I hope everyone had a nice Thanksgiving holiday! What's the healthiest food you ate? How about the least! Now that Monday is here is it time to get "back on track" or were you on track regardless of the holiday weekend?View Thread
Dear diabetes Community, I would like to dedicate my 500th post to the excellent staff at WebMD who have created the opportunity for all of us to engage with one another. The diabetes community is something very unique and special. So please join me in thanking the staff for all they do behind-the-scenes to make this happen. I look forward to increasing my activity on this community board throughout the upcoming holiday season and into 2014. Michael Dansinger, MD.View Thread
What if doctors prescribed having more sex to treat diabetes? Sound crazy? I don't know any doctors who prescribe sex to treat diabetes, but after hearing a recent lecture I'm starting to wonder, "Why not?"
There's a general notion that sex is favorable to good health, but most doctors don't specifically encourage their patients to have more sex. Naturally, we don't want to encourage unprotected or unsafe sex associated with sexually transmitted diseases, or sex that leads to unwanted pregnancies. Also, we don't want to encourage reckless sex that leads to car accidents or dislocated hips or other unforeseen injuries, and the last thing we want is for someone to have a heart attack during sex and blame us for it.
Sex is one form of exercise that most people like! It's good for the heart and circulation, and helps maintain good blood flow to the sex organs. "Use it or lose it " is a fair statement, particularly in older people and those with diabetes.
Erectile dysfunction occurs in over half of men with diabetes, especially after several years of poor blood sugar control, and maintaining sexual frequency may potentially help delay or avoid erectile dysfunction. Not surprisingly, eating right and exercising can help partially reverse erectile dysfunction in men, by improving blood pressure , blood flow, body fat and hormone levels. Women with diabetes may also be at increased risk for sexual problems and it stands to reason that maintaining an active sex life may help prevent such problems.
Healthy sleep habits are very important for diabetes management — and sex and sleep are closely related, (enough to be considered "bedfellows" perhaps). Sex improves sleep, and vice versa . Similarly, problems with sleep can interfere with sex . Sex releases hormones that help promote sleep (especially in men), and sleep promotes hormones that favor good blood sugar control and appetite control. By the same token, inadequate sleep quality or quantity promotes hormones that worsen blood sugar control, appetite, weight gain, diabetes and heart disease.
So here we have a cycle of gradually decreasing health, sleep and sex over time. As one aspect worsens, the others may too, on and on it goes. The shame of it is that people generally like sex and sleep and feeling good.
Can we break the cycle? Is it as simple as turning off the TV an hour earlier and having more sex ? Unfortunately, it's not always so simple. Doctors are in a great position to help patients recognize and reverse this cycle, and should embrace the power of healthy sexuality to fight chronic illness, but most are not doing so. It is not because doctors are unaware of the health benefits of sex. It is not that doctors are afraid of the remote negative outcomes mentioned above. Doctors don't bring up sex because it's so easy not to, and because patients don't typically bring it up on their own.
This mirrors the reasons doctors and patients often don't bring up obesity and weight loss during the course of a routine health visit. Because visits are often rushed, the problem is not acute, there are lots of other priorities and starting the discussion seems risky. I know we can do much better. - Michael Dansinger, MDView Thread
This study consisted of 5145 adults with type 2 diabetes who had a body mass index (BMI) > 25. They were overweight when they came in to the study and were randomly assigned to the intensive lifestyle arm or the diabetes support and education (DSE) arm, which was, in essence, the control group who were given education and meetings twice a year, but they were not given the intervention that we provided to the lifestyle group. The intensive lifestyle group had a wonderful intervention: They were given individual sessions with a nutritionist and/or a trainer, they had group sessions, they had refresher courses, and they were given all the tools they needed to really work on and succeed at their lifestyle intervention. I think our patients did a fantastic job, and we were able to see an 8.6% reduction in body weight in the first year. That was not entirely sustained. During the next year, that weight loss changed to only about 5% of their body weight, but that was maintained through the duration of the trial to 11 years. We were able to show that we could produce modest weight loss and improve physical activity over time in these individuals with type 2 diabetes. However, what we did not show was a reduction in cardiovascular events and death. When you start talking to your patients about this trial, it does not mean that they should go out and eat anything they want and stop exercising. Again, there are real benefits to lifestyle change. Patients in the control group, the DSE group, did not gain