Tuesday, 29 July 2025

Patients With Diabetes More Likely to Experience Adverse Financial Outcomes

From physiciansweekly.com

MONDAY, July 28, 2025 (HealthDay News) — Patients with type 2 diabetes may experience substantially more adverse financial outcomes compared with patients without diabetes, according to a study published online July 28 in JAMA Network Open.

Matthew Pesavento, Ph.D., from The Ohio State University in Columbus, and colleagues investigated the association of type 2 diabetes and adverse financial outcomes. The analysis included electronic health records linked to credit records for 166,285 adults with at least one medical encounter at a primary care medical centre (from Oct. 1, 2017, to Dec. 31, 2021). 

The researchers found that for patients with versus without diabetes, estimated probabilities were significantly higher for any adverse financial outcomes (64.5 versus 49.9 percent), below-prime credit scores (59.7 versus 45.9 percent), medical collections (36.9 versus 23.9 percent), nonmedical collections (38.4 versus 27.7 percent), delinquent debt (23.3 versus 15.6 percent), debt charge-offs (15.4 versus 10.1 percent), bankruptcy filings (2.1 versus 1.4 percent), and foreclosures (0.5 versus 0.3 percent). Overall, among patients of Black race, enrolled in Medicaid, of Hispanic ethnicity, younger than 65 years, without earned income, and of female sex, the adjusted prevalence of adverse financial outcomes was higher.

“This information also may inform holistic treatment approaches that might ease the financial vulnerability of individuals with diabetes,” the authors write.

https://www.physiciansweekly.com/patients-with-diabetes-more-likely-to-experience-adverse-financial-outcomes/ 

Saturday, 26 July 2025

How Often Do You Need to Check Your Blood Sugar?

From everydayhealth.com/diabetes

Blood sugar checks are essential for the diagnosis and treatment of every form of diabetes. 

“Glucose monitoring is critical for preventing short-term and long-term complications of diabetes,” says Jessica Pius-Nwagwu, RN, an associate director of dissemination and implementation for the American Diabetes Association. “It provides real-time feedback on glucose fluctuations, identifies low and high glucose levels both with risks, and informs medical adjustments.”

There is no single recommendation for blood sugar monitoring that applies to everyone with diabetes. How often you should check your blood sugar varies according to your condition, the medications you use, and other health factors.

Types of Blood Sugar Measurements

There’s more than one way to measure your blood sugar.

Blood Sugar Meter or Continuous Glucose Monitor (CGM)

A blood sugar meter reveals your blood sugar level at the moment the test is taken.

Most people with diabetes are first taught how to measure their blood sugar with a blood sugar meter. You draw a drop of blood, insert it into a “fingerstick,” and receive the device’s reading of your blood sugar level at that moment. Depending on your diabetes management status, you may be advised to use a blood sugar meter multiple times a day, only once a day, or even less frequently.
For many people with type 2 diabetes, the most important time to use a blood sugar meter is first thing in the morning. This is known as a fasting blood sugar test, as it measures blood sugar after you have not eaten or drunk anything but water for at least the past eight hours. This can provide an important baseline of your blood sugar at its lowest level, unaffected by food, drink, exercise, and other daily habits.

Doctors may encourage others, especially those who use insulin to manage their type 1 or type 2 diabetes, to test their blood sugar multiple times throughout the day, including before and after meals and exercise. These checks can show how food and lifestyle choices affect diabetes management and can help determine how much insulin they need and how often.

continuous glucose monitor (CGM) is a newer wearable device that sends blood sugar measurements to a smartphone or digital receiver around the clock, and it can sound alarms when blood sugar gets dangerously high or low. This can make it an important tool for people with type 1 or type 2 diabetes who want or need to track how and when their blood sugar rises and falls, though not all insurance plans cover CGMs.

Marilyn Tan, MD, a clinical associate professor of medicine specializing in endocrinology, gerontology, and metabolism at Stanford University in California, explains that CGMs measure changes in the interstitial fluid that contains blood sugar, rather than blood sugar itself.

“So readings may lag and may be less accurate at extremes of glucose [levels],” Dr. Tan says.

