Type 2 diabetes is linked with the reduction of certain cognitive abilities

Type 2 diabetes is linked with the reduction of certain cognitive abilities, known as executive functions, revealed a study led by University Of Waterloo. Researchers explained that the executive functions inhibit habitual thinking patterns, knee-jerk emotional reactions and reflexive behaviors such as making impulse purchases or automatically following social cues.

32. Because of that We ordained for the Children of Israel that if anyone killed a person not in retaliation of murder, or (and) to spread mischief in the land - it would be as if he killed all mankind, and if anyone saved a life, it would be as if he saved the life of all mankind. And indeed, there came to them Our Messengers with clear proofs, evidences, and signs, even then after that many of them continued to exceed the limits (e.g. by doing oppression unjustly and exceeding beyond the limits set by Allah by committing the major sins) in the land!.

35. O you who believe! Do your duty to Allah and fear Him. Seek the means of approach to Him, and strive hard in His Cause as much as you can. So that you may be successful.

36. Verily, those who disbelieve, if they had all that is in the earth, and as much again therewith to ransom themselves thereby from the torment on the Day of Resurrection, it would never be accepted of them, and theirs would be a painful torment. 5. Surah Al-Ma'idah (The Table Spread with Food)

Lead author of the study, Corrie Vincent, said, "Cognition was an integral part of brains because people rely on it when they are attempting to behave in a way that was contrary to their natural inclinations or what the environment impels them to do." 

The study showed that people with type 2 diabetes experience burnout in managing their disease. This inability of self-management was often a source of concern among family members, physicians and even the patients themselves. Senior author of the study, Peter Hall, explained, "The problem was the fact that effective diabetes management relies pretty heavily on executive function, and people with this disease especially requires more executive control, but because of the disease's effect on the brain there are less intact resources for exerting it." 

Researchers advised individuals with type 2 diabetes to consistently monitor their dietary choices check their blood sugar levels and adhere to medication schedules, as it was associated with decreased quality of life and a number of microvascular and macrovascular complications if not properly managed. 

People with type 1 diabetes today lose more than a decade of life to the chronic disease, despite improved treatment of both diabetes and its complications, a new Scottish study reports.

Men with type 1 diabetes lose about 11 years of life expectancy compared to men without the disease. And, women with type 1 diabetes have their lives cut short by about 13 years, according to a report published in the Jan. 6 issue of the Journal of the American Medical Association.

The findings "provide a more up-to-date quantification of how much type 1 diabetes cuts your life span now, in our contemporary era," said senior author Dr. Helen Colhoun, a clinical professor in the diabetes epidemiology unit of the University of Dundee School of Medicine in Scotland.

Diabetes' impact on heart health appeared to be the largest single cause of lost years, according to the study. But, the researchers also found that type 1 diabetics younger than 50 are dying in large numbers from conditions caused by issues in management of the disease -- diabetic coma caused by critically low blood sugar, and ketoacidosis caused by a lack of insulin in the body.

"These conditions really reflect the day-to-day challenge that people with type 1 diabetes continue to face, how to get the right amount of insulin delivered at the right time to deal with your blood sugar levels," Colhoun said.

A second study, also in JAMA, suggested that some of these early deaths might be avoided with intensive blood sugar management.

In that paper, researchers reduced patients' overall risk of premature death by about a third, compared with diabetics receiving standard care, by conducting multiple blood glucose tests throughout the day and constantly adjusting insulin levels to hit very specific blood sugar levels.

"Across the board, individuals who had better glucose control due to intensive therapy had increased survival," said co-author Dr. Samuel Dagogo-Jack, chief of the division of endocrinology, diabetes and metabolism at the University of Tennessee Health Science Center in Memphis.

Strict control of blood sugar appears to be key. Researchers observed a 44 percent reduction in overall risk of death for every 10 percent reduction in a patient's hemoglobin A1c, a test used to determine a person's average blood sugar levels over the prior three months, Dagogo-Jack said.

The Scottish study looked at the life expectancy of nearly 25,000 people with type 1 diabetes in Scotland between 2008 and 2010. All were 20 or older. There were just over 1,000 deaths in this group.

The researchers compared the people with type 1 diabetes to people without the chronic disease. Researchers used a large national registry to find and analyze these patients.

The investigators found that men with type 1 diabetes had an average life expectancy of about 66 years, compared with 77 years among men without it. Women with type 1 diabetes had an average life expectancy of about 68 years, compared with 81 years for those without the disease, the study found.