weight. In fact, they slightly lost weight over time, so these patients weren't out there doing nothing. They were actually doing a little bit and minding their health. Moreover, patients in both groups started out better in terms of their control than many of our patients. The average A1c level was 7.3% at the beginning of the trial. LDL cholesterol was 112 mg/dL, they had reasonable blood pressures, and their BMI was about 35. These were not terribly out-of-control patients. Some were, but on average they were a pretty well-controlled group going into this study. We do know that weight loss and exercise can prevent diabetes. I am a big advocate of prevention, both early prevention of obesity altogether, as well as prevention of diabetes in individuals who have become overweight. Lifestyle changes can help prevent diabetes. Once you have diabetes, I think weight loss and exercise can have benefits, but they are not going to reduce the risk for the primary outcome that we set for Look AHEAD, which was a risk for macrovascular events or death. I think it is important to help put this trial into perspective for patients. Look AHEAD will now change into a cohort study in which we follow patients over time. There will be a lot more data coming from Look AHEAD that can be interpreted in the future. This has been Dr. Anne Peters for Medscape. Thank you.View Thread
Hi. I am Dr. Anne Peters from the University of Southern California, and I am here today to discuss why the Look AHEAD trial was stopped. I am one of the principal investigators of the Look AHEAD trial, so I know the trial pretty well. From my perspective, it has been a very interesting study, and I think that we have interesting findings to come that may not be reflected in what has been learned recently. The Look AHEAD trial looked at the benefits of weight loss and exercise in the treatment of type 2 diabetes.[1> I can tell you from the outset that we were successful. We got our patients to lose weight, increase their physical activity, and do it over a long period of time -- for up to 11 years. I think that is important: We were able to reach our lifestyle goals. But the primary outcome of this study was a macrovascular event outcome. It consisted of nonfatal myocardial infarction, nonfatal stroke, death, or hospitalization for angina. In terms of the primary outcome, we did not see a difference between the 2 groups at 11 years. Overall, the rates of cardiovascular events and death were actually quite low in both the intervention group and the control group. We did not see a difference in the lifestyle arm even though they did better in terms of weight loss and increased physical activity. There was, however, only 1 outcome. I believe that there are many other outcomes that people derived along the way from losing weight and becoming more physically active. For instance, we know that rates of sleep apnea were lower in the group that was intensively treated. We know that patients had lower rates of urinary incontinence and they were on less medication. There are many things that we need to analyze further in order to fully look at the benefits of weight loss and exercise in this population, but we do know that they did not improve the 1 big macrovascular primary outcome. We also need to look at subsets; there may be people who did better or worse in terms of responding to the intervention. All of these analyses (although I want them all done right away) have not been finished yet. I think that there is a lot that we have to do to truly look at all the benefits and risks of a lifestyle intervention. Those are the headlines. Let me go into the details to explain a little more.View Thread
The Look AHEAD study tested the effectiveness of lifestyle coaching (caloric reduction and increased exercise) and weight loss (compared to a usual care control group with no weight loss) for reducing rates of cardiovascular events in overweight patients with type 2 diabetes over the course of up to 11 years.
The study was halted last week--two years early--because there was no difference in cardiovascular events between the lifestyle coaching group and the usual care control group.
I was surprised because I was fairly confident that the long-term weight loss (5% of initial body weight--around 10-12 pounds) over 5-10 years in most participants, would translate into delayed onset or prevention of cardiovascular events compared to the control group.
It is still hard for me to know what to make of this unexpected and disappointing result. Once more information about the results becomes available it may become easier to draw some useful conclusions.
I think it would be a mistake to conclude there is no point to making an effort to eat right and exercise. I believe patients in the lifestyle coaching group did not require as much medication as the control group, and they may have had many real health benefits and improved quality of life on many fronts. I must also wonder whether an alternative dietary approach or an even more intensive approach would have made the difference. We will learn more once we have a chance to "study the wreckage" of this disappointing study result. I really wish it had proven that we can prevent heart disease and cardiovascular events in such patients. In the meantime I will continue to believe that lifestyle change can make a tremendous difference for patients once we learn to fully harness its power.