Daily Digest

Everyday, we sort through more than 200 newly released journal articles and choose one to highlight for you.

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How to make money selling nothing

The Wall Street Journal reports that 2016 was the first year that bottled water outsold carbonated beverages, in number of units. The good part of this news is that sugar-sweetened beverages make up the bulk of carbonated beverage sales, and a decre...

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Lifestyle Psychosocial

Does yoga really help diabetes?

Yoga is increasingly popular in all age groups, and with this popularity have come a number of health and wellness claims. I feel that anything that moves your body, takes you away from the stresses of everyday life, and results in positive personal ...

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Food-Weight

There is no Paleo-diet, really

I had a hard time understanding Paleo-diets when they first became popular. Wasn't the Paleolithic period really long, and wasn't there a large variation in hominid habitats? I recommend Paleofantasy for a nice scientific look at the Paleolithic era...

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Environment

The community side of the chronic care model

Ed Wagner's chronic care model has appeared in thousands of Powerpoint presentations, but often to groups that represent traditional healthcare systems of larger governmental bodies. The community side is always mentioned, but details and examples ar...

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Food-Weight

Sleeve gastrectomy taking over

Weight-loss surgeries are trending up in the United States, but also in the rest of the world. Another trend, reported today in Surgery for Obesity and Related Diseases is the increasing use of sleeve gastrectomy, a surgical approach much simpler t...

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Meds

Discontinuing insulin

Insulin remains a common treatment for people with type 2 diabetes, as everyone with type 2 diabetes slowly loses their insulin producing beta cells over time. Despite insulin's utility and common use, it is not infrequent that people stop their ins...

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Genes-physiology

Making new beta cells

At its most basic level, diabetes results from the lack of insulin producing beta cells. Beta cell loss of over 90% occurs before the onset of type 1 diabetes, and type 2 diabetes only becomes difficult to treat when the continually progressive but u...

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Not too much, not too little

Moderate alcohol ingestion has a clear association with improved cardiac outcomes in epidemiologic studies, and this study released today in the Journal of the American Heart Association convincingly links the level of alcohol consumption to change...

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Food-Weight

Occasional days of eating less

I was attracted to this article, released today in Science Translational Medicine, by the title, which starts "Fasting-mimicking diet...". The authors point out the advantages, in animal studies, of prolonged fasting; longer lifespan, reduced infla...

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Healthcare

Better numbers, lower costs

The clinical trial data is clear; lower blood pressure, LDL cholesterol, and A1C numbers reduce future diabetes-related complications such as cardiovascular disease (CVD), retinopathy and neuropathy. These are long-term complications, however, and fo...

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Genes-physiology

Measurement at the edge

The ability to measure something accurately, reproducibly, and by a number of different laboratories is one of the most important steps to new knowledge. The story of irisin is an excellent example to this. First reported in 2012, it's discovery was ...

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Health Policy

A new approach to academic publishing

"Publish or perish" isn't just a cliche, it is a fundamental driver of success and employment for a biomedical researcher. Publishing is done in peer reviewed journals, which provide important curating and peer review activities, but which also delay...

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Food-Weight Healthcare

Bariatric surgery moves forward

The use of bariatric surgery continues to rise, and its use in people with diabetes has expanded to the point where it is now called metabolic surgery, since it does not always involve people who are obese. Early claims of curing diabetes have change...

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Global Health Meds

When 1/4 times 4 is greater than 1

Combination pills, especially for blood pressure, offer benefit to the patient in convenience, and studies have shown their clear benefit in treating hypertension. The approach tested in todayC's Lancet release, goes even further, using small one-qu...

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Healthcare

Fatty → Fibrotic → Cirrhotic

NAFLD (Non-alcoholic fatty liver disease) is increasing prevalent, and usually associated with insulin resistance and metabolic syndrome. While NAFLD itself is of interest, it is those individuals with NAFLD who progress to fibrosis and cirrhosis who...

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Health Policy Meds

The curious pricing of insulin

Human insulin remains one of the few medications, along with thyroid hormone, where we can use the exact same molecule that is naturally produced in our bodies. Costs for human insulin should be, and often are, quite low, and there is  no patent-ba...