A1C Test

A haemoglobin A1C test measures your average blood sugar levels over three months. It does not give instant feedback on your diabetes management decisions. But your doctor may use it to diagnose prediabetes, type 1 diabetes, or type 2 diabetes or to determine how your diabetes treatment is progressing.
Your doctor may want you to have an A1C test as often as every three months, though people with more stable blood sugar control may need a check only once or twice a year.

Typically, a doctor administers an A1C via a blood draw or finger prick, with a sample sent to a lab to process results. Over-the-counter, at-home A1C tests are available. Ask your doctor if they are appropriate for your situation.

Type 2 Diabetes Without Insulin

If you are among the people with type 2 diabetes who do not need insulin to manage their condition, you might not need to check your blood sugar as often as people on insulin. But self-monitoring may be beneficial.

Pius-Nwagwu says that people with type 2 diabetes not on insulin should do a fasting blood sugar test daily, in addition to an A1C test that usually occurs quarterly. She adds that you should check with your doctor about the best frequency for your situation.

Tan says that frequency may depend on factors that include:

  • How controlled your diabetes is
  • Medications such as sulfonylureas that lower blood sugar
  • Availability of test strips

She adds that checking blood sugar after meals may be helpful if you have type 2 diabetes without using insulin, but random blood sugar checks otherwise are usually unnecessary.

Although CGMs are not part of the usual standard of care for people who do not use insulin, research also suggests that they can help monitor blood sugar levels.

Type 2 Diabetes With Insulin

If your type 2 diabetes treatment requires insulin, your doctor may tell you to test your blood sugar several times a day. This is in part to avoid the threat of low blood sugar (hypoglycaemia), a potentially dangerous side effect of insulin use.

According to the American Diabetes Association, you may need to do as many as 6 to 10 daily checks, including:
  • Before meals
    • Before bed
    • Occasionally after meals
    • Before, during, and after exercise
    • When you suspect low blood sugar
    • After treating low blood sugar
    • Before and during critical tasks, such as driving
    If you take a long-lasting basal insulin only once daily, you may require fewer checks than someone who also takes insulin at mealtimes.

    “Typically, someone on multiple daily injections of insulin (basal bolus) needs closer monitoring than someone on once-daily, long-acting insulin,” Tan says, “especially given that there are multiple opportunities to adjust dosing throughout the day and also more opportunities to overdose or underdose on insulin.”

    Tan says that people with insulin-dependent type 2 diabetes should do daily fasting blood sugar checks, with additional random blood sugar checks if unusual symptoms occur. Fasting blood sugar monitoring can help you adjust doses of basal insulin and ultimately lower your blood sugar levels.

    If you have type 2 diabetes and are on insulin, Pius-Nwagwu recommends testing A1C at least twice a year and quarterly if you are not meeting your A1C goals, regardless of the type of insulin. 

  • CGMs also can help, Tan says. Evidence suggests that people with type 2 diabetes who are on insulin benefit from CGM use by increasing control over blood sugar and lowering hypoglycaemia risk.

    “Even once-daily, long-acting insulin can lead to hypoglycaemia, so all of these patients can benefit from a CGM,” she says.  

    Prediabetes or Family History of Diabetes

    If you have prediabetes or a family history of diabetes, you may be at risk for diabetes and benefit from blood sugar monitoring.
    Prediabetes means your blood sugar is elevated slightly, and your condition may progress to type 2 diabetes. If you have prediabetes, your doctor may want you to take an A1C test every one to two years, or more often, to monitor your potential progression toward full-blown diabetes.

    “For those with established prediabetes, an A1C test every three to six months is reasonable,” says Tan, who adds that the frequency depends on how close test results are to type 2 diabetes.

    If you have a family history of type 2 diabetes, the American Diabetes Association recommends A1C testing for screening and potential diagnosis. If your family history includes type 1 diabetes, it also recommends screening for type 1 diabetes autoantibodies.
    Although people without diabetes have used CGMs to monitor their blood sugar levels, there is little or no research showing that the devices benefit people with prediabetes. But some experts have argued that CGMs could help with diabetes prevention.

    Type 1 Diabetes

    Blood sugar checks are critical for people with type 1 diabetes, which requires insulin treatment. People with type 1 diabetes generally have to use insulin before every meal, frequently adjusting their doses based on their food, their physical activity level, and many other factors. It is extremely difficult to dose insulin accurately if you don’t know what your blood sugar level is.
    The American Diabetes Association also recommends 6 to 10 blood sugar tests daily for people with type 1 diabetes, including before and after meals, before bed, during exercise and critical tasks, and during times of high and low blood sugar levels.

