Archive for the 'The Diabetes Facts' Category

Diabetes Care in the Philippines

April 22, 2016

Screen Shot 2016-04-22 at 1.14.02 PMMy article on Diabetes Care in the Philippines is now published in the Annals of Global Health Volume 81, issue 6 November-December 2015. This is a thorough review of the kind of Diabetes Care the Philippines available to our countrymen.

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Diabetes Care in the Philippines

Gerry H. Tan, MD

Abstract
Background

Diabetes is increasing at an alarming rate in Asian countries including the Philippines. Both the prevalence and incidence of type 2 diabetes (T2D) continue to increase with a commensurate upward trend in the prevalence of prediabetes.

Objectives

The aim of this study was to review the prevalence of diabetes in the Philippines and to describe extensively the characteristics of diabetes care in the Philippines from availability of diagnostics tests to the procurement of medications.

Methods

A literature search was performed using the search words diabetes care and Philippines. Articles that were retrieved were reviewed for relevance and then synthesized to highlight key features.

Findings

The prevalence of diabetes in the Philippines is increasing. Rapid urbanization with increasing dependence on electronic gadgets and sedentary lifestyle contribute significantly to this epidemic. Diabetes care in the Philippines is disadvantaged and challenged with respect to resources, government support, and economics. The national insurance system does not cover comprehensive diabetes care in a preventive model and private insurance companies only offer limited diabetes coverage. Thus, most patients rely on “out-of-pocket” expenses, namely, laboratory procedures and daily medications. Consequently, poor pharmacotherapy adherence impairs prevention of complications. Moreover, behavioral modifications are difficult due to cultural preferences for a traditional diet of refined sugar, including white rice and bread.

Conclusions

Translating clinical data into practice in the Philippines will require fundamental and transformative changes that increase diabetes awareness, emphasize lifestyle change while respecting cultural preferences, and promote public policy especially regarding the health insurance system to improve overall diabetes care and outcomes.

Key Words
diabetes; diabetes care; Philippines; Southeast Asia; type 2 diabetes

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Rosiglitazone (Avandia) Does not cause Heart Attack

November 26, 2013

Rosiglitazone (Avandia) Does not cause Heart Attack

Been a user of this drug prior to its removal.  I strongly believe in its usefulness as a drug.  Now I can safely tell my patients that I was indeed right all along.  Sometimes its how the news is perceived by the public that forces others to listen and then strongly believes.  It is best to instead let the Facts do the talking.

 

Your Neighborhood Can Put You At Risk of Diabetes….

September 30, 2012

It is a known fact that diabetes develops because of the changing environment.  From processed food to urbanization resulting in the lack of time to do exercise. But one study done recently and published in Diabetes Care, Sept 2012, tells us that this maybe in reality just right in the corner of our backyard.

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Abstract

OBJECTIVE This study was designed to examine whether residents living in neighborhoods that are less conducive to walking or other physical activities are more likely to develop diabetes and, if so, whether recent immigrants are particularly susceptible to such effects.

METHODS We conducted a population-based, retrospective cohort study to assess the impact of neighborhood walkability on diabetes incidence among recent immigrants (n = 214,882) relative to long-term residents (n = 1,024,380). Adults aged 30–64 years who were free of diabetes and living in Toronto, Canada, on 31 March 2005 were identified from administrative health databases and followed until 31 March 2010 for the development of diabetes, using a validated algorithm. Neighborhood characteristics, including walkability and income, were derived from the Canadian Census and other sources.

RESULTS Neighborhood walkability was a strong predictor of diabetes incidence independent of age and area income, particularly among recent immigrants (lowest [quintile 1 {Q1}] vs. highest [quintile 5 {Q5}] walkability quintile: relative risk [RR] 1.58 [95% CI 1.42–1.75] for men; 1.67 [1.48–1.88] for women) compared with long-term residents (Q1 to Q5) 1.32 [1.26–1.38] for men; 1.24 [1.18–1.31] for women). Coexisting poverty accentuated these effects; diabetes incidence varied threefold between recent immigrants living in low-income/low walkability areas (16.2 per 1,000) and those living in high-income/high walkability areas (5.1 per 1,000).

CONCLUSIONS Neighborhood walkability was inversely associated with the development of diabetes in our setting, particularly among recent immigrants living in low-income areas.

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This study has general implications for primary prevention of diabetes. Choosing the right place to live is probably the most preventable risk to developing diabetes which is not well controlled can have significant long term health implication.

It is the belief that if your neighborhood is conducive to walking or running or biking… then most of the dwellers will have no reason not to exercise.  But if the environment where you live is not conducive to walking, then this becomes an excuse to be a couch potato.

 

 

Sleep and Diabetes: Quality Matters NOT Quantity!!!!

May 30, 2011

Go to fullsize imageLack of sleep causes stress. Stress increases stress hormones that can increase glucose. Understandably,lack of sleep equals risk for diabetes.  I used to believe from previous studies that a duration of sleep less than 7 hours increases ones risk to develop diabetes. 

 Now comes a new study published in Diabetes Care March 2011, that tell us Quality is important than Quantity…

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OBJECTIVE To examine whether sleep duration and quality are associated with fasting glucose, fasting insulin, or estimated insulin resistance in a community-based sample of early middle-aged adults.

RESEARCH DESIGN AND METHODS This was an ancillary study to the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Habitual sleep duration and fragmentation were estimated from 6 days of wrist actigraphy collected in 2003–2005. Insomnia was defined as self-reported difficulty falling asleep or waking up in the night three or more times per week plus average sleep efficiency of <80% based on actigraphy. Fasting blood samples to measure glucose and insulin were collected after the sleep measures during the CARDIA clinical examination in 2005–2006. Insulin resistance was estimated using the homeostatic model assessment (HOMA) method. Analyses were cross-sectional and stratified by the presence of diabetes.

