Another Sweet Saturday – 09.17.22

Our 1-year RCT indicated that a lifestyle intervention program can be highly successful in older adults with diabetes and chronic comorbidities. In this specific population, lifestyle intervention not only improved glycemic control associated with improved insulin action and secretion but also improved age-relevant outcomes such as body composition, physical function, and quality of life.

Alessandra Celli, Yoann Barnouin, Bryan Jiang, Dean Blevins, Georgia Colleluori, Sanjay Mediwala, Reina Armamento-Villareal, Clifford Qualls, Dennis T. Villareal; Lifestyle Intervention Strategy to Treat Diabetes in Older Adults: A Randomized Controlled Trial. Diabetes Care 1 September 2022; 45 (9): 1943–1952. https://doi.org/10.2337/dc22-0338

From the periods 1988–1994 to 2017 to March 2020, there was an increase in the prevalence of diagnosed diabetes (from 4.6% to 11.7%), but no change in prevalence of persistent undiagnosed diabetes (from 2.23% to 2.53%) or confirmed undiagnosed diabetes (from 1.10% to 1.23%). Consequently, the proportion of all undiagnosed diabetes cases declined from 32.8% to 17.8% (persistent undiagnosed diabetes) and from 19.3% to 9.5% (confirmed undiagnosed diabetes). Undiagnosed diabetes was more prevalent in older and obese adults, racial/ethnic minorities, and those without health care access. Among persons with diabetes, Asian Americans and those without health care access had the highest proportion of undiagnosed cases, with rates ranging from 23% to 61%.

Michael Fang, Dan Wang, Josef Coresh, Elizabeth Selvin; Undiagnosed Diabetes in U.S. Adults: Prevalence and Trends. Diabetes Care 1 September 2022; 45 (9): 1994–2002. https://doi.org/10.2337/dc22-0242

Remember, Stay as Thin as You Can as Long as You Can.

Exposome! (I Learned a New Word Today)

In an extensive review, the team found that the early life exposome, which encompasses one’s diet, lifestyle, weight, environmental exposures, and microbiome, has changed substantially in the last several decades. Thus, they hypothesized that factors like the westernized diet and lifestyle may be contributing to the early-onset cancer epidemic…

Possible risk factors for early-onset cancer included alcohol consumption, sleep deprivation, smoking, obesity, and eating foods. Surprisingly, researchers found that while adult sleep duration hasn’t drastically changed over the several decades, children are getting far less sleep today than they were decades ago. Risk factors such as highly-processed foods, sugary beverages, obesity, type 2 diabetes, sedentary lifestyle, and alcohol consumption have all significantly increased since the 1950s, which researchers speculate has accompanied altered microbiome.

Cancers in adults under 50 on the rise globally – https://www.sciencedaily.com/releases/2022/09/220906161454.htm. Brigham and Women’s Hospital. “Cancers in adults under 50 on the rise globally: Researchers identify risks factors and trends behind an increasing incidence of early-onset cancers around the world.” ScienceDaily. (accessed September 7, 2022).

I’ve been cooking a lot this week and decided to give myself a break tonight. Grab a burger maybe some pizza.

Then I read this article.

Maybe I will cook tonight.

Loneliness and Mortality

The discomfort of loneliness eases with time. You come to accept solitude like a cracked tile in a corner of the bathroom floor. Eventually, you just stop noticing the defect. For older people, however, one crack could easily, quietly, lead to more. Living in isolation, for people over 50, can spur a 50 percent increased risk of dementia, according to the CDC, and a 32 percent increased risk of stroke. Loneliness is also associated with higher rates of anxiety, depression, and suicide. Prolonged isolation is the equivalent to smoking 15 cigarettes a day. (And older members of marginalized communities are at an even higher risk for all of the above when they’re socially secluded.) In the years since my mom lost her husband and her friends in Florida, her health declined and her shine dimmed. The woman who owns more makeup than Dolly Parton — including Stila compacts from the early aughts she audaciously calls “my vintage cosmetics” — stopped putting on her face.

My Mom Has No Friends — https://www.thecut.com/2022/08/helping-my-mom-make-friends.html

A beautifully written article. I hope you choose to read the entire piece.

Covid-19 and a Plant Based Diet

Okinawa, one of the blue zone regions, is highlighted due to its extreme longevity, plant-based diet, and now, the population’s resistance to COVID-19.

People in Okinawa, for example, consume a predominantly plant-based diet rich in phytochemicals and antioxidants… They also consume abundant green leafy vegetables and soy products, with minimal fat (about 6% of the total energy intake). In addition to their high life expectancy and low mortality from cardiovascular disease and certain types of cancers, Okinawans have enjoyed a remarkable resistance to COVID-19 mortality. As of June 16, 2021, the COVID-19 mortality in Okinawa, Japan, was 0.08% (163 deaths out of 19,782 cases), which is one-sixteenth that of Tokyo (mortality rate 1.3%; 2183 deaths out of 167,416 cases).