Heart disease accounted for the most lost life expectancy among type 1 diabetics, affecting 36 percent of men and 31 percent of women. Diabetes damages the heart and blood vessels in many ways, mainly by promotinghigh blood pressure and hardening of the arteries, Colhoun said.

However, those younger than 50 appeared to die most often from diabetes management complications.

In men, about 29 percent of life expectancy lost for people under 50 was due to diabetes management-related complications like diabetic coma or ketoacidosis, a condition in which the body suffers from high levels of poisonous acids called ketones. These ketones are created when the body burns fat for energy, because low insulin levels are preventing the conversion of blood sugar into fuel. In women under 50, that number was 22 percent, according to the study.

Intensive treatment of their diabetes might have extended these lives, Dagogo-Jack suggested.

In his study, more than 1,400 people with type 1 diabetes were randomly assigned to either receive intensive management of their diabetes or normal therapy. People who got intensive therapy kept near-constant tabs on their blood sugar levels, and made quick adjustments to their insulin therapy to keep their blood sugar as close to normal as safely possible, the study reported.

The intensive therapy lasted an average of 6.5 years, through the mid-1980s and 1990s. Afterward, patients were taught how to conduct their own intensive management and urged to continue using those techniques. Doctors then tracked their health and progress through the end of 2012.

After an average 27 years of follow-up, the researchers found that the odds of dying were nearly one-third lower for the intensive management group who kept their blood sugar tightly controlled.

Such intensive diabetes management is now more achievable than it was back in the 1980s, when the study began, said Dr. Ned Kennedy, chair of endocrinology for the Cleveland Clinic.

"Time has moved on and technology has moved on considerably," Kennedy said. "Many patients now have access to real-time multiple glucose measurements during the day, either by doing finger stick measurements or using continuous glucose monitoring," he explained.

"The real exciting developments are, we are getting to the stage where we can marry up the information from continuous glucose monitoring to the delivery of insulin through insulin pumps," Kennedy continued. "This technology will make it easier for large numbers of patients to reach the level of glucose control that these patients achieved."

As far as the ongoing loss of life expectancy to type 1 diabetes, both Colhoun and Dagogo-Jack said that the Scottish findings can be looked at as positive.

People in the 1920s diagnosed with type 1 diabetes had a life expectancy "on the order of months, clearly less than one year," Dagogo-Jack said. The discovery of insulin improved things somewhat, but it wasn't until the 1980s that medicine figured out how to best use insulin to control blood sugar levels.

"It looks as though we are on the right track," Colhoun said. "Outcomes are improving, and I expect they will continue to improve, but we are by no means there yet."

As many as one in five adults with diabetes have early signs of diabetes-related eye problems, such as diabetic retinopathy, which can cause blindness, according to a study published in the November 2014 issue of JAMA Ophthalmology. The researchers say these results demonstrate the need for screening and intervention to protect vision. The American Diabetes Association recommends that people with diabetes see an eye doctor for an examination each year.

“The only way to check for diabetes effects on the eye is a dilated eye exam,” says Kundandeep Nagi, MD, an ophthalmologist and assistant program director of ophthalmology at the University of Texas Health Sciences Center in San Antonio. “Diabetes is a microvascular disease that affects the small blood vessels, including those in the eye.”

It's also important for people with diabetes to understand how eye health and the condition intersect, including the terminology used to explain diabetes-related eye problems. Here are key terms you need to know:

Eye Doctors

• Ophthalmologist. This eye professional has earned a medical doctor (MD) or doctor of osteopathy (DO) degree. Ophthalmologists can perform eye exams, prescribe corrective lenses and medications, diagnose eye conditions, and perform surgery.
• Optician. This is a technical specialist who can help adjust lenses and eye glasses prescribed for vision correction.
• Optometrist. This is an eye specialist who has earned a doctor of optometry (OD) degree. Optometrists can examine eyes, provide vision correction recommendations, and prescribe medication to treat eye disorders.

Anatomy of the Eye

• Eye lens. The lens of the eye is the clear tissue through which images are focused onto your retina.
• Macula. This is the center of the retina, responsible for your detailed central vision — the focused vision needed for reading or threading a needle, for instance.
• Optic nerve. The signals picked up on the retina travel to your brain through the optic nerve so you can interpret what you see.
• Retina. The retina is a thin layer of nerve tissue located in the back of the eye. It's sensitive to light, which allows it to accept the images of what you see. The retina is fed by the small blood vessels in your eye and depends on that blood flow to function well.
• Vitreous. This is the clear, jelly-like substance that fills the eye and is attached to the retina.