RESULTS There was no association between sleep measures and fasting glucose, insulin, or HOMA in the 115 subjects without diabetes. Among the 40 subjects with diabetes, after adjustment for covariates, 10% higher sleep fragmentation was associated with a 9% higher fasting glucose level, a 30% higher fasting insulin level, and a 43% higher HOMA level. Insomnia was associated with a 23% higher fasting glucose level, a 48% higher fasting insulin level, and an 82% higher HOMA level.

CONCLUSIONS The observed association between poor sleep quality and higher glucose, insulin, and estimated insulin resistance among subjects with diabetes warrants further examination of the effect of sleep disturbances on glucose control in type 2 diabetes.

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In the study, sleep duration was assessed as the amount of sleep obtained per night while sleep fragmentation was based on the periods of restlessness and movements that the pateints had during the night.

What is interesting in the study was that there was no association between sleep duration and glucose metabolism in groups with or without diabetes.  This is in contrast to earlier studies which showed otherwise. 

However sleep fragmentation was signicantly associated with increasing blood sugar so that for every 10% higher sleep fragmentation,  there was an associated 9% higher fasting glucose and higher insulin level suggesting insulin resistance.  What is important is that sleep fragmentation WAS not associated with higher glucose if one is NOT a diabetic.  Meaning, sleep disturbance is a risk factor  for poor blood sugar control among diabetics!

In conclusion, the authors assessed that POOR sleep and NOT Short Duration is associated with poor glucose control!!!  That intervention to warrant investigations of causes for poor sleep can help make diabetics have better control.

So do you snore? and probably stop breathing often?

Ask your partner… and better have your sleeping pattern assessed as this may lead to better control of your blood sugar if corrected!

The Dangers of Sugary Drinks

November 16, 2010

Consumption of sugary drinks not only make you gain weight BUT now has been proven to strongly increase your risk to develop Diabetes and other obesity related diseases. 

A new study has shown us there is a  link regarding the risk of developing diabetes to intake of sugary drinks and this link is high enough to approximate the risk that one gets from smoking!!!!

This new study is published in the recent publication of Diabetes Care in 2010:

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OBJECTIVE: Consumption of sugar-sweetened beverages (SSBs), which include soft drinks, fruit drinks, iced tea, and energy and vitamin water drinks has risen across the globe. Regular consumption of SSBs has been associated with weight gain and risk of overweight and obesity, but the role of SSBs in the development of related chronic metabolic diseases, such as metabolic syndrome and type 2 diabetes, has not been quantitatively reviewed.

RESEARCH DESIGN AND METHODS: We searched the MEDLINE database up to May 2010 for prospective cohort studies of SSB intake and risk of metabolic syndrome and type 2 diabetes. We identified 11 studies (three for metabolic syndrome and eight for type 2 diabetes) for inclusion in a random-effects meta-analysis comparing SSB intake in the highest to lowest quantiles in relation to risk of metabolic syndrome and type 2 diabetes.

RESULTS: Based on data from these studies, including 310,819 participants and 15,043 cases of type 2 diabetes, individuals in the highest quantile of SSB intake (most often 1-2 servings/day) had a 26% greater risk of developing type 2 diabetes than those in the lowest quantile (none or <1 serving/month) (relative risk [RR] 1.26 [95% CI 1.12-1.41]). Among studies evaluating metabolic syndrome, including 19,431 participants and 5,803 cases, the pooled RR was 1.20 [1.02-1.42].

CONCLUSIONS: In addition to weight gain, higher consumption of SSBs is associated with development of metabolic syndrome and type 2 diabetes. These data provide empirical evidence that intake of SSBs should be limited to reduce obesity-related risk of chronic metabolic diseases.

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In practical terms, the association between intake of sugary drinks and Diabetes can be translated to something like this:

For every  12 oz sugar laden drink that you order in a restaurant today like the ever famous and popular sugary and tasty Ice Tea or canned OJ… a roughly 25% increase in risk  for you to develop Diabetes on top of your risk to gain more weight!

So if one actually drinks 2-3 bottles of Soda per day then the risk is further increased to 30% roughly similar to the risk one gets due to smoking!

Would it be better to take Diet Drinks then? It maybe safer BUT the associated increase in food intake is the culprit.  Likewise there are some concerns now that link Diet Sodas also to increased risk of Metabolic syndrome suggesting that artificial sweeteners may have a role in itself. 

So my recommendation to my patients is to limit one’s consumption to only 1 diet soda per day and if possible enjoy Water instead!

Coffee is GOOD for the HEART

August 27, 2010

Go to fullsize imageAnother good news for us coffee lovers. 

Coffee has been shown to have good effects on the vessels and has been shown to improve the vessels capacity to dilate.  This finding is another plus factor for us drinkers of coffee because it helps reduce the stress of the heart in pushing blood out of the vessels. 

And this plus effect is on top of previous studies showing coffee to be protective against developing diabetes.

The study will be presented during the European Society of Cardiology meeting as an abstract.  The abstract was discussed online in MedPage today.

