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Dealing With Diabetes & Depression

Rates of depression are significantly higher for patients with diabetes, especially those who are elderly, when compared with people without diabetes. About 20% to 30% of patients with diabetes suffer from clinically relevant depressive disorders. “Depression can worsen glycemic control in those with diabetes,” says Jason C. Baker, MD. Research suggests depression is associated with a higher risk of developing diabetes complications and adverse outcomes. Conversely, improving depressive symptoms has been shown to lead to better glycemic control. “Depression can result in reduced physical activity and a greater need for medical care and prescriptions, which in turn can increase healthcare costs and worsen quality of life,” Dr. Baker says. “In order to improve the management of patients with these two conditions, it’s imperative that healthcare providers be aware of this link and its consequences.” He adds that effective pharmacologic and non-pharmacologic treatments are available and may be of benefit in some situations. Routine Screening The stress of managing diabetes on a daily basis and the effects of the disease on the brain may contribute to depression, according to Dr. Baker. “There are multiple factors that may be at play, but one of the most important things clinicians can do is screen patients with diabetes for depression,” he says. “Oftentimes, physicians focus solely on the chief complaint or on A1C, blood pressure, and cholesterol numbers. We need to take a more holistic approach and be vigilant about seeking out depression or other mental health problems. This should become a routine part of all diabetes care.” Dr. Baker says that it can be challenging to address depression when managing patients with...

Treatment Trends for Type 2 Diabetes

The burden of diabetes is expected to increase over the next few decades in the United States, with about one in three American adults projected to be at risk for developing the disease by 2050. Diabetes has also been linked to a considerable economic burden, with annual direct medical expenditures for treating and managing the disease totaling nearly $250 billion in 2012. Most of the medical expenditures for diabetes are attributable to hospitalizations and physician services, but the costs of prescription therapies are also significant. With the high prevalence and burden of diabetes, the disease has become a ripe target for pharmaceutical development. “During the past decade, several important changes in the diabetes marketplace have occurred,” explains G. Caleb Alexander, MD, FACP. For example, in the early 2000s, glitazones were rapidly adopted for use, but subsequent evidence suggested that these agents were associated with cardiovascular risks. In turn, this led to substantial declines in the use of glitazones during the latter half of the decade.  In addition, new long-acting insulins and several new classes of therapies have emerged to treat type 2 diabetes, including injectable incretin mimetics such as glucagon-like peptide 1 (GLP-1) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium glucose cotransporter 2 (SGLT-2) inhibitors. The costs of these medications can be high, but clinicians appear to be interested in using them because of their novel mechanisms of action and potential promise in helping to improve glycemic control among those with type 2 diabetes.   Examining Recent Patterns Over the past 2 decades, clinical investigations have examined changes in the treatment of diabetes. These analyses identified several important trends,...
Why Newly Proposed Nutrition Labels Are “Good”

Why Newly Proposed Nutrition Labels Are “Good”

Physician-Chef Points Out the Pros, Cons of Three Suggested Changes It’s nothing new to the American consumer that food packaging emphasizes only part of a product’s health story, and the fact that the nutritional labeling hasn’t been overhauled in 20 years hasn’t helped, says cardiologist and professional chef Michael S. Fenster, MD. A proposed update, which could take a year or more to appear on store shelves, is being driven by first lady Michelle Obama, as part of her “Let’s Move” campaign. “Our current nutrition labeling is the same as that implemented in the 1990s, except with the 2006 addition of trans fats information. It’s based on nutrition data and eating habits from the 1970s and 1980s,” says “Dr. Mike,” author of “Eating Well, Living Better: The Grassroots Gourmet Guide to Good Health and Great Food” (whatscookingwithdoc.com). From the perspective of physician and foodie, he analyzes what’s good about the first lady’s proposed new label, and what could be improved. • Good: Calorie counts would be displayed in a bigger, bolder font. Emphasizing calories allows consumers to think with a helpful “energy in / energy out” baseline. Do I really need the calories in this product when I could stand to lose a few pounds? That’s a reasonably good question to promote. ***Basing the value of food primarily on calories over-simplifies the evaluation process. An energy drink may have zero calories, but it’s not better for you than an apple, which may have 100 calories. We cannot overlook nutrition! • Good: Serving sizes would be determined from real data reflecting the portions real people typically eat. A serving of ice cream...
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