Sodium-Glucose Cotransporter 2 Inhibitors May Prevent Type 2 Diabetes in High Risk Individuals

The commonly accepted definition of prediabetes is as follows: prediabetes is when a person has abnormally high blood glucose, but the blood glucose is not high enough to be called diabetes. Over 96 million adult Americans have prediabetes and most of them don't know they have the condition. And for those persons with prediabetes who also have chronic kidney disease or heart failure, one study, which was a meta-analysis, indicates that Sodium-Glucose Cotransporter 2  or SGLT2 inhibitors can be helpful in lowering the risk of progression from prediabetes to type 2 diabetes. 

SGLT2 inhibitors are an FDA-approved family of prescription medications that are used in conjunction with diet and exercise to reduce blood sugar levels in persons with type 2 diabetes. "Medicines in the SGLT2 inhibitor class include canagliflozin, dapagliflozin, and empagliflozin. They are offered as both single-ingredient formulations and in combinations with other diabetes medications, such as metformin." SGLT2 inhibitors reduce blood sugar by stimulating the kidneys to excrete sugar through urine.

The meta-analysis, mentioned above, was performed by searching randomized controlled trials (RTCs) in the Medline and Embase databases. The study's objective was to determine if SGLT2 inhibitors lowered the risk of diabetes in individuals with prediabetes. The study consisted of 5655 participants with prediabetes. The database searchers were completed on February 11, 2022.

After comparing individuals with prediabetes who used SGLT2 inhibitors with a control group, the researchers concluded that SGLT2 inhibitors lowered the risk of diabetes. In fact, the researchers indicated that SGLT2 inhibitors lowered the risk of type2 diabetes for "adults with prediabetes and heart failure or chronic kidney disease."

Since type 2 diabetes is a serious condition which is continuing to be more prevalent, healthcare providers should use all tools in their arsenals to lower the risk of the disease progressing from prediabetes to diabetes. Lifestyle medicine methods are often used to treat prediabetes to delay or prevent type 2 diabetes. Perhaps, for those patients with prediabetes and heart failure or chronic kidney disease, SGLT2 inhibitors may be worth considering.

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Changing DASH Diet Components Can Improve the Diet

The DASH diet, or the Dietary Approach to Stop Hypertension, is a diet aimed at treating high blood pressure. And in general, the diet is considered to be a healthy pattern of eating that can lower blood pressure. One study suggests that using plant-based protein instead of animal-based protein in the diet can improve the effectiveness of the diet.

The DASH diet puts a special focus on eating fruits, vegetables and whole grains. The diet also emphasizes protein from fish, poultry and nuts. These foods are high in calcium, protein, potassium and fiber, and the nutrients can help lower blood pressure. Further, after looking at the top diets in use in 2022, the U.S.News rated the DASH diet as the second best overall diet. The U.S.News indicated that the diet puts limitations on saturated fats and salt. And that individuals who follow the DASH diet will eventually lower their salt consumption to about 1500 mg per day.

In the DASH diet, the source of the protein is not specified. It can be plant based or animal based. The above-referenced study compared the effectiveness of animal versus plant protein in the DASH diet. In the study, which was a double-blind randomized controlled clinical trial, ninety obese patients with metabolic syndrome, aged 30-70, were randomly assigned to two DASH-diet groups.

One of the groups consumed plant protein and the other consumed animal protein. The study was an 8-week experiment. At the start and conclusion of the study, measurements of blood pressure, weight, and waist circumference (WC) were taken.

Blood pressure, fasting plasma glucose (FPG), triglyceride (TG) concentrations, weight, and WC all decreased significantly in both groups. However, after adjusting for weight change, the drop in FPG and systolic blood pressure (SBP) was greater in the plant-based-protein DASH group than in the animal-based-protein DASH group. For total cholesterol, LDL-C, and HDL-C, no significant differences were detected among or between groups.

The DASH diet has a reputation for being a healthy diet. Indeed, it has been shown to effectively treat hypertension. The diet can help a person achieve improvements in cardiometabolic measurements. But placing more emphasis on plant-based rather than animal-based protein, in the diet, might be a good way to improve what is already a good diet.

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Are Mediterranean Diets Superior to Intermittent Fasting Diets in the Long-Run?

Obesity is associated with common ailments including hypertension, type 2 diabetes, high cholesterol, sleep apnea, some forms of cancer, and periodontal disease. And there are a number of diets used in the treatment of obesity. Two types of diets that receive a good deal of attention are Mediterranean diets and Intermittent Fasting (IF) diets. And one study, comparing the two types of diets, has concluded that an energy restricted form of the Mediterranean diet is superior to IF diets for weight management and body composition.