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One to two cups a day correlated with greater aortic distensibility compared with rarely consuming coffee (P=0.45) in a cohort of men and women 65 and older on the Greek island of Ikaria

Likewise, Chrysohoou and colleagues found that, compared with rarely drinking coffee, moderate consumption of one or two cups a day was associated with:

  • Lower prevalence of diabetes (22% versus 34%, P=0.02)
  • Lower prevalence of high cholesterol (41% versus 55%, P=0.001)
  • Lower body mass index (28 versus 29 kg/m2, P=0.04)
  • Higher creatinine clearance levels (70.2 versus 65 mL/min, P=0.01)
  • Lower prevalence of cardiovascular disease (19% versus 26%, P=0.04)
  • Higher values of aortic distensibility (P<0.05)

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The coffee blend that was used according to the authors were of the traditional Greek blends, which apprently have higher levels of phenol compounds thought to be protective for the heart than coffee typically consumed in the U.S.

This study tells us to drink coffee in moderation and advises us to drink only 1-2 cups per day.

There you go guys…another toast to more days of fun with coffee……

Napping May Not Be Healthy After All….

August 23, 2010

Go to fullsize imageSiesta is still practiced by some of us up to now.  We take a break after lunch to take a nap to recharge and be back to work in the afternoon feeling fresh. But is this practice really healthy or can it cause harm instead?

A new study published in Sleep has this to say:

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Study Objective: Intentional napping is very common, particularly in China. However, there are limited data regarding its potential health effects. We therefore examined the possible relationship between napping and type 2 diabetes.
 

Design: Cross-sectional analysis of baseline data from the Guangzhou Biobank Cohort Study.

Setting: Community-based elderly association in Guangzhou, China.

Participants: 19,567 Chinese men and women aged 50 years or older.

Measurements and Results: Self-reported frequency of napping was obtained by questionnaire and type 2 diabetes was assessed by fasting blood glucose and/or self-reports of physician diagnosis or treatment. Participants reporting frequent naps (4-6 days/week and daily) were 42% to 52% more likely to have diabetes. The relationships remained essentially unchanged after adjustments were made for demographics, lifestyle and sleep habits, health status, adiposity, and metabolic markers (odds ratio for diabetes 1.36 [95% CI 1.17–1.57] in 4-6 days/week, 1.28 [1.15–1.44] in daily nappers). Similar associations were found between napping and impaired fasting glucose. Removal of those with potential ill health and daytime sleepiness did not alter the observed associations.

Conclusions: Napping is associated with elevated prevalence of diabetes and impaired fasting glucose in this older Chinese sample. Our finding suggests that it is less likely that diabetes leads to daytime sleepiness. This raises the possibility that napping may increase the risk of diabetes. Confirmation by longitudinal studies is needed.

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In the study approxiametly 2/3 of the napper took a nap just like everyopne else i.e. around 1 hour after lunch and usually lasts around 60 minutes. 

So I guess the population is really well represented as this is the usual behaviour of a typical napper. 

 What is important is that the longer and more frequent one naps, the higher the risk of developing diabetes.

The study confirms previous studies from the US and Germany regarding the association of napping and diabetes as well as all cause mortality or death.  Imagine trying to take a break to feel better and instead cuts down on your life span.  Something to think about! 

In Short: Napping may not be safe or healthy after all!!!

Coffee or Tea To Prevent Diabetes…

July 27, 2010

I have posted studies on coffee and tea as a way to prevent diabetes based on single study results.  Now comes a metaanalysis which compiles all data from  different studies to see if there are trends toaward prevention.  This new metaanalysis was published in  Archives of Internal Medicine this year:

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Background  Coffee consumption has been reported to be inversely associated with risk of type 2 diabetes mellitus. Similar associations have also been reported for decaffeinated coffee and tea. We report herein the findings of meta-analyses for the association between coffee, decaffeinated coffee, and tea consumption with risk of diabetes.

Methods  Relevant studies were identified through search engines using a combined text word and MeSH (Medical Subject Headings) search strategy. Prospective studies that reported an estimate of the association between coffee, decaffeinated coffee, or tea with incident diabetes between 1966 and July 2009.

Results  Data from 18 studies with information on 457 922 participants reported on the association between coffee consumption and diabetes. Six (N = 225 516) and 7 studies (N = 286 701) also reported estimates of the association between decaffeinated coffee and tea with diabetes, respectively. We found an inverse log-linear relationship between coffee consumption and subsequent risk of diabetes such that every additional cup of coffee consumed in a day was associated with a 7% reduction in the excess risk of diabetes relative risk, 0.93 [95% confidence interval, 0.91-0.95]) after adjustment for potential confounders.

 Conclusions  Owing to the presence of small-study bias, our results may represent an overestimate of the true magnitude of the association. Similar significant and inverse associations were observed with decaffeinated coffee and tea and risk of incident diabetes. High intakes of coffee, decaffeinated coffee, and tea are associated with reduced risk of diabetes. The putative protective effects of these beverages warrant further investigation in randomized trials.

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 This study hypothesizes what we believe is a true association to the protective effect of coffee and tea in developing diabetes.

What is significant is the fact that so far no untoward problems have been encountered with drinking coffee except a benefit to preventing diabetes which may have a great implication to those at risk of the disease.

But dont forget…lifestyle change should continue to be the priority in the heirarchy of prevention.  Coffee is just an add on….

I will definitely continue to enjoy my cup of coffee every morning and another cup in the afternoon daily.  Decaf at night is tempting.

Another Reason To Exercise…

July 1, 2010

weight-loss.womendiary.net/pic/kids-exercise.jpgI really dont look at exercise as a way to lose weight. Definitiely it can help but the bottom line for weight loss is really restricting the amount of calories one takes in.  But the reality of exercise are the benefits one gets with it especially if done regularly.

I do exercise daily by jogging solely to maintain my weight to a normal level for my height because of my risk to develop diabetes due to a strong family history.

