Showing posts with label Experts. Show all posts
Showing posts with label Experts. Show all posts

Saturday, December 11, 2010

Diabetes 'time bomb ticking,' experts say

By 2020, more than half the nation's adult population will have diabetes or the condition that precedes it, which will create more than $3 trillion in health-care expenses, a new report says.

El Paso is likely to be hit harder than many other areas, said Mickey Molina, an El Paso Diabetes Association board member.

"Because of our demographics, the fact (El Paso) is primarily Hispanic, I think the numbers here will be worse," Molina said. The incidence of diabetes among Hispanics is nearly double that of non-Hispanic whites, according to the American Diabetes Association. The causes are not entirely clear, Molina said, but probably are related to diet.

The report, created by UnitedHealth Group's Center for Health Reform and Modernization, estimates that 52 percent of the adult population will have diabetes or prediabetes in 10 years. Treating that population will cost an estimated $3.35 trillion, the report says.

"Our new research shows there is a diabetic time bomb ticking in America, but fortunately, there are practical steps that can be taken now to defuse it," Simon Stevens, the group's executive vice president, said in a statement. "Making a major impact on the prediabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models."

Prevention and control of the disease could cut costs by as much as $250 billion over the decade, the report says.

"The only way

to curtail diabetes is to prevent it," Molina said.

About 27 million U.S. residents now have diabetes, the report states. Nearly a quarter of them are unaware that they have the disease, according to the report.

It estimates that an additional 67 million have prediabetes. About 60 million of them, it says, are not aware of their condition, which has few symptoms.

Prediabetes is characterized by elevated glucose levels that are not high enough for a diabetes diagnosis. Recent research, according to the American Diabetes Association, has shown that the condition can damage the heart and circulatory system.

El Paso County had 74 cases of diabetes per 1,000 people in 2005, according to the federal Centers for Disease Control and Prevention's National Diabetes Surveillance System.

Nationally, there were 53 cases per 1,000 people. Texas, in that same year, had the highest diabetes rate of any Southwest border state.

Molina said he believes those numbers understate the problem.

Many people are in denial when it comes to diabetes, said Molina who estimates about a quarter of El Pasoans have some form of the disease or its precursor.

"It's really a terrible disease because it comes in the back door," said Molina, who has been diagnosed with Type 2 diabetes.

"People don't think about it until they get the blurry vision or the cramps" that can be symptoms of diabetes.

Once you are diagnosed, there is no cure, Molina said.

Prevention includes exercise, weight loss in some cases and, above all, a healthful diet.

"The diabetes diet is the diet everybody else should be eating, which is a balanced diet," Molina said. "You have to make a change in lifestyle."

Molina also believes medical costs are higher than estimated.

"Nobody ever died of diabetes," Molina said. "But you have the heart problems, the kidney problems, the eye problems."

In 2009, a person diagnosed with diabetes required a total of about $11,700 in health care annually, the report says.

The remainder of the population required an average of $4,400 a year, it states. And people who suffered complications from diabetes required an average of $20,700 annually, it says.

"So many people are in denial, and they think once they get it, they can take a pill and go on their merry way," Molina said.

"It doesn't work that way."

Chris Roberts may be reached at chrisr@elpasotimes.com; 546-6136.


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Saturday, November 20, 2010

Experts issue recommendations for treatment of post-bariatric surgery patients

ScienceDaily (Nov. 4, 2010) ? The Endocrine Society has released a new clinical practice guideline for the nutritional and endocrine management of adults after bariatric surgery, including those with diabetes mellitus. The guideline features a series of evidence-based clinical recommendations developed by an expert task force. The guideline is published in the November 2010 issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.

Between 1999 and 2004, obesity rates in the United States increased by 24 percent. Bariatric surgery has gained wide acceptance as a treatment for severe obesity, especially when complicated by type 2 diabetes. Common operations include laparoscopic banding procedures and gastric surgeries, which restrict the volume of food entering the stomach and intestines. Patients undergoing bariatric surgery may still experience weight regain and may also present with associated co-morbidities, including type 2 diabetes, polycystic ovarian disease, metabolic bone disease, fatty liver, hypertension and obstructive sleep apnea.

"Bariatric surgery is not a guarantee of success, and patients require postoperative care," said David Heber, MD, PhD, of the University of California, and chair of the task force that developed the guideline. "To help prevent weight regain, ensure that co-morbid conditions are adequately managed and ease the transition to life after bariatric surgery, the guideline recommends that patients receive the support of a multidisciplinary team that includes an experienced primary care physician, endocrinologist or gastroenterologist."

