Does exercise help with type 2 diabetes?

If you have been diagnosed with type 2 diabetes and exercise regularly but see no improvement in your blood sugar control, you are not alone.
A study in a recent issue of the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism shows that as many as 20 percent of people with type 2 diabetes do not see any improvement in blood sugar management even when they take part in supervised exercise.
The researchers led by Lauren Marie Sparks, PhD, of Florida Hospital and the Sanford-Burnham Medical Research Institute in Orlando, FL. reviewed data from clinical studies of people with type 2 diabetes who participated in exercise regimens, as well as animal and genetic studies in an effort to determine what role genetics may play in whether someone with type 2 diabetes can improve blood sugar control from exercise.
They found that around 15 percent to 20 percent of individuals with Type 2 diabetes did not see any improvement in their blood sugar control, insulin sensitivity or a measurement of fat-burning capabilities called muscle mitochondrial density. Genetic and animal studies indicate this resistance to exercise is encoded in DNA and can be handed down through generations.
“More research is needed to determine which people with or at risk of developing Type 2 diabetes will respond to an exercise program and which will not,” Sparks said in a press release. “Genetic and epigenetic patterns could hold the key to differentiating between the two groups. With that information in hand, we can target specific interventions and treatments to the individuals who will benefit most and identify novel treatment approaches to help those who do not respond to exercise.”

Can Yogurt Help Prevent Diabetes?

Written by Michael O’Leary

An analysis of data from three large populations studies with nearly 290,000 participants seems to confirm that consuming yogurt daily was associated with an 18 per cent lower risk of type 2 diabetes. The study was published in the British medical journal, BMC Medicine.

Researchers from Harvard School of Public Health pooled the results of three large cohort studies that followed the medical history and lifestyle habits of health professionals. These studies were the Health Professionals’ Follow-up Study (HFPS), which included 51,529 US male dentists, pharmacists, vets, osteopathic physicians and podiatrists, aged from 40 to 75 years; Nurses’ Health Study (NHS), which began in 1976, and followed 121,700 female US nurses aged from 30 to 55 years; and Nurses’ Health Study II (NHS II), which followed 116,671 female US nurses aged from 25 to 42 years beginning in the year 1989.


Within the three studies 15,156 cases of type 2 diabetes were identified during the follow-up period. The researchers found that the total dairy consumption had no association with the risk of developing type 2 diabetes. They then looked at consumption of individual dairy products, such as skimmed milk, cheese, whole milk and yogurt. They found that consumption of one 28g serving of yogurt per day was associated with an 18 per cent lower risk of type 2 diabetes.

The study confirms similar finding of a British study from about a year ago that also found that while overall consumption of diary products did not affect type 2 diabetes risk, those who consumed more than 20 ounces of low-fat yogurt a week had a 28 per cent reduced risk of developing diabetes.

The researchers stopped short of saying that yogurt was the cause of lower risk for type 2 diabetes, saying it will take a randomized comparison study to show that, but they did say that, “The consistent findings for yogurt suggest it can be incorporated into a healthy dietary pattern.”

Just Diagnosed With Type 2? Metformin Is The Winner! (Why Are Other Drugs Used?)

written by Michael O’Leary

A study in JAMA Internal Medicine this past fall found once again that metformin should be the first line treatment for type 2 diabetes, which isn’t really the news. The study also found that despite the guidelines recommending metformin first, only 57.8 percent of newly diagnosed patients began treatment with metformin.

Since metformin became the standard of care for type 2 diabetes, six classes of drugs have been introduced including thiazolidinediones (Actos®) that remove sugar from the blood, sulfonylureas (Amaryl, Glucotrol) that increase the amount of insulin produced by the pancreas, GLP-agonists (Byetta and Victoza) that promote weight loss, DPP-IV blockers (Onglyza, Tradjenta, Galvus) that decrease blood sugar levels, Meglitinides (Prandin and Starlix) which also lower blood sugar levels, and alpha-glucosidase blockers (Precose and Glyset) that block absorption of carbohydrates.


Photo: “Winner” by David Melchor Diaz is licensed under CC by 2.0

The study, led by Dr. Seth Berkowitz of the Department of Medicine at Brigham and Women’s Hospital, Harvard Medical School, analyzed the insurance records of 15,516 patients who were prescribed oral blood sugar-lowering medications between 2009 and 2013. They looked at the first medications prescribed and the second medication prescribed within 90 days of the end of the first prescription.