Recently in a report from the American Diabetes Association as reported in Medscape Endocrinology June 26, 2010 is a good study that looked at the effect of exercise in preventing diabetes:

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Obese boys who engaged in regular aerobic or resistance exercise — without dietary changes — had significant improvements over 3 months in their total body fat, visceral adipose tissue concentrations, and insulin sensitivity than their more sluggish counterparts.

The results were independent of the type of exercise assigned, and suggest that a moderate increase in activity (180 minutes per week) can help prevent type 2 diabetes mellitus in this high-risk population.

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In the study, whether aerobic or resistance training did not matter.  The insulin sensitivity analysis was the same in both groups although better with the resistance training group. 

Plus… this study only looked at the effect of exercise and risk for diabetes without restricting calorie intake.  Suggesting that exercise indeed can have tremendous benefical effects in preventing one from developing chronic medical metabolic conditions that can have long term complications.

There you go guys… another good reason to get going…grab your shoes and start running!

Cut Down on Sweetened Juice To Help Improve BP

June 14, 2010

Go to fullsize imageOne major aspect in controlling ones BP is to lower salt intake. Salt basically increases the reaction of the blood vessels to contrict or “close” – raise your BP then increase the pressure of the heart in pumping blood out of the circulation which in the long term cause heart failure or heart enlargement. As a precaution, we always warn patients from enjoying too much salt.

Now comes an interesting study published in Circulation in June 2010 looking at another aspect of food that we know should be avoided if one has high sugar…but now is known to affect and lower ones BP also.

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BACKGROUND: Increased consumption of sugar-sweetened beverages (SSBs) has been associated with an elevated risk of obesity, metabolic syndrome, and type II diabetes mellitus. However, the effects of SSB consumption on blood pressure (BP) are uncertain. The objective of this study was to determine the relationship between changes in SSB consumption and changes in BP among adults.

METHODS AND RESULTS: This was a prospective analysis of 810 adults who participated in the PREMIER Study (an 18-month behavioral intervention trial). BP and dietary intake (by two 24-hour recalls) were measured at baseline and at 6 and 18 months. Mixed-effects models were applied to estimate the changes in BP in responding to changes in SSB consumption. At baseline, mean SSB intake was 0.9+/-1.0 servings per day (10.5+/-11.9 fl oz/d), and mean systolic BP/diastolic BP was 134.9+/-9.6/84.8+/-4.2 mm Hg. After potential confounders were controlled for, a reduction in SSB of 1 serving per day was associated with a 1.8-mm Hg (95% confidence interval, 1.2 to 2.4) reduction in systolic BP and 1.1-mm Hg (95% confidence interval, 0.7 to 1.4) reduction in diastolic BP over 18 months. After additional adjustment for weight change over the same period, a reduction in SSB intake was still significantly associated with reductions in systolic and diastolic BPs (P<0.05). Reduced intake of sugars was also significantly associated with reduced BP. No association was found for diet beverage consumption or caffeine intake and BP. These findings suggest that sugars may be the nutrients that contribute to the observed association between SSB and BP.

CONCLUSIONS: Reduced consumption of SSB and sugars was significantly associated with reduced BP. Reducing SSB and sugar consumption may be an important dietary strategy to lower BP.

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What does this study tell us:

 That of the >800 adults in the study: that drinking one less sugar-sweetened beverage a day resulted in the lowering of both systolic and diastolic BP by about 1.2 mm Hg and 1.1 mm Hg  over 18 months period of observation.

I am actually not surprised by this relationship.  We all know, anytime a patient has high BP, I always make sure he is not at risk to become diabetic with high cholesterol since the three always come in groups and are always partners in crime. So controlling for one may result in the improvement of the other.  So any dietary intevention that I do for my patients incorporate for the control of the three conditions.

Remember: For every 3-mm-Hg reduction in systolic BP : the risk of dying from stroke is reduced by 8% and the risk of dying for heart disease is redcued by 5%.  So any small amount of decrement is worth it!

There you go guys: another reason to cut down on SUGAR!

Coffee or Tea Keeps Diabetes Away….

May 11, 2010

Anothe rgood news for coffee lovers like me… Now comes a new study agina showing the reduction in ones risk to develop diabetes.  The study was recently published in the Archives of Internal Medicine December issue

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Background  Coffee consumption has been reported to be inversely associated with risk of type 2 diabetes mellitus. Similar associations have also been reported for decaffeinated coffee and tea. We report herein the findings of meta-analyses for the association between coffee, decaffeinated coffee, and tea consumption with risk of diabetes. Methods  Relevant studies were identified through search engines using a combined text word and MeSH (Medical Subject Headings) search strategy. Prospective studies that reported an estimate of the association between coffee, decaffeinated coffee, or tea with incident diabetes between 1966 and July 2009.

Results  Data from 18 studies with information on 457 922 participants reported on the association between coffee consumption and diabetes. Six (N = 225 516) and 7 studies (N = 286 701) also reported estimates of the association between decaffeinated coffee and tea with diabetes, respectively. We found an inverse log-linear relationship between coffee consumption and subsequent risk of diabetes such that every additional cup of coffee consumed in a day was associated with a 7% reduction in the excess risk of diabetes relative risk, 0.93 [95% confidence interval, 0.91-0.95]) after adjustment for potential confounders.

Conclusions  Owing to the presence of small-study bias, our results may represent an overestimate of the true magnitude of the association. Similar significant and inverse associations were observed with decaffeinated coffee and tea and risk of incident diabetes. High intakes of coffee, decaffeinated coffee, and tea are associated with reduced risk of diabetes. The putative protective effects of these beverages warrant further investigation in randomized trials.