Can a Plant-Based Diet Mitigate the Risk of Severe COVID-19? — https://www.bluezones.com/2022/02/can-a-plant-based-diet-mitigate-the-risk-of-severe-covid-19/#

Journal Reference: Kahleova, H., Barnard, N.D. Can a plant-based diet help mitigate Covid-19?. Eur J Clin Nutr 76, 911–912 (2022). https://doi.org/10.1038/s41430-022-01082-w

Incidence and Characteristics of Remission of Type 2 Diabetes in England: A Cohort Study Using the National Diabetes Audit

Remission of type 2 diabetes was generally infrequent in routine care settings but may be a reasonable goal for a subset of people who lose a significant amount of weight shortly after diagnosis.

Incidence and Characteristics of Remission of Type 2 Diabetes in England: A Cohort Study Using the National Diabetes Audit – Diabetes Care 2022;45(5):1151–1161
https://doi.org/10.2337/dc21-2136

Thinking About Retirement (or just another fine Saturday Morning)

Andel’s suggestion to anyone contemplating retirement: “Find a new routine that’s meaningful.” He points to people living in the Blue Zones, regions of the world that have been identified to be home to a greater number of residents who’ve reached the age of 100 and beyond. One of the common characteristics among Blue Zone inhabitants is, says Andel, “these people all have purpose.”

Think Retirement Is Smooth Sailing? A Look at Its Potential Effects on the Brain — https://getpocket.com/read/2840794990

The funny thing about life at “retirement age” and still working is you think about retirement a lot.

Since I still work a full time job I have a lot of trouble envisioning what my retirement will look like.

After reading this article and listening to Andel’s short talk I am now scared of retirement.

I need to figure out how to avoid brain rot. But my journal tells me I already have.

My Purpose is to educate others on diet and disease, weight loss and weight management by sharing my personal journey through writing and other teaching activities.

Fatigue and Higher Mortality

Glynn and her colleagues administered the Pittsburgh Fatigability Scale to 2,906 participants aged 60 or older in the Long Life Family Study, an international study that follows family members across two generations. Participants ranked from 0 to 5 how tired they thought or imagined that certain activities — such as a leisurely 30-minute walk, light housework or heavy gardening — would make them. Follow-up for this work concluded at the end of 2019, to avoid any increased mortality impact from the COVID-19 pandemic, which gave the team an average of 2.7 years of data on each participant. After accounting for a variety of factors that influence mortality, such as depression, pre-existing or underlying terminal illness, age and gender, the team found that participants who scored 25 points or higher on the Pittsburgh Fatigability Scale were 2.3 times more likely to die in the 2.7 years after completing the scale, compared to their counterparts who scored below 25.

University of Pittsburgh. “Feelings of fatigue predict early death in older adults.” ScienceDaily. http://www.sciencedaily.com/releases/2022/01/220124084616.htm (accessed January 27, 2022).

The App That Helps Me Be a More Patient Centered Physician — A Country Doctor Writes:

One of the most rewarding things I do in my clinic happens on my iPhone. When I sit down with a middle aged patient to talk about their cardiovascular risk, I open the risk calculator created by the American Heart Association and the American College of Cardiology. I talk my way through as I enter […]

The App That Helps Me Be a More Patient Centered Physician — A Country Doctor Writes:

The risk calculator is quite useful but I re-blogged this post for its link to the Hale study, which was news to me. This study published in 2004 showed older people between the ages of 70 and 90 who followed a Mediterranean diet have 50% lower rate of all-cause and cause-specific mortality than people who dine on the SAD Western diet. The four primary risk factors were diet, moderate alcohol intake, physical activity, and non-smoking.

Lifestyle matters.

Another Sweet Sunday – 12.12.21

RESULTS During 170,148 person-years (PY) (median follow-up 8.5 years), 283 individuals died: 133 with type 1 (103.0/100,000 PY), 55 with type 2 (161.5/100,000 PY), 87 with secondary (1,952/100,000 PY), and 8 with other/unknown diabetes type (312.3/100,000 PY). SMRs (standardized mortality ratios) (95% CI) for the first three groups were 1.5 (1.2–1.8), 2.3 (1.7–3.0), and 28.0 (22.4–34.6), respectively. Diabetes was the underlying cause of death for 42.1%, 9.1%, and 4.6% of deaths, respectively. The SMR was greater for type 2 than for type 1 diabetes (P < 0.001). SMRs were significantly higher for individuals with type 1 diabetes who were <20 years of age, non-Hispanic White and Hispanic, and female and for individuals with type 2 diabetes who were <25 years of age, from all race/ethnic minority groups, and from both sexes.

Demographic Correlates of Short-Term Mortality Among Youth and Young Adults With Youth-Onset Diabetes Diagnosed From 2002 to 2015: The SEARCH for Diabetes in Youth Study — Diabetes Care 2021 Dec; 44(12): 2691-2698. https://doi.org/10.2337/dc21-0728

CONCLUSIONS In the Danish population screened for diabetes with HbA1c, the highest risk of MACE (major adverse cardiovascular event) and all-cause mortality was found in subjects with HbA1c just below the diagnostic threshold for diabetes. Our results highlight the need for increased focus on the treatment of cardiovascular risk factors for subjects with prediabetes.

Prediabetes Defined by First Measured HbA1c Predicts Higher Cardiovascular Risk Compared With HbA1c in the Diabetes Range: A Cohort Study of Nationwide Registries — Diabetes Care 2021 Dec; 44(12): 2767-2774. https://doi.org/10.2337/dc21-1062