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Outcomes

How to avoid diabetes-related kidney disease

A recent health survey from the Cleveland Clinic revealed that more people thought that kidney disease was the leading cause of death for people with diabetes than any other cause. Heart disease is clearly the leading cause of death for people with ...

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Meds

Low B12 missed in metformin users

At present there are no guidelines recommending routine testing of vitamin B12 in metformin users, despite the very consistent data that B12 deficiency accompanies longer-term use of metformin. This study released today from the VA demonstrates that ...

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Genes-physiology

Eating breakfast primes the liver

The benefits that eating breakfast has on weight control are often touted, but are not well supported by current data. What is supported is the benefit that breakfast eating has on post-lunch glucose and insulin levels. This well-done physiologic st...

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Technology-Internet

Organs on a chip: slow progress

The original idea of organs on a chip caught everyone's interest, but like most areas of new research, progress has been slower than expected. Part of this is related to the new techniques themselves, but this article in today's Nature Medicine show...

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Lifestyle

Sweet sleep: how do I measure thee?

Sleep is an important component of health, with numerous studies linking both sleep duration and sleep quality to measures of well-being, and also to metabolic measures such as insulin resistance and glycemic control. Polysomnography (PSG) done in a ...

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Outcomes

Using retinopathy to determine a population A1C

This article published today in the Journal of Diabetes and Its Complications proposes a novel and useful way to assess the time-averaged A1C of a population. In the DCCT/EDIC clinical trial, which still provides the best data on long-term complica...

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Health Policy

Life at the bottom of the ladder

The Macarthur ladder is a common approach to assessing subjective socioeconomic status (SES), and many studies have confirmed that living at the bottom of the ladder is associated with poorer health, and a higher chronic disease burden. This is not j...

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Health Policy

The future of electronic medical records

One of the most important but less talked about components of the Affordable Care Act (ACA) pertains to electronic medical records (EMRs). The ACA developed slowly escalating requirements for EMRs. The first requirements were modest, such as having ...

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Food-Weight

Not bitter melon but bitter taste

  Bitter melon, or Momordica charantia, is a bitter tasting Asian fruit that is often touted for its benefit in diabetes. However, like most herb and food-based treatments, clinical studies haven't shown any solid benefit in diabetes or weig...

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Food-Weight

Getting our timing right

Our modern day life often seems controlled by the clock, but it is clear that we are also controlling, or changing our own clocks; our circadian clocks, that is. Circadian clocks have developed across all life forms from bacteria to humans, and the e...

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Environment

Be careful where you breathe

The impact of small (less then 2.5 µg) particulate matter, termed PM2.5 found in smog is increasingly being recognized as a significant factor in chronic diseases, and not just asthma and COPD. The effect on metabolism has been recognized in a numbe...

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Food-Weight

When we eat, not just what we eat?

Food is always a hot topic, and not just in the popular press. Academic articles in which diet was a major component have increased in number every year from 2001 (1,740) through 2015 (6,406). Despite these thousands of articles, we really don't know...

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Technology-Internet

There are changes ahead

One of my favorite quotes is by Bill Gates: "We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don't let yourself be lulled into inaction". Continuous glucose monitor...

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Health Policy

Selling cessation

Smoking prevalence has decreased in the United States and in England, but still runs at around 15% in the U.S. and a little higher in England. There are a number of smoking programs available which consistently show a benefit over controls, yet many ...

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Outcomes

Seeing improvement

Loss of sight is one of the biggest concerns for everyone with diabetes, with lower income groups having bigger fears than others. These feelings exist despite solid data that the risk of vision loss is low and decreasing. For example, diabetes is no...

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Health Policy

Diabetes guidelines lag

Today's JAMA commentary points out that current diabetes treatment recommendations should be guided by more than just A1C, as recent studies on glucose lowering medications have shown that some now have impacts on lowering cardiovascular complicatio...

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Environment

Too fine to escape

We often talk about changes in food intake and physical activity as the main environmental factors behind the increasing incidence of diabetes in developing countries. However, pollution is an underappreciated factor. Extremely fine particulate matte...

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Global Health

Diabetes troubles in China

Diabetes is increasing faster in developing countries than it is in the U.S. and Western Europe, and this well-documented report released today details the huge impact that this is having on morbidity and mortality. The increase in diabetes is usuall...