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This study again shows same conclusion as in the past that a mere 4 cups of coffee per day whether regular or decaf has been shown to reduce ones risk to develop diabetes by 27%.  And what is interesting is that for every extra cup of coffee, an additional 7 % further reduction is risk to develop diabetes was noted.

The study therefore points out to one thing…that caffeine may not be the factor as decaf can result in similar reduction in risk.  Other chemicals present in coffee therefore need to be explored…. 

However…one should not resort to just relying on coffee to reduce our risk to develop diabetes.  We have to remember that lifestyle and proper food intake has been shown to reduce the risk of developing diabetes by a whoooping 50%….

There you go guys…enjoy our coffee!!!!

Soft Drinks and Health….

March 1, 2010

More and more studies are linking the consumption of soft drinks to health hazards… a recent article published in Cancer, Epidimeology, Biomarkers and Prevention showed that consumption of thses sugary drinks can increase ones risk to develop pancreatic cnacer.

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Background: Sugar-sweetened carbonated beverages (called soft drinks) and juices, which have a high glycemic load relative to other foods and beverages, have been hypothesized as pancreatic cancer risk factors. However, data thus far are scarce, especially from non-European descent populations. We investigated whether higher consumption of soft drinks and juice increases the risk of pancreatic cancer in Chinese men and women.

Methods: A prospective cohort analysis was done to examine the association between soft drink and juice consumption and the risk of pancreatic cancer in 60,524 participants of the Singapore Chinese Health Study with up to 14 years of follow-up. Information on consumption of soft drinks, juice, and other dietary items, as well as lifestyle and environmental exposures, was collected through in-person interviews at recruitment. Pancreatic cancer cases and deaths were ascertained by record linkage of the cohort database with records of population-based Singapore Cancer Registry and the Singapore Registry of Births and Deaths.

Results: The first 14 years for the cohort resulted in cumulative 648,387 person-years and 140 incident pancreatic cancer cases. Individuals consuming ≥2 soft drinks/wk experienced a statistically significant increased risk of pancreatic cancer (hazard ratio, 1.87; 95% confidence interval, 1.10-3.15) compared with individuals who did not consume soft drinks after adjustment for potential confounders. There was no statistically significant association between juice consumption and risk of pancreatic cancer.

Conclusion: Regular consumption of soft drinks may play an independent role in the development of pancreatic cancer. Cancer Epidemiol Biomarkers Prev; 19(2); 447–55

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The study highlights the consumption of sugar laden soft drinks as a culprit but not other sugary fruit juices.  Other findings that I need to highlight include:

  • Smokers in the study  had a 49% increased risk for pancreatic cancer.  Another reason for one to consider stopping smoking.
  • A history of diabetes was not associated with an increased risk for pancreatic cancer.  But I would say…any diabetic should be screend for pancreatic cancer and this disease manifests a high blood suagr.
  • Drinking 2 or more soft drinks per week was associated with more than 80% increase in risk for pancreatic cancer after adjustment for other risks.  Now …. I know of some who drink soft drinks daily 2-3 x. Scary thought indeed!!!!  In short LIMIT!

Heres a confusing thought from the study though: after adjustment, juice intake of 2 or more drinks per week overall was not associated with increased risk, but when smokers were excluded, there was an association between juice intake and pancreatic cancer risk increasing a persons risk by 60%.  More studies need to be done to examine this relationship. 

So friends…just like my reminder all the time… Limit and limit and not totally eliminate!

We still dont know what is really in the soft drinks that make us unwell.  For now… enjoy it but limit the consumption to sugar free Diet soft drinks. 

Better still enjoy the water!  its FREE!

Weight Loss and Health….

November 6, 2009

Now the good news….

The main reason for my weight loss through lifestyle change is my aim to reduce my risk to develop diabetes in the future.  After a scary 96 mg/dl fasting blood sugar during my annual executive checkup, I pushed myself to achieve my ideal BMI becuase apparently I was overweight.

Now as published in Lancet this October 29, 2009, the long term Diabetes Prevention Program extended study showed long term benefits of modest weight loss through lifestyle as better in preventing the progression of the disease compared to intake of medication called Metformin. 

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Background

In the 2·8 years of the Diabetes Prevention Program (DPP) randomised clinical trial, diabetes incidence in high-risk adults was reduced by 58% with intensive lifestyle intervention and by 31% with metformin, compared with placebo. We investigated the persistence of these effects in the long term.

Methods

All active DPP participants were eligible for continued follow-up. 2766 of 3150 (88%) enrolled for a median additional follow-up of 5·7 years (IQR 5·5—5·8). 910 participants were from the lifestyle, 924 from the metformin, and 932 were from the original placebo groups. On the basis of the benefits from the intensive lifestyle intervention in the DPP, all three groups were offered group-implemented lifestyle intervention. Metformin treatment was continued in the original metformin group (850 mg twice daily as tolerated), with participants unmasked to assignment, and the original lifestyle intervention group was offered additional lifestyle support. The primary outcome was development of diabetes according to American Diabetes Association criteria. Analysis was by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00038727.

Findings

During the 10·0-year (IQR 9·0—10·5) follow-up since randomisation to DPP, the original lifestyle group lost, then partly regained weight. The modest weight loss with metformin was maintained. Diabetes incidence rates during the DPP were 4·8 cases per 100 person-years (95% CI 4·1—5·7) in the intensive lifestyle intervention group, 7·8 (6·8—8·8) in the metformin group, and 11·0 (9·8—12·3) in the placebo group. Diabetes incidence rates in this follow-up study were similar between treatment groups: 5·9 per 100 person-years (5·1—6·8) for lifestyle, 4·9 (4·2—5·7) for metformin, and 5·6 (4·8—6·5) for placebo. Diabetes incidence in the 10 years since DPP randomisation was reduced by 34% (24—42) in the lifestyle group and 18% (7—28) in the metformin group compared with placebo.