The Mediterranean diet is said to have originated in the Mediterranean basin in what some people call the cradle of society. The diet's foundation consists of the following: fruits and vegetables, whole grains, legumes and nuts, olive oil instead of butter, herbs and spices rather than salt, red meat only a few times a month, fish and poultry. The Mediterranean diet has been shown to be a healthy eating pattern.

Intermittent fasting (IF) is a recurring type of eating pattern where there are alternating periods of eating and fasting. In one study where high quality food was used in the IF diets, "The researchers concluded that [an] IF protocol optimized weight loss and improved body composition, cardiometabolic health, and hunger management.”

While both Mediterranean and IF diets have received positive reviews, one study compared an energy restricted Mediterranean diet with four different IF diets, and concluded that the Mediterranean diet is superior to IF diets.

 

The 13-week study consisted of 360 participants. The participants' ages ranged from 18 to 65 years. The participants had BMIs from 27 to 35 kg/m2. During weekly face-to-face meetings, the investigators collected participant data, including demographic information, physical activity related numbers, eating patterns,  and anthropometric measurements.

The researchers concluded that both the IF diets and the Mediterranean diet led to weight loss and similar, positive anthropometric changes. However, the researchers suggested that the long-term health benefits  are not apparent for IF eating patterns. Therefore, for the long-run, the Mediterranean diet is a better choice.

Of course, there are a number of  good, well-known diets in use today. And Mediterranean and IF diets are among them. While the Mediterranean diet could be a better diet in the long-run, determining the best diet-fit for a patient may be more important than a particular diet. Indeed, the best diet for an individual is the diet the individual will stick to.

 

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Prediabetes is Linked to Coronary Artery Calcification

According to the CDC, 96 million adults in America have prediabetes. Additionally, the majority of people with prediabetes are unaware of their disease. And prediabetes can lead to type 2 diabetes. Prediabetes is a condition that deserves attention not only because it can lead to type 2 diabetes, but because the condition is associated with other diseases. For example, a recent study reveals that there is a link between prediabetes and coronary artery calcification.

The American Diabetes Association and the CDC define prediabetes as follows: 5.7% ≤ HbA1c ≤ 6.4%;  100 mg/dL ≤ FPG ≤ 125 mg/dL;  140 mg/dL  ≤ OGTT≤ 199 mg/dL. Prediabetes is known to be associated with cardiovascular disease, kidney problems and, of course, diabetes. And, as mentioned above, the link to coronary artery calcification has been uncovered.

Coronary artery calcification, or CAC, is a buildup of calcium in the two main arteries of the heart, commonly known as the coronary arteries. This buildup occurs after about five years of plaque (fat and cholesterol) formation in the arteries. CAC is a sign of coronary artery disease and can provide information to your healthcare practitioner to assist them in assessing your cardiovascular risk.

In the CAC study, three groups of participants were established using fasting blood glucose (FBG) and HbA1c. One group was defined by the following prediabetes characteristics: 100 mg/dL ≤ FBG ≤ 125 mg/dL and HbA1c < 5.7%). Another group was defined by the following: FBG < 100 mg/dl and 5.7% ≤ HbA1c ≤ 6.4%. And finally, one group was defined by the following:  100 mg/dL ≤ FBG ≤ 125 mg/dL and 5.7% ≤ HbA1c ≤ 6.4%. Consisting of 1541 participants, the study took place between 2011 to 2019. None of the participants had a history of cardiovascular disease.

The investigators concluded that "CAC risk and CAC progression were consistently highest in individuals meeting both [the] glucose and HbA1c criteria" for prediabetes, while individuals meeting either one of the prediabetes criteria "showed a significantly increased risk of CAC progression."

The study just adds more evidence to the greatly held position that prediabetes should be treated because of its link to more serious health conditions.

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A Sedentary Lifestyle in Low Back Pain and Cardiovascular Disease

A lifestyle in which an individual engages in very little physical activity is often called a sedentary lifestyle. And individuals in every region of the world are becoming less active. People tend to be sedentary when they engage in leisure activities such as using computers, watching television, or playing video games. Also, while people are at work, they frequently complete their tasks while seated at a desk. For older people, leading a sedentary lifestyle can raise a person's chance of developing cardiovascular disease as well as lower back pain.

According to the findings of one study, leading a sedentary lifestyle can increase the likelihood of developing low back pain (LBP). To perform the investigation, which was a meta-analysis, the researchers looked at 27 separate studies. The studies were discussed in articles that were made available in databases such as PubMed, Embase, Web of Science, and Scopus. The analysis of the 27 studies revealed that leading a sedentary lifestyle increased one's likelihood of developing LBP.

