For diabetics, losing weight may delay kidney problems

Healthy eating, staying active and losing weight are already recommended for people with type 2 diabetes, and new research suggests these steps may also delay or prevent chronic kidney disease.

For diabetics, losing weight may delay kidney problems

About 35 percent of U.S. adults with diabetes have some degree of kidney disease, and diabetes is the major cause of kidney failure and dialysis, according to the study’s lead author Dr. William C. Knowler.

“This result along with many others tends to reinforce the value of weight loss interventions and hopefully motivates people with diabetes to lose weight,” said Knowler, who is chief of the Diabetes Epidemiology and Clinical Research Section of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland.

He and his co-authors reexamined data from an existing study of lifestyle modifications for people with type 2 diabetes.

For the original study, more than 5,000 overweight or obese Americans with type 2 diabetes ages 45 to 76 were divided into two groups. Half received diabetes support and education and the other half aimed to lose seven percent of their body weight through reduced calorie diets and increased physical activity.

People were recruited for the study between 2001 and 2004. For the first year or so, the weight-loss group met regularly with dieticians, case managers and physical activity experts to stay on track toward their calorie, activity and weight-loss goals.

The study continued, with encouragement to stick to diet and exercise programs, through 2012. As with many weight loss programs, the first year is the critical period for weight loss and later years are spent maintaining it, which can be difficult, Knowler said.

At the one-year mark, the diet and exercise group had lost an average of 8.6 percent of their body weight, compared to less than one percent lost in the support-and-education group.

Over the entire study period, people in the diet and exercise group were 31 percent less likely to develop very high risk chronic kidney disease, according to urine tests.

The study’s primary aim was to investigate the power of weight loss to reduce the risk of heart problems or stroke, and as the researchers published previously, no benefit was seen there.

Knowler emphasized, however, that the weight loss program did improve the outlook for kidney disease and many other aspects of health, including depression, knee pain, urinary incontinence and heart rate recovery after exercise.

Dr. Dick de Zeeuw writes in an accompanying editorial in The Lancet Diabetes and Endocrinology that he found the kidney-health benefit with no heart benefit difficult to reconcile.

de Zeeuw, of the Hiddo Lambers Heerspink Department of Clinical Pharmacy and Pharmacology at the University of Groningen in Germany, also writes that using very high risk chronic kidney disease as the marker of success or failure in the study doesn’t line up with what most trials like this would do if a drug were being tested instead of a lifestyle change.

Nevertheless, these results reinforce the existing recommendation that people with type 2 diabetes should maintain a healthy weight, he told Reuters Health.

“In one sense it doesn’t add anything to existing recommendations because for overweight people, weight loss and increased activity are recommended already,” Knowler said. “But we don’t really put a lot of force behind that recommendation.”

For most people, telling them to lose weight and handing out some pamphlets is not enough, he said. This study indicates that an intense program of major behavioral change, including counseling, group session and mutual reinforcement can work.

“Any approach that results in sustained weight loss should work just as well,” Knowler said.

Source: fox news


High-Salt Diets Could Double Risk of Heart Woes for Diabetics

High-Salt Diets Could Double Risk of Heart Woes for Diabetics

A diet loaded with salt is associated with double the risk of heart attack or stroke in people with type 2 diabetes. The risk skyrockets even higher among those whose diabetes isn’t well-managed, a new Japanese study reports.

The study found that people with diabetes who consumed an average of 5.9 grams of sodium daily had double the risk of developing heart disease than those who consumed, on average, 2.8 grams of sodium daily. In addition, heart disease risk jumped nearly 10-fold for people with poorly managed type 2 diabetes and a diet with excess salt.

However, it’s important to note that this study only found an association between salt intake and increased heart disease; the study wasn’t designed to prove that the increased salt intake actually caused heart disease.

Still, experts believe it’s important to limit salt in the diet.