They found that 8,964 patients (57.8 percent) were initially prescribed metformin and only 25 percent of those added a second drug within 90 days. They also found that among those who started with sulfonylureas, 32 percent added a second medication, while 39 percent of those who started thiazolidinediones, and 38 percent of those who started with DPP-IV drugs added second medications soon after.

In addition they found that there was no reduction in risk of low blood sugar events, emergency department visits, or cardiovascular events among those who started on medications other than metformin.

In an accompanying editorial in the same journal, Drs. Jodi Segal and Nisa Maruthur noted that the study did not include a newer class of drugs called sodium-dependent glucose transporter 2 inhibitors, or SGLT blockers as they had not been approved at the time of the study.

“Less understandable is the exclusion of injectable medications from the glucagon-like peptide-1 agonists (GLP-1) class despite their approval for use as first line therapy and availability since 2005,” they wrote.

More importantly, they raised the question of whether having to add a second drug is measure of effectiveness since drug response can vary greatly between individuals and that intensifying treatment is appropriate in terms of reaching patients’ individual blood sugar targets.

Does Gastric Banding Help Overweight People With Type 2 Diabetes?

written by Michael O’Leary

While the evidence showing that weight-loss surgery can halt type 2 diabetes in obese people grows, less is known about whether such a drastic intervention might also benefit people who are overweight, but not obese.  (The difference between overweight and obese is a technical one.  Obese refers to people with a body mass index of over 30.  Overweight refers to people with a body mass index between 25 and 29.9.  To calculate your own BMI, visit this link on the NIH website.)

In the first such study designed to make the case for bariatric surgery as treatment for type 2 diabetes in overweight people, Australian researchers compared outcomes in 25 people with a BMI of 25 to 30 treated with gastric band surgery and standard care with 25 similar people treated with standard care alone.

The researchers, led by Emeritus Professor Paul O’Brien and Dr John Wentworth from the Centre for Obesity Research and Education (CORE) at Manash University in Victoria, Australia, followed both groups for two years, and documented blood sugar control during that time. They published their findings in the April 8, 2014 The Lancet Diabetes & Endocrinology.

The gastric surgery consisted of minimally invasive laparoscopic surgery, sometimes called keyhole surgery due to the small incisions needed for the procedure, and placement of an adjustable band around the neck of the stomach to restrict food intake.

After two years, 12 (52 percent) of those in the gastric surgery group had their diabetes in remission, compared to two (8 percent) of those in the standard care group. In addition, the results showed a strong link between the amount of weight loss and the amount of diabetes control. The more weight loss the greater the reduction in diabetes.

One person in the surgery group needed a second surgery due to complications and four others needed adjustments to the gastric band that was too restrictive and made it difficult to eat.

It is a small study, but it is among the first to test such surgery in people who are not obese and normally don’t qualify for such surgery for weight-loss purposes. The researchers concluded that their study shows that weight-loss such as achieved with gastric banding should be given higher priority as a means of treating type 2 diabetes.

Nevertheless, It will require testing in many more people who are only overweight before weight-loss surgery wins FDA approval in the US for treatment of type 2 diabetes.

Ever wondered if you or someone in your family might be at risk of type 2 diabetes? Take the test March 25.

by Michael O’Leary

As part of its American Diabetes Association Alert Day on March 25, people will be encouraged to take the Diabetes Risk Test. You might be surprised by the results.

No need to prep for it, it’s free, takes about two minutes, and only asks a total of eight questions. It’s easy and it could give you something to talk about with your doctor.

The ADA estimates that about one-third of those with diabetes (about 5.7 million people) don’t know it. Even more people are thought to be prediabetic.

The U.S. Department of Health and Human Services estimates that about one in four U.S. adults aged 20 years or older – or 57 million people – had prediabetes in 2007. Those with prediabetes are likely to develop type 2 diabetes within 10 years, unless they take steps to prevent or delay diabetes.

So this test is intended to help people find out if they may be among that number and to encourage them to find out.

The leading risk factors for type 2 diabetes?

  • Being overweight
  • Inactive lifestyle
  • Older than 45
  • High blood pressure
  • Family history
  • Ethnicity

Another benefit of taking the test is finding out that you can do things to prevent or reverse the disease. If you are overweight, lose as little as seven percent of your weight by eating a better, more healthful diet that is low in fat and calories, and get regular exercise.

The Diabetes Prevention Program study showed that doing those three things could lower your risk of type 2 diabetes by 58 percent. These lifestyle changes were even more beneficial for study participants over 70 years old, who cut their risk by 71 percent.

