Diabetes Archive

Having high blood sugar, even without diabetes, can increase the risk for dementia. The higher blood sugar rises, the more that risk goes up.

It appears older adults with diabetes who experience at least one severe bout of low blood sugar may have double the risk for developing dementia. It also appears that low blood sugar occurs more often in people with dementia.

Metformin—the drug that millions of people with diabetes take to control their blood sugar—may be on the brink of a second career. Evidence from a variety of studies suggests that metformin may delay or slow the progression of prostate cancer. Metformin does not, however, appear to prevent the development of prostate cancer in the first place.

There are many reasons to keep your blood sugar under control: protecting your arteries and nerves are two of them. Here’s another biggie: preventing dementia, the loss of memory and thinking skills that afflicts millions of older Americans. A study published today in the New England Journal of Medicine shows that even in people without diabetes, above normal blood sugar is associated with an increased risk of developing dementia. The study does not prove that high blood sugar causes dementia, only that there is an association between the two. For that reason, don’t start trying to lower your blood sugar simply to preserve your thinking skills, cautions Dr. Nathan. There’s no evidence that strategy will work, although he says it should be studied. But it is still worth keeping an eye on your blood sugar. Excess blood sugar can lead to diabetes and a variety of other health problems, including heart, eye, kidney, and nerve disease.

An old, aspirin-like drug called salsalate could help control blood sugar in people with type 2 diabetes. In the TINSAL-T2D trial, 286 volunteers took pills containing either salsalate or a placebo for nearly a year. Over the course of the trial, those in the salsalate group had lower blood sugar levels, and some were even able to reduce dosages of other diabetes medications they were taking. Experts aren’t exactly sure how salsalate helps control blood sugar, but its effectiveness supports the idea that inflammation plays a role in type 2 diabetes. Although the results are promising, what we really need to know about salsalate (or any new or repurposed drug) is how its long-term benefits and risks stack up against each other. The trial was too small and too short to determine those risks. According to the researchers, such “outcomes require continued evaluation before salsalate can be recommended for widespread use” by people with type 2 diabetes.

Q. My doctor says I may have too much visceral fat. Why is this a problem and what can I do about it?

A. Visceral fat (sometimes called abdominal fat) is fat that accumulates in our abdomen, padding the spaces between our abdominal organs. Unlike the fat just beneath the skin—the kind we can grab with our hands, called subcutaneous fat—visceral fat seems to be more harmful to our health. It is linked to insulin resistance, which may lead to type 2 diabetes, and to an increased risk for cardiovascular disease. In women, it is also associated with a higher risk of breast cancer and the need for gallbladder surgery.

Q. My doctor says I need more potassium in my diet. However, I have diabetes, and orange juice and bananas have too much sugar. What foods can I eat to get potassium without too much sugar?

A. You can obtain potassium from a number of vegetables that provide potassium with fewer carbohydrates (sugars) than orange juice and bananas. Some examples include asparagus, tomatoes, and green leafy vegetables, such as spinach. Fruits with the highest potassium content (bananas, melons, and apricots) are also high in carbohydrates, but there are some that supply potassium with fewer carbs, such as strawberries and nectarines. For a complete list of the potassium in different foods, go to www.health.harvard.edu/100.

Long-awaited results from a nearly 10-year trial exploring the effect of changes in diet and exercise among people with diabetes weren’t what most people expected. The Look AHEAD trial found that intensive efforts to lose weight by eating less and exercising more didn’t provide any more protection against heart disease—a common co-traveler with diabetes—than standard diabetes support and education. The spin from some media reports is that weight loss doesn’t reduce heart disease risk among people with type 2 diabetes, but I think that’s the wrong interpretation. The results of the Look AHEAD trial don’t contradict the value of lifestyle changes. People in the intensive change group improved their blood sugar with fewer drugs, saving an estimated $600 per year, they were also less likely to have developed chronic kidney disease and less self-reported vision problems. The Look AHEAD results reinforce for me that diabetes care needs to be tailored to the individual.

City dwellers often think of rural America as a throwback to past “good old days.” But when it comes to obesity and diabetes, people living outside urban areas offer a frightening glimpse of the future. While more than 8% of Americans now have diabetes, in some rural counties 20% of the residents have diabetes. Those counties also tend to have high rates of obesity. Barriers to healthy living contribute to both obesity and diabetes. So does lack of primary care physicians. One answer may be greater reliance on community health workers—lay people trained to provide diabetes education and outreach. In Birmingham, Alabama, the Cities for Life program has doctors refer people with diabetes to “patient navigators” who help them find local resources such as nearby exercise classes or mobile farmers’ markets.

A lot is known about diabetes. But a discovery that could change how this disease is treated shows just how much more there is to learn. A team of Harvard Medical School researchers has discovered a hormone called betatrophin made by liver and fat cells that signals the body to make more insulin-producing beta cells. A report of their work appears in this month’s issue of the prestigious scientific journal Cell. In mice with diabetes, experimentally turning on the production of betatrophin inside liver and fat cells caused an increase in beta cells and a dramatic improvement in blood sugar. It will, of course, take much more research in mice—and then in humans—to determine if this newly discovered hormone can serve as a treatment for diabetes. So it’s too soon to get excited that the discovery of betatrophin will translate directly into a new treatment for diabetes. But it is another example of the human body’s power to naturally repair itself.