Other recommendations from the guideline include:

Active nutritional patient education and clinical management to prevent and detect nutritional deficiencies for all patients undergoing bariatric surgery;Management of potential nutritional deficiencies for patients undergoing malabsorptive procedures as well as strategies to compensate for food intolerance in patients who have had a malabsorptive procedure to reduce the risk for clinically important nutritional deficiencies;Patient enrollment in a comprehensive program for nutrition and lifestyle management; andFuture research aimed at addressing the effectiveness of intensive postoperative nutritional and endocrine care in reducing morbidity and mortality from obesity-associated chronic diseases.

The Hormone Foundation, the patient education affiliate of The Endocrine Society, has published a companion patient guide. It outlines steps patients and their health care team should take to avoid nutritional deficiencies and resulting complications, such as protein malnutrition or bone loss, particularly after malabsorptive operations. The guide explains that, in most patients, obesity-related health problems disappear or greatly improve after surgery. It also encourages patients to have realistic expectations about what the surgery can do for them and the lifestyle changes they must make to lose weight and keep it off.

The patient guide can be found online at: www.hormone.org/bariatric-patient-guide.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by The Endocrine Society, via EurekAlert!, a service of AAAS.

Note: If no author is given, the source is cited instead.


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Monday, October 25, 2010

Experts advocate realigning type 2 diabetes treatments with disease's natural history

ScienceDaily (Oct. 6, 2010) ? A new consensus statement published in the September 2010 issue of The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM) finds that the increasing recognition that beta-cell failure occurs much earlier and severely than commonly believed suggests that regular glycemia screening, early identification of patients at metabolic risk and prompt and aggressive intervention deserves greater emphasis.

The consensus statement is based on the findings of a working group of basic researchers, clinical endocrinologists and primary care physicians convened by The Endocrine Society, to consider whether current knowledge regarding pancreatic beta-cell defects justifies retargeting and retiming treatment for diabetes in clinical practice.

"There is widespread evidence that conventional approaches to the management of type 2 diabetes have been inadequate," said Jack L. Leahy, MD, of the Vermont Regional Diabetes Center in South Burlington, and one of the authors of the consensus statement. "Studies have increasingly shown that beta-cells have an important role in the progression of diabetes and if we could gain a better understanding of that role, we may be able to develop new and effective means of treatment. To that end, working group members advocate for continued basic research to elucidate the nature and mechanisms of beta-cell failure in type 2 diabetes."

Evidence from both human and animal studies suggests that type 2 diabetes is characterized by dysfunctional beta-cells that cannot adapt insulin secretion to compensate for increasing insulin resistance. Beta-cell failure is believed to occur at an early stage in the progression of diabetes, and accumulating evidence suggests that the decline in beta-cell function may be slowed or even reversed, particularly if addressed early.

"Another recommendation of the working group is to explore new educational approaches to promote pathophysiology-based clinical practices, and that is why the Society has launched the new Web site, BetaCellsinDiabetes.org," said Leahy. "It is our hope that the new site will aid primary care physicians in the interpretation of concepts of disease pathogenesis, such as beta-cell dysfunction, and improve medical decision-making regarding treatment of type 2 diabetes. We have made the site practical by synthesizing research, creating case studies, providing a curated list of the published literature, and inviting viewers to comment throughout the site."

In the consensus statement, experts also recommend additional studies to establish the clinical value of pharmacological therapies targeting beta-cell function. In addition, further research should aim to determine whether specific genetic subtypes of type 2 diabetes lend themselves to individualized therapy to slow or reverse beta-cell decline.

"More research is needed to determine whether preserving beta-cell function improves morbidity and mortality rates," said Leahy. "Nonetheless, the increasing recognition that beta-cell failure occurs much earlier and severely than commonly believed suggests that regular glycemia screening, early identification of patients at metabolic risk and prompt and aggressive intervention deserves greater emphasis."

The 2009 working group meeting was funded by an unrestricted educational grant from Novo Nordisk.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by The Endocrine Society, via EurekAlert!, a service of AAAS.

Journal Reference:

J. L. Leahy, I. B. Hirsch, K. A. Peterson, D. Schneider. Targeting β-Cell Function Early in the Course of Therapy for Type 2 Diabetes Mellitus. Journal of Clinical Endocrinology & Metabolism, 2010; 95 (9): 4206 DOI: 10.1210/jc.2010-0668

Note: If no author is given, the source is cited instead.


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