“The findings are very important from a public health point of view,” said Dr. Prakash Deedwania, chief of cardiology for the Veterans Administration Central California Health Care System and a professor at the University of California, San Francisco School of Medicine.

“Everyone’s focused on controlling glucose [blood sugar] to prevent diabetes complications. Salt intake is not as well emphasized, but this shows it should be reduced as well,” said Deedwania, a member of the American College of Cardiology’s Prevention of Cardiovascular Disease Committee.

The study highlights the need for people with diabetes to track more than just carbohydrates when managing their daily diet, said Deedwania.

Public health officials previously have established a link between diabetes and heart disease. There are about 29 million Americans with diabetes, and they die from heart disease at a rate 1.7 times higher than people without diabetes, according to the U.S. Centers for Disease Control and Prevention (CDC).

Salt — also called sodium — is known to increase blood pressure, according to the American Heart Association. Accordingly, U.S. nutritional guidelines call for limits on salt intake. Because of the already increased risk of heart disease, people with diabetes should consume no more than 1,500 milligrams of sodium per day. People without diabetes should limit their sodium intake to 2,300 milligrams, the CDC says. In the current study, the lowest average was 2.8 grams a day, which equals 2,800 milligrams.

“This is something we have been touting with diabetes patients,” said Dr. Spyros Mezitis, an endocrinologist at Lenox Hill Hospital in New York City. “Now we have more evidence to solidify our arguments.”

The new study involved nearly 1,600 people, aged 40 to 70, participating in a nationwide study of diabetes complications in Japan. They responded to a survey about their diets, including salt intake, and researchers reviewed data on heart complications participants experienced over the course of eight years.

The investigators found no link between salt intake among diabetics and increased risk of kidney disease, diabetes-related eye problems or death.

Diabetes and salt have similar harmful effects on the cardiovascular system, Mezitis said. Both cause blood vessels to harden, and both increase the risk of blood clots that can cause a heart attack or stroke.

“Because the vascular complications of diabetes are similar to those of salt, that’s where it becomes doubly as bad,” he said. “The higher the salt intake, the worse the cardiovascular effects we see.”

However, Mezitis cautioned that the study needs to be replicated in America. Japanese patients are not as heavy as Americans, they eat less salt, and they do not take as many cholesterol-lowering drugs.

The study also relied on people’s own reports of salt intake, which could lead to some inaccuracy, said Dr. Robert Carey, a professor of endocrinology at the University of Virginia and spokesman for the Endocrine Society.

“I would not recommend any guideline changes based on this study, but I think this study strongly suggests there may be a relationship with cardiovascular disease and salt intake among diabetics,” Carey said.

Source: health day


Healthy lifestyle to improve oral health in diabetics

Diabetics, who are at a higher risk of suffering from oral health problems, can avoid these by adopting a healthy lifestyle.

Researchers at the University of Copenhagen have helped a large group of diabetics to markedly improve their oral health through health coaching.

“Diabetics are at a higher risk of suffering oral health issues like periodontitis and caries and other problems like dry mouth, fungal infections and poor wound healing,” said Ayse Basak Cinar, assistant professor at department of odontology at the university.

In all, 186 patients with type 2 diabetes participated in the study done in Turkey – the first in the world – to demonstrate the role of health coaching in improving dental health.

The patients with diabetes were divided into two groups.

One group was given traditional health information, for example a brochure on good dental hygiene.

The other group was offered motivational health coaching in the form of 3-6 sessions over a six-month period, focusing on diet, stress management and dental care, said the research published in the journal Clinical Oral Investigations.

“In patients who were given personal health coaching, biological markers for periodontitis – also known as loose teeth disease – were reduced by as much as 50 percent over a six-month period,” the research noted.

“The patients in the trial group saw a significant decline in long-range blood sugar levels, whereas figures for the control group were unchanged,” said.

“Health coaching is a resource-intensive intervention. However, dishing out brochures to patients with diabetes and thinking that this would help is also a costly approach for the society,” he added.

Source; Business standard