Interpretation

During follow-up after DPP, incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group, but the cumulative incidence of diabetes remained lowest in the lifestyle group. Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years.

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The study clearly shows that weight loss through lifestyle changes can significantly reduce ones risk to develop diabetes by as much as 34%. 

The Intensive lifestyle changes in the study consisted of lowering fat and calories in the diet and increasing regular physical activity to 150 minutes per week.  Most exercise was in a form of walking.  Modest weight loss was around 15 lbs in the first year but overtime regained them all but 5 lbs over the next 10 years.  I guess this shows that lifestyle really is difficult for some to maintain.

What matters most for this study is that lifestyle change through fitness and nutrition really works.  The only problem is how one can maintain to be active throughout ones life and how one can withstand the sight of FOOOOD!!!! 

For me….Its a matter of discipline and focus… The two main ingredients to achieving success through behavioral modification.  Clinically, the measure of success is when one is able to maintain the weight loss beyond 1 year of intervention.  Losing weight in 6 months is good…but gaining them back in the next 6 months is bad…..

The Facts are here… the Benefits are known… The rest now depends on YOU!

Walking versus Jogging

October 12, 2009

Walking as an exercise is the simplest form of activity.  I used to walk at least 4x a week.  That has been my form of exercise eversince I decided to emabark on a healthy lifestyle.   BUT I was not really consistent in doing so. There was always a reason for me not to do it this day or the next day. 

But when I started a new regimen of activity after I had a blood sugar of 96 ( with my strong family hist0ry and being the youngest of 9 with a diabetic mother: my risk is pretty high)…and a BMI of 26…I was definitely overweight… I found the differerence between simply brisk walking and running or actually jogging.

I only jog.  Meaning leisurely running 5 km per hour.  I posted my regimen before as the WOG: where I Walk and Jog but for the past several months Ive elevated the activity to all- jogging for 45 min per day. 

 The difference in terms of stamina, ” the feeling good” after the exercise and the “urge” to do it again the next day was something I did not feel whan I was brisk walking.  The sweating was 100 x more and the ” good sense of well being” feeling after the exercise was experienced even more!  I guess the endorphins are really kicking in when you sweat more and do more strenuous activities than just by simply walking without sweating it out!

The added factor to this exercise activity is of coure the maintenance of ones weight.  So far with my diet regimen and my jogging, Ive successfully maintained my weight and BMI of 22.

So guys… which is better?

Try it yourself and you make a choice.  Whatever your choice is …both are great activities to keep you healthy!

The Thigh and The Heart…Where’s The Connection?

September 21, 2009

Check your thighs… are they thin or thick?  big or small?

Now get a tape measure and read on…..

An intriguing study published in the British Medical Journal made me think….

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Objective To examine associations between thigh circumference and incident cardiovascular disease and coronary heart disease and total mortality.

Design Prospective observational cohort study with Cox proportional hazards model and restricted cubic splines.

Setting Random subset of adults in Denmark.

Participants 1436 men and 1380 women participating in the Danish MONICA project, examined in 1987-8 for height, weight, and thigh, hip, and waist circumference, and body composition by impedance.

Main outcome measures 10 year incidence of cardiovascular and coronary heart disease and 12.5 years of follow-up for total death.

Results:

  •  A small thigh circumference was associated with an increased risk of cardiovascular and coronary heart diseases and total mortality in both men and women.
  •  A threshold effect for thigh circumference was evident, with greatly increased risk of premature death below around 60 cm.
  • Above the threshold there seemed to be no additional benefit of having larger thighs in either sex.
  • These findings were independent of abdominal and general obesity, lifestyle, and cardiovascular risk factors such as blood pressure and lipid concentration.

Conclusions:

  • A low thigh circumference seems to be associated with an increased risk of developing heart disease or premature death.
  • The adverse effects of small thighs might be related to too little muscle mass in the region.
  • The measure of thigh circumference might be a relevant anthropometric measure to help general practitioners in early identification of individuals at an increased risk of premature morbidity and mortality.

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What is interesting of this study is the finding that the risk to cardiovascular disease was in fact  more highly related to thigh circumference than to waist circumference. 

Now therefore…we have a very simple way of determining based on a method we can easily do anywhere pt measure and assess ones risk! 

The CUT OFF size is 60 cm…that’s the magic number …anything smaller is harmful so the study says….

Will the risk reverse once we increase the circumference of the thighs? Again …the whole picture of a healthy lifestyle still is the best way to combat chronic diseases and heart disease. 

But for now, thinner thighs mean lesser muscle mass which may mean insulin may not work properly and therefore can predispose this individual to diseases like diabetes and high blood pressure.   In this study, the people with a thigh measurement of less than 46.5 centimetres (18 inches)had roughly double the chances of getting heart and circulation problems or dying during the study.  

So what needs to be done? If you have a small thighs you can do something about it!!!!

Exercise!!!

Another reason for us to move and work out!

The Benefits of Exercise Go Beyond Prevention….

July 23, 2009

We all know the benefits of exercise.  It has been shown to afford a better lifestyle due to prevention of chronic diseases associated with sedentary behavior. 

What we dont know is how following a rigorous physical activity and being FIT can have an impact on a patients recovery from certain illnesses that unfortunately can happen due to the NON modifiable risk factors like family history and age!

A study from the Mayo Clinic published in BMJ this month shows us that indeed the benefits of exercise can go beyond Prevention:

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Background: The importance of physical activity as a modifiable risk factor for stroke in particular and cardiovascular disease in general is well documented. The effect of exercise on stroke severity and stroke outcomes is less clear. This study aimed to assess that effect.

