News to EmPower You!

By Dace Trence, MD, FACE

Thyroid and Diabetes : Often a Duo

Research from Germany looking at patients with diabetes mellitus type 2 (a diabetes that is the result of both the body’s own insulin not working as well as it should combined with a decrease in insulin production) showed that just over one in four people with diabetes also had thyroid disease.

The majority developed their thyroid condition after they had had diabetes diagnosed first. And many more women had a thyroid problem than men. These would not be surprising findings.

What was surprising was that if prior to diagnosed diabetes, thyroid disease was already present, or if diagnosed with thyroid disease in the same year as diabetes, there was an earlier need to start insulin. The time before starting insulin was 2.5 years versus 8 years. The researchers did add that their data might have included patients diagnosed as having type 2 diabetes, but really having a slower onset of type 1 diabetes – a condition called latent autoimmune diabetes in adults (LADA). This diagnosis is usually made by testing blood for the presence of antibodies to pancreatic tissue, but was not done in their study participants. This is important, as diseases that are the result of an autoimmune process (the body producing antibodies to its own tissues), typically cluster together, meaning if you have one autoimmune disease, your risk of having or developing another is higher. And many thyroid conditions are felt to be autoimmune system-related. So this is a possible factor that could make the numbers found different.

So what is the take-home message?

If you have diabetes, ask if your thyroid function has been checked. If not, ask to have it checked, particularly if you are a female, as you do have a risk for developing a thyroid condition!

Hemo globin A1c and Blood Sugars ...Not So Much a Duo

The American Association of Clinical Endocrinologists’ (AACE) recommendations for the control of diabetes target an HbA1c (a measure of average blood sugars over the past three months) of 6.5 percent or less, while the American Diabetes Association suggests less than 7 percent, with both organizations acknowleding individualization depending on a variety of factors.

Day-to-day care of diabetes to get to a target HbA1c is supported by self-monitored blood glucose (sugar) values, obtained by fingersticks that create a tiny drop of blood that then can be absorbed by a chemically treated strip that is placed in a glucose meter.

What these fingerstick glucose targets should be has been a bit unclear. Your doctor might have given you a range of sugar values to aim for. Researchers in Boston wanted to see what these sugar ranges should be–premeal and at bedtime–to match a recommended HbA1c level. They looked at data from an earlier study, the ADAG (A1c- Derived Average Glucose),that used fingerstick glucose results, also a continuous glucose sensor with at the same-time HbA1c measures at specific time intervals. Study participants included 237 patients with type 1 diabetes and 141 with type 2 diabetes from the original ADAG study group. What was surprising were the glucose levels that seemed to match with HBA1c!

For example, you might have been told to aim for fasting blood glucose level of less than 120 mg/dL(milligrams per deciliter), and results from ADAG found that actual average fasting blood glucose to achieve HbA1c levels of 5.5 percent to 6.49 percent was 122 grams per liter. But for an HbA1c level of 6.5 percent to 6.99 percent, average fasting glucose was 142 grams per mg/ dl. Postmeal sugars (defined as those checked at 90 minutes after starting a meal) averaged 144 grams per mg/dl for HbA1c of 5.5 percent to 6.49 percent and 164 grams mg/dl for a 6.5 percent to 6.99 percent range.

So what is the take-home message?

Discuss with your diabetes medical team what would be an appropriate HbA1c goal for you. Then discuss these recent findings to decide on what your fasting blood sugar target should be, as well as what your postmeal target should be. You might find that you safely could aim for a higher fasting sugar, but in contrast, a lower post-meal sugar!

Food and Diabetes -Not at all a Duo

Finally, researchers from New York have reported that specific chemicals found at high concentrations in fried and grilled meats may raise the risk of diabetes and dementia. Mice raised on a diet that contained a high concentration of chemicals called glycotoxins showed early signs of diabetes. The mice also were found to have brain changes with symptoms similar to those seen in Alzheimer's disease. The animals that ate a diet rich in a glycotoxin called advanced glycation end products, or AGEs, showed a build-up of protein called amyloid in their brains. Amyloid in the brain was not seen in mice raised on a low-AGEs diet. Amyloid presence is believed to be linked to Alzheimer’s dementia. Additionally, when the researchers looked at a small number of people over age 60, they found those with higher levels of glycotoxins in their circulation had more memory and other thought-process problems, as well as signs of insulin resistance, which can precede diabetes, when these people were followed over a relatively short period of time – nine months. Glycotoxins are very common in animal products, including meat and dairy produce, but levels increase considerably when food is fried, grilled, or smoked. Levels of glycotoxins go up when food is cooked dry at high temperature. The researchers suggest that how we prepare our food could make a substantial impact in lowering the risk of both diabetes and dementia.

So what is the take-home message?

Poach or boil your breakfast egg–skip the frying. Have a fresh muffin or bagel–skip toasting. And maybe skip the bacon altogether!