Diabetes Digest

Diabetes Disparities Legislation Introduced in Congress

Recognizing that diabetes is one of the most serious health threats that disproportionately affects Americans of color, a bipartisan team of legislators has introduced the Eliminating Disparities in Diabetes Prevention Access and Care Act of 2009 (EDDPAC) into the 111th U.S. Congress. Sponsored in the House by Reps. Diana DeGette (D-CO) and Michael Castle (R-DE) as HR 1995 and in the Senate by Frank Lautenberg (D-NJ) and Johnny Isakson (R-GA) as S 844, the proposed legislation calls for coordinating prevention, research, treatment and education across multiple federal health agencies to develop culturally appropriate solutions to the diabetes epidemic in minority communities. For more information, and to contact your state’s legislators about supporting these bills: www.house.gov and www.senate.gov.

It’s a Recession. Do You Know Where Your Diabetes Patients Are?

The American Diabetes Association (ADA) is warning health care professionals that the current economic crisis is having a devastating effect on the nation’s diabetes patients. According to ADA, many diabetics who have lost jobs, income and health insurance have been forced to cut back on—or even give up completely—the care they need to control their disease and prevent the development of life-threatening complications. Some financially strapped patients are endangering their health by canceling doctor visits and scrimping on, or not buying, their insulin, diabetes drugs and blood glucose monitoring supplies. Others are turning to options such as tax-subsidized and charity care, emergency room care and clinics that offer free samples of diabetes medicines.

Race and Ethnicity—Not Weight—May Be Biggest Predictor of Diabetes Risk

A research study published in the Winter 2009 issue of the journal Ethnicity and Disease sheds some interesting light on why Americans of color are so disproportionately affected by type 2 diabetes compared to white Americans. Being obese or overweight has long been considered the biggest contributing factor in the development of the disease. But now, researchers from the Cancer Research Center of Hawaii have found that type 2 diabetes is at least twice as prevalent in American Indians, Native Hawaiians, Latinos, African Americans and Japanese Americans than in whites regardless of body weight. In fact, ethnic differences in the prevalence of diabetes were found even in underweight adults. These results strongly suggest that genetics plays a role in the development of type 2 diabetes, the researchers conclude.

Minority Americans Falling Behind on National Diabetes Awareness Goals

The National Diabetes Goal (NDG), established in May 2008 by a coalition of leading diabetes advocacy organizations, seems simple enough to meet: “By 2015, 45% of Americans who are risk for type 2 diabetes will know their blood glucose level and what actions to take.” But the results of a recent survey by Novo Nordisk’s National Changing Diabetes® Program (NCDP) reveal that an alarming 83% of at-risk Americans aren’t even taking the most basic steps toward diabetes awareness, such as getting a blood glucose test. In particular, the survey found that 44% of at-risk African Americans and 42% of at-risk Hispanics did not meet any element of the DNG, even though these populations are at greater risk of developing diabetes than their white counterparts. According to the NCDP, “this study clearly demonstrates the need for greater education and awareness, especially among people who are at risk.” For more information about how you can get involved with the NDG and the NCDP: www.nationaldiabetesgoal.com and www.ncdp.com.

Telephone Intervention Helps Low-Income Diabetics Manage their Disease

Diabetes Digest

When it comes to helping low-income patients with poorly controlled diabetes improve their ability to manage their disease, group therapy is a good intervention—but automated telephone prompts are even better. Those are the findings of a University of California, San Francisco study that compared the effectiveness of these two outreach strategies in helping an ethnically diverse group of low-income men and women improve diabetes self-management skills such as medication adherence, diet, exercise, blood sugar monitoring, and eye and foot care. The research, published in the April 2009 issue of Diabetes Care, found that study participants assigned to either monthly diabetes management group sessions or weekly automated phone prompts offering diabetes control tips had significant improvement in their ability to manage their condition. However, those who received and responded to weekly telephone prompts in their native language—with individualized nurse-delivered follow-up as needed—reported the biggest improvements, especially in areas like increased physical activity and better foot care.

Low-Income Moms with Diabetes at Risk for Pre- and Post-Partum Depression

Nurses need to be aware that researchers at Harvard Medical School have discovered a possible link between diabetes and pregnancy-related depression in low-income women. The study, which reviewed data on more than 11,000 women, found that low-income women with diabetes who were pregnant or recently gave birth were almost twice as likely to develop depression during or after pregnancy than non-diabetic women (15.2% vs. 8.5%). In fact, their risk of pre- or post-partum depression was higher regardless of whether they had developed diabetes before or during their pregnancy, were taking insulin or diabetes drugs, or had no previous history of depression. While the study results, published in the February 25 issue of the Journal of the American Medical Association, raise a number of unanswered questions, the researchers do recommend that “health care facilities need to pay particular attention for depression in women with diabetes during the post-partum period.”

I Yam a “Diabetes Superfood” (and So Are Beans, Berries, Yogurt and More)

The ADA has recently issued a list of “diabetes superfoods,” so called because they have a low glycemic index (GI) and contain nutrients that are necessary for good diabetes management, such as fiber, potassium, magnesium and antioxidants. They also have been shown to lower blood glucose, blood pressure and cholesterol. Foods on the list include sweet potatoes, beans (kidney, black, pinto, etc.), dark green leafy vegetables, citrus fruits, tomatoes, berries, fish with omega-3s (salmon, tuna, etc.), whole grains, nuts, fat-free milk and yogurt. For more information, patient education materials and superfoods recipes: Sarah Bradley, (703) 549-1500, ext. 2231, sbradley@diabetes.org.

Low-Carb Diets Best at Controlling Diabetes. Make That Extremely Low-Carb.

The results of a study conducted at Duke University Medical Center suggest that an extremely low-carbohydrate eating regimen known as a “ketogenic diet” is dramatically more effective in reducing blood glucose levels in obese patients with type 2 diabetes than a low-calorie, low-glycemic diet. This is no ordinary low-carb diet: It severely restricts patients’ carb intake to a scant 20 or fewer grams per day, far less than the ADA’s recommended 130 grams. In the Duke study, more than 95% of patients on the ketogenic diet were able to reduce or even eliminate their need for diabetes medications, compared to only 62% of patients on the low-calorie diet. However, the researchers caution, the ketogenic diet is so extreme and requires so much behavioral modification that some patients may be unable to comply with it.