    Given a nearly constant need for accurate blood sugar measurements and an enhanced risk of hypoglycaemia, the American Diabetes Association recommends that people with type 1 diabetes use CGMs.

    As for A1C tests, Osagie Ebekozien, MD, MPH, the chief quality officer at the American Diabetes Association, says people with type 1 diabetes should get them quarterly, though the association’s guidelines say controlled type 1 diabetes may require only two tests a year.

    Can You Test Your Blood Sugar Too Often?

    As a general rule, data on blood sugar is a good thing when it comes to diabetes management.

    “For healthcare providers, more data is helpful,” says Tan, adding that more tests can guide treatment decisions and monitor blood sugar fluctuations.

    Blood sugar monitoring, however, can contribute to diabetes burnout and feeling overwhelmed. Costs of testing devices can add up, and finger pricks can be painful.
    When in doubt, check with your doctor or endocrinologist about how much you need to monitor your blood sugar for your situation. Mental health support can also help you deal with difficult emotions related to diabetes care.

    The Takeaway

    • Routine blood sugar monitoring is a vital part of diabetes management and can prevent complications.
    • Testing options include fingerprick tests, continuous glucose monitoring (CGM), and A1C tests that measure longer-term averages.
    • If your type 1 or type 2 diabetes requires insulin treatment, you may require as many as 10 blood sugar tests each day, and could benefit from even more by using a CGM.
    • Always talk to your doctor about which blood sugar monitoring plans will work best for your specific condition.

Friday, 25 July 2025

How ultra-processed food may fuel Type 2 diabetes

From ewg.org

Type 2 diabetes affects roughly 34 million Americans. The numbers are rising, especially among children, and ultra-processed food might be playing a role.

Americans are increasingly consuming this type of food, which can include packaged snacks, soda, instant noodles, fast food, frozen entrees and refined bread. Americans’ dietary habits for ready-to-eat foods has gone up over the past two decades, according to a 2022 study. 

On average, ultra-processed food or UPF, accounts for almost 60% of an American adult’s diet. It’s even higher for kids and teens, representing more than two-thirds of their total calories. 

The rising consumption of these foods may play a role in the increased incidence of long-term chronic diseases like cancer, heart disease, cardiovascular disease, Crohn’s disease, depression and brain disorders like dementia. 

Rising prevalence of Type 2 diabetes 

Some studies have associated increased consumption of UPF with a higher risk of developing Type 2 diabetes, one of the most widespread chronic diseases in the U.S. 

Type 2 diabetes accounts for 90% to 95% of all diabetes cases, and according to the National Institutes of Health nearly 12% of people in the U.S. of all ages have diabetes. 

With Type 2 diabetes, the body begins to lose its ability to effectively regulate blood sugar. Disruptions to the body's usual metabolic system can also lead to higher blood pressure, cholesterol, glucose levels and obesity. 

The incidence of Type 2 diabetes went up dramatically between 2002 and 2018 for all children in the U.S, especially for Black and American Indian children. 

There is a growing body of research linking UPF consumption and the risk of Type 2 diabetes, with high intake increasing the risk in one study by as much as 31%, according to a 2022 study.

In 2024, European researchers found that each 10% increase in UPF consumption in the diet was associated with a 17% higher incidence of diabetes.

This rise could mean hundreds of thousands of additional diabetes cases across the U.S.

Defining ultra-processed food

Food can be categorised by how much it has been processed – ranging from unprocessed whole food to ultra-processed. Most food products found in the grocery store are processed in some way, even if it’s just cooking or pasteurizing to make it safe and edible. 

Ultra-processed foods are different. 

They are made using one or more industrial ingredients like artificial colours and flavours, non-sugar sweeteners, and additives such as emulsifiers and thickeners. UPF is designed to be cheap, irresistibly palatable and ready to eat straight from the package. These products are engineered so we keep wanting to eat them. 

Part of what makes them so craveable is their often high levels of sugar and fat.  