Methods: Data collected for patients enrolled in the Ischemic Stroke Genetics Study were reviewed for prestroke self-reported levels of activity and 4 measures of stroke outcome assessed at enrollment and approximately 3 months after enrollment. Logistic regression was used to assess the association between physical activity and stroke outcomes, unadjusted and adjusted for patient characteristics.

Results: A total of 673 patients were enrolled; 50.5% reported aerobic physical activity less than once a week, 28.5% reported aerobic physical activity 1 to 3 times weekly, and 21% reported aerobic physical activity 4 times a week or more. Patients with moderate and high levels of physical activity were more likely to have higher Barthel Index (BI) scores at enrollment. A similar association was detected for the Oxford Handicap Scale (OHS). After 3 months of follow-up, moderate activity was still associated with a high BI score. No significant association was detected for activity and the OHS or Glasgow Outcome Scale at follow-up after adjustment for patient characteristics.

Conclusions: Higher levels of self-reported prestroke physical activity may be associated with functional advantages after stroke. Our findings should be seen as exploratory, requiring confirmation, ideally in a longitudinal study of exercise in an older population.

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Theoritically, the study results are obvious in that according to the author….”A brain that generally has good blood and oxygen flow from aerobic exercise will be in a better position to compensate for neurological deficits caused by a stroke.”

The results also say it all: that Exercise indded can be beneficial in all phases of the disease from prevention to recovery.  

 Among patients who reported less exercise in the year before their stroke those individuals were significantly more likely to have one or more bad outcomes while those who were into moderate to high levels of activity, the odds of a better outcome were higher. 

Likewise, in terms of recovery and functional capacity post stroke after three months , individuals who had both moderate and high exercise levels were associated with significantly better functional outcomes.  Great News specially to our diabetic patients who love to exercise! 

There you go… the many wonders of exercise !!!

You Get Everything GOOD with EXERCISE!  

The 20-40 RULE in Fitness and Disease

July 13, 2009

My 20-40 rule:

A low fitness level in your teens translate to a high level of risk for developing diabetes by age 40! 

That’s the message I got from this study published in Diabetes Care called the CARDIA Fitness Study.

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Objective: Test the association of fitness changes over 7- and 20-years on the development of diabetes in middle-age.

Research Design and Methods: Fitness was determined based on the duration of a maximal graded exercise treadmill test (Balke protocol) at up to three examinations over 20-years from 3989 black and white men and women from the Coronary Artery Risk Development in Young Adults study. Relative fitness change (%) was calculated as the difference between baseline and follow-up treadmill duration/baseline treadmill duration. Diabetes was identified as fasting glucose ≥126 mg/dL, post-load glucose ≥200 mg/dL, or use of diabetes medications.

Results:

  • Diabetes developed at a rate of 4 per 1000 person-years in women (n=149) and men (n=122) and lower baseline fitness was associated with a higher incidence of diabetes in all race-sex groups (hazard ratios from 1.8 to 2.3).
  •  On average, fitness declined 7.6% in women and 9.2% in men over 7 years.
  • The likelihood of developing diabetes increased per standard deviation decrease (19%) from the 7-year population mean change (−8.3%) was in women (hazard ratio [HR]=1.22, 95% CI: 1.09, 1.39) and men (HR=1.45, 95% CI: 1.20, 1.75) following adjustment for age, race, smoking, family history of diabetes, baseline fitness, body mass index (BMI), and fasting glucose.
  • Participants who developed diabetes over 20 years experienced significantly larger declines in relative fitness over 20 years vs those who did not..

Conclusions: Low fitness is significantly associated with diabetes incidence and explained in large part by the relationship between fitness and BMI.

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This study shows that inidviduals risk to develop lifestyle related diseases especially diabetes are at increasing overtime depending on the level of fitness:

  • Women were at 22% increased risk of developing diabetes
  • men were at a 45% increased risk…

 for every standard deviation decrease from the mean fitness change.  This relationship continued to exists even after adjusting for age, smoking, family history of diabetes, and baseline fasting glucose.  In fact the researchers noted that the baseline BMI was a better predictor for developing diabetes than the baseline fasting glucose as well as baseline fitness.

What Do These Data MEAN?

  • If two individuals have similar fitness level; the bigger person with a higher BMI is more likely to develop diabetes than the smaller frame guy overtime in the next 10-20 years.
  •  The possible mechanism by which fitness decreases risk for diabetes is most likely related to the regulation of body mass.  A lower BMI means better insulin sensitivity and less production of toxic substances by increased adiposity that can lead to further cardiovascular complications associated with obesity and diabetes. 

The authors conlcuded:

That regular physical activity to “improve and maintain cardiorespiratory fitness is an important component of a healthy lifestyle.” 

 AMEN!

How To Exercise To Reduce Heart Disease…

June 30, 2009

We heard the news of Michael Jackson’s death.  It is known that Heart disease continues to be a leading killer worldwide.  Blame it to lifestyle and the world’s reliance to fast food and technology.  In parallel to the rise of heart disease is the rising prevalence of Diabetes and Obesity which I believe will no longer spare anyone because of the environment we are in and the kind of acitvities and lifestyle the next generation is in and will have!

It is therefore imperative that we deal with this rising prevalence of heart disease upfront and not relying heavily on medications to get us through!  Simple steps can be done but steps that need diligence, perseverance and discipline!  It is therefore best to start these steps NOW than later!

I myself am doing these steps NOW and not later when I will get the disease of Diabetes due to age and strong family history. 