Left untreated, diabetes can lead to kidney failure, loss of vision, or cardiovascular damage. So take control of your health, take the test and find out if you may be at risk.


We R the Cure

Had a great phone call the other day with Mike Anderson, founder of  Mike was diagnosed with type 1 diabetes about fifteen years ago as an adult.  Recognizing the importance of clinical trials, he’s launched a website that is dedicated to educating patients about potential research options.

He’s located in Richmond, Virginia – and participates in a great deal of research at the University of Virginia.  Check out his site here:


Talk to the Hand to Control Diabetes

by Michael O’Leary

In a variation on an old joke, family medicine experts at Tufts University are urging doctors to “talk with the hand,” as an easy-to-remember approach to illustrating treatment goals for patients with type 2 diabetes.

In an editorial in the February issue of American Family Physician, Allen Shaughnessy, PharmD and professor of family medicine, says that a simple use of one’s hand is an effective way to communicate with patients about the treatment priorities for type 2 diabetes.

“Glycemic control is stuck in people’s minds as the primary goal of treatment, but evidence has existed since the 1970s that other interventions are of greater benefit,” Shaughnessy said in a press release. “Some degree of glycemic control is necessary to prevent symptoms. It’s just that the return on investment is low when we try to push patients with diabetes to get their blood glucose as close as possible to normal.”

Using his hand, he demonstrates the descending order of priorities for intervention starting with the thumb as the highest priority and ending with the pinky relative to improving length and quality of life for those living with type 2 diabetes. The list includes:

  1. Stop smoking
  2. Control blood pressure
  3. Metformin therapy
  4. Lowering cholesterol
  5. Controlling blood sugar

“Our aim in proposing the ‘lending a hand’ is to communicate the most beneficial interventions patients can make to reduce their symptoms and risk of death from diabetes complications,” said co-author Deborah Erlich, M.D., M.Med.Ed., “But this model requires a shift in thinking away from the outdated idea that glucose reduction is most important, which may be a challenge.”

According to the National Diabetes Information Clearinghouse, diabetes is a major cause of heart disease and stroke and the leading cause of new cases of blindness among adults.

Can Low-Fat Yogurt Help Prevent Diabetes?

by Michael O’Leary

It is always nice when the foods we like turn out to be good for us. That seems to be the case this week for yogurt. We eat a lot of yogurt in this country, according to the Agricultural Marketing Resource Center, Americans consume about 12 pounds of yogurt a year, which is much less than the 63 pounds per year consumed in Sweden, but still a lot of fermented dairy product.

A British study this week showed that consuming low-fat yogurt reduced the risk of developing type 2 diabetes by 28 percent compared to consuming no yogurt. The researchers published their results in Diabetologia (the journal of the European Association for the Study of Diabetes).

Actually the researchers led by Dr. Nita Forouhi of the University of Cambridge found that overall consumption of dairy products did not affect the risk of type 2 diabetes, but when they looked at fermented dairy products, there was an inverse link between consumption and diabetes risk. In other words the more yogurt consumed, the lower the risk of type 2 diabetes among those studied.

“At a time when we have a lot of other evidence that consuming high amounts of certain foods, such as added sugars and sugary drinks, is bad for our health,” Forouhi said in a press release,  “it is very reassuring to have messages about other foods like yogurt and low-fat fermented dairy products, that could be good for our health.”

The study analyzed a subset of 4,127 of the more than 25,000 people living in Norfolk, UK who kept food diaries as part of participating in the large EPIC-Norfolk study. This allowed the researchers to assess the risk of diabetes in relation to the consumption of total dairy product consumption and also consumption of different types of dairy products. They compared the dietary records of 753 people who developed new-onset type 2 diabetes over 11 years of follow-up, with 3,502 randomly selected study participants.

They found that while total milk and cheese intakes were not associated with diabetes risk, those with the highest consumption of low-fat fermented dairy products (such as yogurt, fromage frais (cream cheese) and low-fat cottage cheese were 24 percent less likely to develop type 2 diabetes over the 11 years, compared with non-consumers.

When they separated out yogurt from the other low-fat fermented dairy products, they found that those who consumed more than four 5 ounce cups of low-fat yogurt a week had a 28 per cent reduced risk of developing diabetes. (Food weights were estimated using photographs representing portion sizes.)

The researchers caution that this type of study cannot prove that eating dairy products reduces diabetes risk, but they note that dairy products do contain beneficial nutrients and yogurt contains probiotic bacteria and a special form of vitamin K associated with fermentation.