Studies have shown that consumption of UPF may interfere with our brain’s reward system and the signals that tell us to stop eating. This may lead to eating more of these foods compared to minimally processed foods.

Health impacts of UPF

Studies have linked UPF consumption to metabolic diseases such as metabolicsyndrome and fatty liver disease.

UPF’s combination of high energy density and hyperpalatability promotes overconsumption. This can also contribute to weight gain. 

U.S. obesity rates have risen over the past several decades. Obesity also significantly increases the risk of developing Type 2 diabetes.  

Overconsumption can increase fat storage in the body and interfere with the body’s metabolic processes. This can increase insulin production and fat storage in the liver, both of which promote Type 2 diabetes. 

Policy failures and state action 

The Food and Drug Administration is failing to protect us from harmful food chemicals, including those in UPF. Nearly 99% of food chemicals introduced since 2000 have been approved by the food and chemical industry, and not reviewed by the FDA. 

Progress on oversight for food chemicals and UPF has come largely from state governments.

California recently enacted two first-in-the-nation bans on certain food chemicals, including harmful food dyes in school food. EWG co-sponsored both of these bills. 

Other states have introduced and passed similar legislation.  

The California Senate is now considering Assembly Bill 1264  which would restrict the offering of harmful UPF in public schools. 

How to limit exposure to harmful UPF chemicals

Food choices are often driven by availability and cost. Ultra-processed foods in many categories are often cheaper than less processed foods. 

It doesn’t help that so much of what’s in the grocery store is UPF – by one estimate, as much as 70%

But, just as higher consumption of UPF can be connected to Type 2 diabetes, the reverse is also true: Replacing UPF in the diet with food that is less processed can lower the incidence of diabetes

Not all UPF are equally harmful either, and processing alone doesn’t make food unhealthy. Plain Greek yogurt, whole wheat bread and whole grain cereals are processed foods that contain nutrients like protein and fibre.

For many UPF, there’s a healthier, less-processed alternative. Instead of yogurt with added flavours, artificial colours, zero-calorie sweeteners and thickeners, you might choose a yogurt with simple ingredients: cultured milk and fruit.

The key to identifying these products is reading ingredient lists and nutrition facts. This means looking beyond marketing claims, including greenwashing. Here’s what you can do: 

Consult EWG’s free, searchable Food Scores database, which offers ratings for more than 80,000 food and beverage products based on nutrition, ingredient concerns and processing. A flag that identifies the most unhealthy UPF appears as part of the nutrition facts in the EWG Top Findings section of a product when applicable. 

Our Healthy Living app makes it easy to check what’s in products at the store.

https://www.ewg.org/news-insights/news/2025/07/how-ultra-processed-food-may-fuel-type-2-diabetes 

Wednesday, 23 July 2025

What is Driving Type 2 Diabetes in the US?

From patientcareonline.com

Type 2 diabetes and its high and rising rates in the US are the result of a perfect storm of converging systemic, behavioural, environmental, and economic factors.

Type 2 diabetes (T2D) is a chronic, progressive disease marked by the body's inability to properly use insulin, a hormone essential for regulating blood glucose levels. In this metabolic condition, cells become resistant to insulin’s effects, prompting the pancreas to produce more of the hormone in an attempt to compensate. Over time, this compensatory mechanism fails, resulting in persistent hyperglycaemia. Prolonged elevation of blood sugar levels leads to systemic complications, including cardiovascular disease, neuropathy, chronic kidney disease, and vision impairment.

The scope of this disease in the US is staggering. As of 2021, approximately 38.4 million Americans (~11.6% of the population) were living with diabetes, with T2D accounting for between 90% and 95% of those cases.² Of these individuals, 29.7 million were diagnosed, while an estimated 8.7 million (nearly 23%) were unaware of their condition. Prediabetes is even more prevalent: nearly 98 million US adults—over one in three—were identified as having elevated blood glucose levels that place them at increased risk of progressing to type 2 diabetes.

The US faces a perfect storm of converging systemic, behavioural, environmental, and economic factors that drive its high and rising T2D prevalence.

Overweight and Obesity

Obesity is the most significant modifiable risk factor. More than 40% of American adults meet the clinical criteria for obesity, an endocrinologic condition that directly contributes to insulin resistance and metabolic dysfunction. Obesity in childhood is also rising and and poses a growing concern. Currently obesity affects nearly 20% of children and adolescents, a trend that further increases future risk of diabetes and related chronic diseases.