For instance, utilizing a computer at work for longer than four hours a day can result in LBP. LBP might develop if a person spends more than seven hours a day sitting. Additionally, LBP may result from playing video games for at least twelve hours a week.

And with respect to a sedentary lifestyle in older people, a recent Finnish study looked at a cohort of  660 subjects, consisting of 277 men and 383 women. The mean age of the group was 68.9 years, and the study took place from 2013 to 2015.

The researchers found that a lower risk of cardiovascular disease is seen in older persons who limit their inactive time and engage in more daily physical exercise -- of any intensity. In fact, reducing inactive time and engaging in mild physical exercise are linked to lower all-cause mortality.

Since sedentary lifestyle can lead to LBP and increased cardiovascular risk, healthcare providers should encourage their patients to engage in exercise. And by the way, not only can exercise help treat LBP and lower cardiovascular risk, exercise may slow the decline in cognitive skills.

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Healthcare Cost for Type 2 diabetes

The National Diabetes Prevention Program (NDPP) services can prevent or delay type 2 diabetes for individuals with prediabetes. The NDPP services include help with healthy diet, physical activity, and lifestyle modification to lower stress. In delaying or preventing type 2 diabetes, the NDPP services can reduce healthcare costs.

Reducing healthcare costs is a significant concern with respect to diabetes. And since older people incur more healthcare costs, in general, one recent study looked at the cost of providing healthcare services to people with type 2 diabetes who were over 65. The CMS version of the NDPP, called the Medicare Diabetes Prevention Program, or MDPP, addresses diabetes prevention for Medicare beneficiaries, the majority of which are over 65 years of age.

In recent research conducted in Finland, investigators looked at "electronic patient records" to find people over 65 who had been told they had diabetes. After a selection process, 187 people with diabetes and 176 people without diabetes were chosen for the study. Information on how often primary care was used by the chosen participants was taken from electronic patient records for a one-year period.

It was found that, after a year, individuals with diabetes had more doctor's appointments, nurse's appointments, lab work done, and inpatient care at the community hospital than patients without a diagnosis of type 2 diabetes.

The older persons with type 2 diabetes who participated in these healthcare activities paid more for healthcare. In fact, the CDC reports that the average person with diabetes spends $16,750 a year on medical expenses. That is roughly 2.3 times what someone without diabetes would spend on medical care.

The NDPP and the MDPP (to some extent) are public-private arrangements that offer type 2 diabetes prevention services in healthcare and community settings. The NDPP and MDPP have been shown to decrease healthcare cost by delaying or preventing type 2 diabetes. To adequately address diabetes and type 2 diabetes prevention, healthcare providers should either offer treatment services or refer patients to community or healthcare organizations offering the services.

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Flaxseed, C-Reactive Protein and Central Obesity

 "Flaxseeds are a good source of dietary fiber and omega-3 fatty acids." And flaxseed may be beneficial in other ways. One study has shown that flaxseed consumption may aid in reducing the amount of C-reactive protein (CRP) in the blood. And another study has shown that flaxseed consumption may also aid in the reduction of central obesity.

According to one of the studies mentioned above, CRP is related to inflammation or swelling of the arteries. And this swelling is associated with cardiovascular problems. In the study, which was a Harvard  women's study consisting of 18,000 subjects, researchers noticed that CRP appeared to be more indicative of cardiovascular risk than cholesterol levels. In fact, a high CRP level could increase the risk of cardiovascular problems by a factor of three.

And flaxseed, which contains a large amount of dietary fiber, has been shown to lower the levels of CRP in the blood. In one study, consisting of 27 men who had cardiovascular risk factors, there was a decrease in CRP after the men were given flaxseed. The researchers indicated that "a decrease in inflammatory markers (CRP and TNF-alpha) was observed after flaxseed intake." The researchers suggested "that flaxseed added to a weight loss diet could be an important nutritional strategy to reduce inflammation markers..."

Furthermore, flaxseed added to a diet may reduce central obesity. In a 12 week flaxseed study, 60 overweight and obese women were randomized into two groups. Both groups were put on a balanced diet. However, the control group consumed 30 g/day of milled rice, while the treatment group consumed 30 g/day of milled flaxseed. At the end of the 12 week intervention, the researchers found that "there was [a] significantly higher reduction rate in waist circumference (WC) and waist to hip ratio (WHR) ... in the flaxseed consuming group compared to the control group."

Healthcare providers often look for ways to enable a person to improve his or her health through diet. Using flaxseed as part of a healthy diet may be a way to do that. Therefore, the use of flaxseed may be something healthcare providers might want to consider.

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