Diabetes Archive

News briefs

Bisphenol A (BPA), used to make some plastics and epoxy resins, has made headlines for years because of its association with an increased risk for obesity, diabetes, high blood pressure, and cardiovascular disease in humans. Now high levels of BPA exposure have been linked to an increased risk for premature death from any cause, according to a study published online Aug. 17, 2020, by JAMA Network Open. Scientists analyzed the survival rates of about 3,900 people who provided health information and urine samples and were then followed for 10 years. People with the highest levels of BPA in their urine had a 51% higher risk of dying during that period, primarily from heart disease, compared with people who had the lowest levels of BPA. The findings don't prove that BPA caused premature death, but they add to concerns about BPA's potential toxicity. BPA and related chemicals are found in many products, such as water bottles, cups, dental sealants, paper receipts, and the linings of food and beverage cans and pipes, so it's hard to avoid them. Simple precautions include relying less on canned foods and more on fresh foods; avoiding plastics with a 3 or 7 recycling label; microwaving food in glass or ceramic containers, not plastic; and looking for BPA-free products.

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News briefs

If your doctor or pharmacist offers a service to monitor blood pressure measurements you send from home (called telemonitoring), consider taking advantage of it. Past research has shown that telemonitoring — often paid for by Medicare — may help you reduce your blood pressure. And a study published online Aug. 31, 2020, by Hypertension suggests telemonitoring is also associated with a long-term reduction in heart attacks, strokes, and medical costs. The recent study is a follow-up to a randomized controlled trial from 2013 that divided 450 people into two groups: those who received routine primary care, and those who received a year of telemonitoring services with a pharmacist who helped manage their treatment. People in the telemonitoring group had lower blood pressure for up to two years afterward, compared with people who received routine care. In the recently published follow-up, which followed the same participants for five years, researchers found there were about half as many heart attacks, strokes, and hospitalizations in the telemonitoring group as there were in the group that received routine care. Because there were fewer cardiovascular problems, people in the telemonitoring group also saved an estimated $1,900 each in medical costs.

On call

Q. I would occasionally get some swelling in my legs. But now I notice it by late afternoon every day. I otherwise feel fine. Should I be worried?

A. It sounds like you have edema, swelling in your legs due to fluid in the soft tissues beneath your skin. This usually occurs when pressure from the fluid inside your veins is high, which forces water out of the blood vessels and into the surrounding tissues.

Ask the doctors

Q. I'm trying to eat less sugar. Can you offer any tips that can help?

A. First, congratulations. Cutting down your consumption of sugar can help protect your health in the long term. Sugar-heavy diets have been linked to health conditions, including obesity, diabetes, and heart disease. Most Americans eat far too much sugar. A U.S. government health and diet survey from 2015–16 found that the average American eats about 17 teaspoons of sugar a day. The Dietary Guidelines for Americans recommend eating no more than the equivalent of 12 teaspoons of sugar a day, and the American Heart Association suggests no more than the equivalent of six teaspoons per day. To cut down on your sugar consumption, your first goal should be to focus on incorporating more whole, unprocessed foods into your daily diet. Eating more of these foods can crowd out processed sources of added sugars in your diet.

In the journals

Scientists continue to explore the right balance of carbohydrates and fat in people's diets. But for overweight or obese older adults, a recent study found that a low-carbohydrate, high-fat diet might offer special health benefits. The results were published online Aug. 12, 2020, by Nutrition and Metabolism.

Researchers asked 40 obese adults, ages 60 to 75, to follow an eight-week diet in which 10% of calories came from carbs, 25% from protein, and 65% from fat. Carb sources included leafy greens, non-starchy vegetables, some fruit, and high-fiber grains. Protein intake consisted of eggs, fish, pork, and poultry. Fat-containing foods included olive oil, coconut oil, nut oils, nut butter, cheese, coconut milk, and avocados.

When diet and exercise are not enough for a person with diabetes to manage their blood sugar, one or more medications may be needed. Adding a second medication can offer additional benefits beyond blood sugar control, but the benefits and risks of these newer classes of drugs must be weighed for each person.

Drinking no more than four or five 8-ounce cups of coffee per day—equal to about 400 milligrams of caffeine—helps people get the drink's health benefits with a lower risk of caffeine side effects like anxiety and nervousness.

On call

Q. My blood pressure stays low. Sometimes it drops so low, it causes dizziness and weakness. What causes this?

A. Of the possible causes of low blood pressure, two are at the top of my list. First, I would review your medications. Drugs prescribed to treat high blood pressure and heart disease are the ones that most often cause this side effect. Reducing the dose with your doctor's approval may be all you need.

On call

Q. What would cause my tongue to suddenly swell? Could this be a possible side effect of medication, or something else?

A. There are many reasons for a swollen tongue. Indeed, a reaction to a medication is one of the more common causes. For example, a well-known side effect of ACE inhibitors (a class of drugs used to control blood pressure) is a condition called angioneurotic edema. Swelling of the face, lips, and tongue can happen quickly in people who take an ACE inhibitor. The reaction may occur soon after it's first taken or at any time thereafter. Sometimes people get this reaction even though they have used the drug for several years. ACE inhibitors are more likely to cause angioneurotic edema in African Americans.