Sedentary Lifestyle

The lack of physical activity in the US is widespread with many contributing factors. Despite strong evidence that moderate exercise improves glucose control and reduces insulin resistance, fewer than 1 in 4 US adults meet the CDC’s physical activity guideline of 150 minutes of moderate-intensity exercise per week. Of interest, there is a growing body of research that supports "weekend warrior" activity, where an individual reaches the weekly exercise target in just 1 or 2 sessions. Evidence has shown that even this irregular exercise pattern is associated with a 33% reduction in cardiovascular mortality and a 21% decrease in all-cause mortality among people with T2D.

Dietary Habits, Ultra-processed Food

The American diet has also evolved in ways that increase risk for T2D. Consumption of ultra-processed foods and sugar-sweetened beverages is common, while intake of fibre-rich whole foods remains below national recommendations, according to the Department of Agriculture and Health and Human Services Agency. This dietary imbalance is particularly harmful in low-income neighbourhoods where access to fresh, healthy food options is limited. Research has consistently shown that this pattern of high-calorie, nutrient-poor intake is a potent contributor to the development of insulin resistance and progression to type 2 diabetes.

Demographics, Genetics

T2D prevalence is unevenly distributed across demographics and has genetic underpinnings as well. The likelihood of developing T2D increases with age, and the disease is more common in individuals with a family history of diabetes. Certain racial and ethnic groups, including Black, Hispanic, American Indian/Alaska Native, and Asian American populations, are at significantly higher risk. Remarkably, Black adults in the US are nearly 60% more likely to be diagnosed with T2D compared to white adults. Among American Indian and Alaska Native adults, the age-adjusted prevalence is 14.5%, nearly double the 7.4% seen in non-Hispanic white populations. While genetic predisposition accounts for up to 72% of heritable diabetes risk, individual gene effects are usually modest.

Social Determinants of Health, Health Care Access

Beyond individual behaviours and biological risk factors, the structure of the US health care and social safety net systems contributes to the crisis. Despite high per capita healthcare spending, many Americans lack reliable access to preventive care, nutrition counseling, diabetes education, and ongoing disease management. The economic burden is equally concerning. The average annual cost of diabetes per person is $16,750, and approximately 1 in every 4 US health care dollars is spent on diabetes-related care. The US also spends approximately $35 billion annually on insulin, yet cost-related underuse remains a barrier to glycaemic control for many people.

Although the National Diabetes Prevention Program, supported by both NIH and CDC, has demonstrated that modest weight loss and physical activity can reduce the risk of T2D by nearly 60%, the program is underutilized and also underfunded. Lack of awareness, poor reimbursement models, and logistical barriers have all hindered broader adoption, particularly in underserved communities.

The Built Environment Contributes

Research has demonstrated that environmental and urban design factors further exacerbate the issues that contribute to the escalating prevalence of T2D. Many American cities and towns are built in ways that discourage physical activity. Communities often lack sidewalks, bike lanes, or access to safe green spaces. This design limits opportunities for routine movement, which is essential for maintaining metabolic health. Additionally, growing evidence suggests that environmental pollutants, including airborne particulate matter, may increase diabetes risk, especially in urban areas with poor air quality.

When combined, all of these factors create a uniquely challenging public health landscape. While lifestyle-related contributors to T2D are well known, their impact is magnified by systemic inequities in food access, housing, education, and healthcare. These intersecting issues form a web of vulnerability that makes the US particularly susceptible to the epidemic levels of diabetes.

How to Stem the Tide

Yet the trajectory is not irreversible. Evidence-based interventions, including lifestyle modification, early screening, community-based prevention programs, and policy reforms targeting food systems and urban planning, offer powerful tools to reduce new cases and improve outcomes for those already affected. To succeed, these interventions must be accessible, equitable, and supported by systemic changes that address the root causes of diabetes, not just its symptoms.

https://www.patientcareonline.com/view/what-is-driving-type-2-diabetes-in-the-us- 

Tuesday, 22 July 2025

Diabetes Technology: Will It Change Your Life?

