.”
— Sudha Tallavajhula, MD

Circadian rhythm and type 2 diabetes risk

Previously the researchers looked at the role of circadian rhythm on type 2 diabetes risk. For this study published in the Annals of Internal Medicine, they looked at the Nurses’ Health Study II, and discovered that ‘night owls’ were more likely to develop type 2 diabetes than ‘early birds’.

Chronotype, or whether people find they need to go to bed and wake up earlier or later, is linked to an individual’s circadian rhythm, which describes a person’s body clock. It is thought to be affected by light levels, among other things.

The researchers also found that ‘night owls’ were more likely to report unhealthy lifestyle behaviours. When data were adjusted for these factors, the effect of chronotype was still there but attenuated.

Although the study did not elucidate underlying mechanisms, it affirmed the importance of healthy routines for the prevention of type 2 diabetes, Becca Anne Krukowski P.h.D, professor of public health sciences at the University of Virginia School of Medicine, who was not involved in the research, told MNT.

“Maintaining healthy routines– including consistent sleep but also regular physical activity and healthy, balanced meals–contribute to overall health and likely prevention of type 2 diabetes,” she said.

https://www.medicalnewstoday.com/articles/sleeping-different-amounts-each-night-linked-higher-diabetes-risk