The recent guideline of the American Heart Association is timing to the events around the world. 

There’s no better time than now to emphasize lifestyle change and exercise but now!  So what do we recommend?

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To improve cardiovascular risk, it is recommended that patients with T2DM accumulate a minimum of 150 minutes per week of at least moderate-intensity and/or 90 minutes per week of at least vigorous-intensity cardiorespiratory exercise.

In addition, resistance training should be encouraged. These guidelines can be achieved with varying contributions of moderate- to vigorous-intensity cardiorespiratory exercise.

Patients should train on at least 3 nonconsecutive days each week to maximize benefits. Individual sessions should last for no less than 10 minutes.

 Sedentary behaviors should be minimized. Exercise training should be implemented long-term.

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Additional recommendations highlighted in the guidelines include:

  • Resistance training should use all muscle groups and progress to  2–4 sets of 8–10 repetitions at a weight that cannot be lifted >8–10 times, with 1–2 minute rest periods between sets.
  • The duration of each individual session can vary, although the aim should be a minimum of 10 minutes per session, at least 3 sessions per day.
  • Patients who elect to walk should perform the task at a brisk pace to be effective.
  • Go guys… jump on to the bandwagon.  Just look around you.  Lance Gokongwei has joined the fitness world!  So can we!

    It’s in the decision When to start that somehow manages to make us Weak and defenseless. Be determined and do it now. 

    Be Fit…Be Slim…

    Be Smart and Be Healthy!

    How Safe Are Artificial Sweeteners….

    March 25, 2009

    One topic that has never died down during these years is the safety of artifical sweteeners.  The problem stems from internet messages and information being propagated by unknown sources regarding the dangers of these products.  As an endocrinologist, I have been recommending these sweeteners to my patients as they actually help stave off the craving for sugar without necessarily increasing the sugar load.

    But how much is enough for these sweeteners?

    Recently the Mayo Clinic organization published views on this controversy and recommendations.

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    The Food and Drug Administration (FDA) has approved the following low-calorie sweeteners for use in a variety of foods. The FDA has established an “acceptable daily intake” (ADI) for each sweetener. This is the maximum amount considered safe to eat each day during your lifetime. ADIs are intended to be about 100 times less than the smallest amount that might cause health concerns.

    Artificial sweetener ADI* Estimated ADI equivalent** OK for cooking?
    Aspartame (NutraSweet, Equal) 50 milligrams (mg) per kilogram (kg) 18 to 19 cans of diet cola No
    Saccharin (Sweet’N Low, SugarTwin) 5 mg per kg 9 to 12 packets of sweetener Yes
    Acesulfame K (Sunett, Sweet One) 15 mg per kg 30 to 32 cans of diet lemon-lime soda*** Yes
    Sucralose (Splenda) 5 mg per kg 6 cans of diet cola*** Yes

    *FDA-established acceptable daily intake (ADI) limit per kilogram (2.2 pounds) of body weight.
    **Product-consumption equivalent for a person weighing 150 pounds (68 kilograms).
    ***These products usually contain more than one type of sweetener.

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    How about the safety of these products?

    Although this is one product has been bombarded with bad publicity probably because of its popularity being present in almost any low calorie foods to diet sodas… the National Cancer Institute and other major health oragnizations including the American Diabetes Association and the US FDA continue to refute these claims… as so far,  there’s no scientific evidence that any of the artificial sweeteners approved for use in the United States cause cancer and that there are now numerous studies to confirm that artificial sweeteners are safe for the general population.

    I for one contnue to use aspartame or splenda for my coffee eevry morning or in the afternoon. I am a user and a believer in these low calorie sweeteners that as long as used properly and not in excess of what is recommended…then it is safe!

    Enjoy The Sweetness of Health!

    Reduce Your Risk for Diabetes Through Weight Loss: The Impact of Weight Loss Surgery

    March 9, 2009

    Go to fullsize imageWeight gain and Obesity play very important roles in the development of chronic diseases like Diabetes, High blood pressure and complications like Stroke and Heart Attack.  One therefore has to incorporate proper lifestyle and good behavior through daily physical acitvity to help avoid developing these conditions.  However there are certain inidividuas where weight loss through these behvioral methods no longer are enough to provide the weight loss one desires and therefore for ” medical” reasons, one resorts to drastic measures like Bariatric surgery.

    But do they work in decreasing the risk? or do they help patients improve disease outcomes?

    Now comes s study published in the American Journal of Medicine, March 2009  to show that weight loss indeed can work wonders to diabetes and that bariatric surgery can help:

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    • 621 studies from 1990 to April of 2006 were analyzed:  78.1% of diabetic patients had complete resolution and diabetes was improved or resolved in 86.6% of patients as the result of bariatric surgery.
    •  Gastric banding yielded 56.7% resolution, gastroplasty 79.7%, gastric bypass 80.3% and BPD/DS 95.1%.
    •  After more than 2 year post-operative, the corresponding resolutions were 58.3%, 77.5%, 70.9%, and 95.9%.
    • The Percent excess weight loss was 46.2%, 55.5%, 59.7% and 63.6%, for the type of surgery performed suggesting that BPD yielded the best result.

    Concluding that:

    • 82% of patients had resolution of the clinical and laboratory manifestations of diabetes in the first 2 years after surgery, and
    • 62% remained free of diabetes more than 2 years after surgery (80% and 75% for the total group).

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    The study for me tells us one thing: that weight loss indeed can work wonders.  However lets not all resort to surgery to achieve improvement in our risk for diseases as surgery also entails risks! 

    While proper diet and physical activity are completely free and easy to do…all they need are the Two D’s to succeed: DETERMINATION and DISCIPLINE!