From healthcentral.com

New devices promise to make managing diabetes much better. But discuss with your health provider which devices and apps are best for you 

New devices continue to hold the promise to make diabetes easier to manage, particularly with the variety of new technological innovations arriving at a fast and furious pace.

Already, some advances are making the often-dreaded finger pricks a thing of the past, while closed loop systems help automate insulin delivery and are termed by one expert as the “the self-driving car” of diabetes management.

Admittedly, it can be difficult, even frustrating, to try and keep up with what’s new and which technological innovation may benefit which people, so we asked two experts to weigh in on what they see as the most promising new health-based devices.

This list has been compiled with guidance from our two experts:

  • David T. Ahn, M.D., program director and Kris V. Iyer Endowed Chair in Diabetes Care at the Mary and Dick Allen Diabetes Center for Hoag Hospital, Newport Beach, CA.

  • Amy Hess-Fischl, M.S., R.D., LDN, BC-ADM, CDCES, a diabetes educator and the transitional program coordinator at Kovler Diabetes Center in Chicago.

                                    Ask your healthcare provider about whether or not new devices may be help you manage your diabetes

Continuous Glucose Monitoring Minus Calibration

Abbott’s continuous glucose monitoring system (CGM) FreeStyle Libre 2 is now available with an iPhone app. That means you can scan your sensor using the FreeStyle Libre 2 app instead of the reader. This newest approach to continuous glucose monitoring can replace the traditional blood glucose finger prick check; instead blood glucose levels are read through a sensor worn on the back of the upper arm. The sensor can now be left in place for up to 14 days, according to the manufacturer.

Another option is the Dexcom G6, which can send glucose readings to your smartphone or Dexcom receiver, with no finger sticks (unless symptoms or expectations don’t match readings).

Getting rid of finger pricks is welcomed by nearly all people with diabetes, Dr. Ahn says. So much so that he predicts this technology, aimed first at those with type 1 diabetes, will soon be embraced by the type 2 diabetes market.

Closed Loop System = Artificial Pancreas

Also called the world’s first artificial pancreas, the hybrid closed-loop insulin delivery system took first place on the Cleveland Clinic’s list of top 10 medical innovations for 2018. The system, also called an automated insulin delivery device, “helps make type 1 diabetes more manageable,” the Cleveland Clinic experts said. The system made the “most promising” list from both experts.

They were talking about the Medtronic MiniMed 670G system. Direct communication between the continuous glucose monitoring device and the insulin pump produces a stabilized blood glucose. The new technology replaces the so-called open loop concept that requires patients to access information from the CGM to determine how much insulin they need to inject.

Now, technology has advanced even more. There’s the Medtronic MiniMed 780G System. It is a self-dosing basal insulin pump with autocorrection dosing.

Smart Pens for Easier Insulin Injection

Smart pens, now offered by a few companies, were a favourite of Dr. Ahn’s. One example is Medtronics’ InPen.

The InPen is a reusable smart insulin pen that uses Bluetooth technology to send dose information to a mobile app. According to the company, it offers support with dose calculations and tracking, thereby taking some of the “mental math” out of diabetes management.

According to Medtronics: “The pen injector is compatible with Lilly Humalog U-100 3.0 mL cartridges, Novo Nordisk Novolog U-100 3.0 mL cartridges, and Novo Nordisk Fiasp U-100 3.0 mL cartridges and single-use detachable and disposable pen needles (not included). The pen injector allows the user to dial the desired dose from 0.5 to 30 units in one-half (1/2) unit increments.”

Strategy Needed to Make the Most of New Devices

Most importantly, diabetes self-care technology must be personalized, says Hess-Fischl. “Figure out what system is your system,” she says, by discussing the options with a certified diabetes care and education specialist or a doctor who knows the technology.

For instance, she says, the artificial pancreas system has wonderful features, but may not work well for someone who wants to manipulate their insulin and not give up what they perceive as needed control. On the other hand, a person who is struggling to manage their blood sugar and finds themselves falling short in meeting glucose goals despite earnest efforts may do well with it, she says.

Consider your preference, as well as your comfort level with technology. “It becomes very personal,” she says, so deciding which technology is best requires an in-depth discussion between you and your health care professional, and this may change as the device options evolve.

https://www.healthcentral.com/condition/diabetes/diabetes-technology