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Healthcare

Picking a blood pressure target

Blood pressure (BP) control in people with diabetes is more important and has more impact than glycemic control. About 80% of people with type 2 diabetes have hypertension, and over 50% have a BP above target. But what should the target be? The ACCO...

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Genes-physiology

Glucagon-more than gluconeogenesis

We usually think that the main role of glucagon is centered on gluconeogenesis, working in opposition to insulin to tightly control blood glucose. Glucagon is elevated in type 2 diabetes, and some of the clinical benefits of GLP-1 receptor agonists ...

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Health Policy

Open access? Let’s open it further

Access to information is crucial, and this is especially important in healthcare. Most healthcare information comes from medical journals, where editors and peer reviewers sift through thousands of submissions. In the past, journals have restricted a...

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Technology-Internet

Academic articles meet social media

How do you find articles that you would like to read? We try to help you here at Health Analytics by scanning newly released articles every day, and choosing one to highlight. Altmetrics provides another approach, highlighting articles based on the d...

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Environment

Summertime, when the living is easy

Pregnancies that occur during periods of famine are associated with low birth weight and increases in diabetes later in life. I wonder if relative differences in nutrition level explain the data presented here from a study of over 400,000 people in ...

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Health Policy

Paying for steps

Financial incentives for health behavior changes is a popular approach, and in 2014 the Affordable Care Act began to allow up to 50% of medical insurance premiums to be rewarded for smoking cessation. Most of these programs show some success during ...

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Healthcare

Connecting is better than referring

This extremely informative study, "Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial" informs us in two different areas: the impact of directly connecting patients vs. just referring them to treatm...

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Meds

Metformin – Hard to Swallow?

Metformin is not only the most useful medication for people with type 2 diabetes, but also one of the most useful and cost-effective medications in all of healthcare. Really the only problem with metformin is if you experience a side effect (abdomina...

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Meds

We don’t seem to like insulin.

Many studies have documented the delay in starting insulin, while this isn’t the major point 0f  this study, it does provide a nice demonstration . The authors identified 15 studies in which basal insulin ws started in insulin naïve people with t...

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Meds

Too much of a good thing?

Blockade of the renin-angiotensin-aldosterone system (RAAS) has been the cornerstone medication approach (along with controlling blood pressure) to prevent progression of renal disease. However, studies looking at the simultaneous use of two classes ...

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Psychosocial

Believing in yourself

Self-efficacy is commonly described as the confidence that you have in performing goal-directed behaviors, and many studies link it to the behaviors needed to achieve good control of your diabetes. A study published today looked at a number of health...

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Lifestyle

Mindful walking

Walking is a common and generally accepted form of physical activity that has shown benefits for reducing cardiovascular risk and improving diabetes control. There is less data available for the health benefits of meditation, but there are certainly ...

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Off the beaten path

Do plants get diabetes?

They can, but not as much as people, the authors say, because they are more efficient at removing free radicals. However, as CO2 in the atmosphere increases, so may diabetes. Mostly an idea, but interesting. See Abstract...

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Lifestyle

What’s in an app?

Apps are an attractive item in healthcare these days, especially in chronic disease. They are inexpensive, amazingly scalable, available 24/7, and can also be visually appealing. However, many people seem to view them as solutions, rather than vehicl...

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Lifestyle

The benefits of sleep

When we talk about modifiable risk factors for developing or controlling type 2 diabetes, we usually focus on food and fitness, and their effect on weight. Smoking is also an important modifiable risk factor, as is sleep duration and quality, which a...

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Healthcare

Don’t walk if you can dance

Dancing can not only improve your mood and social health, but also can also make you live longer! Any type of physical activity has a big impact on diabetes, and also on improving your heart health. Walking is the most common type of activity, and in...

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Lifestyle

Waist circumference and Metabolic Syndrome

Metabolic syndrome (MetS) receives a lot of attention as a marker for cardiovascular risk and for development of diabetes. However, it is not a simple marker, as it is defined as having at least 3 of five different risk markers above a cutoff (or in ...