For the record, the researchers received their funding from the Medical Research Council and the Cancer Research UK, which are similar to the National Institutes of Health and the American Cancer Society, and had no ties to the dairy industry.

Eating More Berries May Cut Type 2 Diabetes Risk

by Michael O’Leary

Consuming lots of berries, vegetables, and of course our favorites, chocolate and wine can protect against type 2 diabetes, a new study shows.

Past studies have shown those foods protect against stroke, heart failure, and cancer. Most of those studies, however looked at the compounds called flavonoids, which form a large family of antioxidant-containing substances.

In a British study appearing online Jan. 20 ahead of Feb. 1, print publication in the Journal of Nutrition, researchers looked at a specific subset of flavonoids, called flavones and anthocyanins. Okay, the chemistry is complicated, but foods high in flavones include herbs and vegetables such as parsley, thyme, and celery. Anthocyanins include berries, red grapes, wine and red or blue-colored fruits and vegetables.

Aedin Cassidy from the University of East Anglia Norwich Medical School led the study of 2,000 healthy women who had completed a food questionnaire designed to estimate total dietary flavonoid intake as well as intakes from six flavonoid subclasses.

Aedin Cassidy With Her Favorite Food

Aedin Cassidy With Her Favorite Food

“This is one of the first large-scale human studies to look at how these powerful bioactive compounds might reduce the risk of diabetes,” Cassidy said in a press release. “Laboratory studies have shown these types of foods might modulate blood glucose regulation – affecting the risk of type 2 diabetes. But until now little has been known about how habitual intakes might affect insulin resistance, blood glucose regulation and inflammation in humans.”

The researchers analyzed blood samples from the women for evidence of both glucose regulation and inflammation. Insulin resistance was assessed using an equation that considered both fasting insulin and blood sugar levels.

“We found that those who consumed plenty of anthocyanins and flavones had lower insulin resistance,” she said. “High insulin resistance is associated with type 2 diabetes, so what we are seeing is that people who eat foods rich in these two compounds – such as berries, herbs, red grapes, wine– are less likely to develop the disease. We also found that those who ate the most anthocyanins were least likely to suffer chronic inflammation – which is associated with many of today’s most pressing health concerns including diabetes, obesity, cardiovascular disease, and cancer.”

The study authors cautioned that the study only showed an association, not cause and effect, nor does it provide any information about how much of these foods need to be consumed to obtain a benefit. Also unclear is how much of a health benefit the compounds really carry.

Cassidy’s team is now seeking men and postmenopausal women to help investigate whether blueberries can improve health linked to heart disease and diabetes. The six-month research study will test if daily consumption of one or two portions of freeze-dried blueberries improves heart health and insulin action in people with metabolic syndrome – a condition characterized by a larger waistline and raised blood sugar, blood fats and blood pressure.

Can Cinnamon Help Prevent Diabetes?

by Michael O’Leary

If you are among the 1 in 4 Americans considered to have prediabetes, you might want to think about increasing your cinnamon consumption. That’s the conclusion of an analysis of several studies of cinnamon and type 2 diabetes in the Journal of Medicinal Food.

Long considered a therapeutic plant, cinnamon is made from the bark of trees grown in China and throughout Southeast Asia. A number of studies have been conducted over the years looking at a variety of potential health benefits of cinnamon.

Paul Davis, a research nutritionist at the University of California Davis compiled the data from eight of these studies, including three new studies and looked at the effect on fasting blood glucose (FBG) in people at risk for type 2 diabetes.

He found that cinnamon intake was associated with a modest reduction in FBG.

“According to our results, it’s a modest effect of about 3 to 5 percent,” Davis told NPR news. This is about the level of reduction found in the older generation of diabetes drugs, he says.

While that isn’t enough to substitute for medications in people with type 2 diabetes, it may be worth considering for the millions of Americans with prediabetes. It isn’t likely to hurt and it could help, plus it tastes good.

There are two cautions for the study. It doesn’t answer the question of what is the optimal amount of cinnamon needed to lower blood sugar in a person with prediabetes, the other is what type of cinnamon is best.

There are many varieties and the most common variety found in your local grocery store is likely to be cassia contains high levels of coumarin, which can cause liver damage when consumed in large quantities in some people who are sensitive to coumarin.

How much is too much? The European Food Safety Authority says that a teaspoon of coumarin a day is the limit. How much coumarin is in a teaspoon of cinnamon is considerably lower than that.

To be safer, the variety Ceylon cinnamon contains very low levels of coumarin but it is more expensive.