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Healthcare

Dispartities in internet usage for healthcare

Seniors are the fastest growing group of internet users, driven by the fact that they still use the internet less than younger people. This study from Kaiser Permanente showed that although over 75% of seniors completed the assisted registration proc...

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Lifestyle

Weighing in on weight

I think that part of the confusion behind discussions of weight and health is semantic. If someone is 5 feet 9 inches tall and weighs over 250 pounds they are overweight and unhealthy, right? Wrong; the BMI would be 36.9, and they would be classified...

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Lifestyle

The impact of our social environment

Social integration, support and strain have strong associations with our physical health and longevity, as nicely shown in this fascinating study which merged data from 4 longitudinal U.S. population studies. The chart below details the effects on CR...

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Healthcare

Welcome to the United States

One of the best examples of the major impact of environment on diabetes incidence is the increase in diabetes seen when immigrants enter the United States. This is especially true for non-Caucasian ethnicities, all of whom have a much higher genetic ...

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Healthcare Lifestyle

The allure of group visits

Group medical visits have been around for a long time, have a number of attractive features, yet the implementation is quite low. Although there are various flavors, the most common are a group of people with a common chonic condition such as diabete...

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Healthcare

Fetal programming and gestational diabetes

As type 2 diabetes increases worldwide, so does the incidence of hyperglycemia during pregnancy, or gestational diabetes. In some populations, such as the Middle East, gestational diabetes may occur in half of the pregnancies. In most cases, the hype...

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Healthcare

Vegetarians live longer, right?

The thought that vegetarian diets are more healthy is common, but most well-done clinical studies have failed to show a benefit. This report is one of the largest, and shows no decrease in mortality in vegetarians compared to meat eaters. Lifestyle c...

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Healthcare

Brown fat and the microbiome

Wow! Two of the trendiest topics in metabolism, brown fat and the microbiome, meet up in this fascinating article. This report studies 2 groups of mice with no microbiome, that is, no bacteria in their guts. This occurred either because they were del...

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Lifestyle

Fitness trumps fatness

In one of his earliest diabetes manuals, Elliott Joslin (who founded the Joslin Diabetes Center in 1898) said that “It is better to discuss how far you have walked than how little you have eaten”. This report shows just that, as aerobic fitness g...

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Healthcare

So you’d like to see an Endocrinologist

Many people have lamented the low number of endocrinologists compared to the number of people with diabetes, with estimates of practicing endocrinologists ranging from 4,000 to 6,000, compared to 29 million people with diabetes. This study looks at t...

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Food-Weight

Men and women, diabetes and heart disease

Everyone learns in medical school that men are at higher risk for death from heart attacks than women, and that fact is commonly repeated in journal articles. It is also commonly repeated that diabetes increases the risk for heart disease, and that d...

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Lifestyle

Exercise is important for everyone, almost

Continuing the story line from above, that sweeping statements can be misleading, what about the obvious benefit of exercise for people with type 2 diabetes? This article nicely lays out the many exceptions to this statement. Perhaps around 10% or mo...

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Lifestyle

It’s where you live, and how you live

Studies have shown that individuals local environment seems to influence their risk of developing diabetes. This has been related to walkability and safety of the neighborhood, as well as to the presence of grocery stores. This article, and the assoc...

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Healthcare

It’s not just fat, it’s where it’s at

We know that fat is complicated, and there are many ways that we approach measuring it. While BMI has become the standard, it’s utility is lessened by recent data showing that people who were overweight (BMI 25- 30) or had grade 1 obesity (BMI 30-3...

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Healthcare

When does it all start?

Longitudinal childhood studies tell us that children’s obesity, fitness and insulin resistance are good predictors of their adult status, and good predictors of adulthood obesity and type 2 diabetes. Other studies have moved the time point further ...

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Food-Weight

Autonomic neuropathy of the gut

A trio of articles in Diabetologia review the troubling current status of neuropathy affecting the gastrointestinal system, one of the most debilitating and frustrating complications of diabetes. The frustration comes mainly from the lack of reliably...

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Food-Weight

Easing resistant blood pressure

Hypertension, present in 80% of people with type 2 diabetes, is a rising problem worldwide. Although there at least eleven different classes of blood pressure lowering medications, around 25% of people treated will have resistant hypertension, define...

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