Symptoms of Eye Problems

• Blindness. Blindness is defined as a visual acuity of 20/200 or worse in the better seeing eye. Among U.S. adults, blindness results from diabetic retinopathy more than any other cause.
• Blurring. Vision that is foggily obscured or lacking in detail is associated with more than 20 eye conditions, including diabetic retinopathy, cataracts, eye injury, eye infections, glaucoma, and macular degeneration.
• Double vision. Medically known as diplopia, having double vision means that you see two images of a single object even though your eyes have usually worked together to give you one image. Diplopia can develop if blood flow to a particular cranial nerve is interrupted, which can happen with diabetes.
• Floaters. This is the name for the dots, spots, strings, specks, or clouds that appear in your field of vision. They may seem to be in front of you but they're actually small specks of material, such as blood or tissue, that are moving around in your eye. They can be the result of injury, swelling, surgery, or tissue detaching and moving in the eye. Diabetic retinopathy is a possible cause of floaters
• Vision loss. Vision loss or reduced vision means that even with glasses or contact lenses to correct vision, you still have difficulty seeing faces, signs, colors, or words. Vision loss can result from many conditions, including diabetic retinopathy. Other causes include cataracts, injury, structural changes, macular edema, and infection.

Eye Conditions

• Cataract. A cataract is a clouding of the lens in one or both of the eyes. Diabetes increases the risk for developing cataracts by about 60 percent.
• Diabetic retinopathy. This is damage to the blood vessels in the eye and the retina of the eye caused by diabetes. There are two types: nonproliferative and proliferative diabetic retinopathy. Damage to the retina can lead to vision loss, blurred vision, floaters or flashes, and blindness.
  • Nonproliferative diabetic retinopathy. This is the earliest stage of diabetic retinopathy, when small blood vessels show signs of damage, like small leaks or cholesterol deposits.
  • Proliferative diabetic retinopathy. At this stage, the blood vessels in the eye might be closing up and preventing blood flow, triggering the eye to build new blood vessels. This process can lead to scarring, swelling, and impaired vision.
• Glaucoma. This develops when fluid pressure in the eye increases, causing damage to the optic nerve. People with diabetes are 40 percent more likely to develop glaucoma than people without diabetes are.
• Macular edema. This is swelling in the macula caused by blood or fluid leaking into it. Leaky blood vessels from diabetes are similar to leaking water pipes in your home. Any change or damage to the macula can result in central vision loss.
• Macular ischemia. This is the closing of small blood vessels, which cuts off blood flow from the macula. It can cause blurry vision.
• Optic neuritis. This is a condition in which inflammation of the optic nerve affects your vision. Diabetes can cause optic neuritis, as can infections, autoimmune diseases, and some medications.
• Retinal detachment. When part or all of the retina separates from the back of the eye, this is called retinal detachment. Movement of vitreous away from the retina can cause this, as can eye injury, nearsightedness, and eye surgery.

Eye Exams and Procedures

• Dilated eye exam. For a dilated exam, medicated eye drops enlarge your pupil so your doctor can best see into your eye.
• Injections. With your eye numbed, medication may be injected into your eye to control bleeding, swelling, and the growth of new blood vessels.
• Photocoagulation. This is laser surgery to close bleeding blood vessels in the retina. It can help protect vision and slow swelling.
• Visual acuity test. This is an eye exam using a chart with letters, shapes, or numbers of different sizes at a set distance to assess vision.
• Vitrectomy. This type of surgery is done to remove abnormal blood vessels or scar tissue that may have developed because of diabetes.

Although people with diabetes should get an annual eye exam, any unusual eye symptoms — such as floaters, flashes, blurriness, pain, double vision, or loss of vision — need to be checked out by an eye doctor promptly.

Did you know that diabetes is the leading cause of blindness in people under the age of 65 in the United States? Diabetes can cause a wide range of vision problems from mildly blurred vision to irreversible vision loss. Fortunately, early detection and careful monitoring can reduce the risk of vision loss due to diabetes.

Diabetic Eye Disease

Diabetic Eye Disease is not a single disease, but rather, the name for a group of eye problems that can result from having Type 1 or Type 2 diabetes. Anyone who has diabetes has a higher risk of vision complications than someone without diabetes. The severity of diabetic eye disease is not always linked to the control of blood sugar. However, the longer someone has been diabetic, the more likely it becomes that he or she will experience vision complications.

Possible problems include:

Diabetic Retinopathy
High blood-sugar levels from diabetes can damage the small blood vessels in the retina—nerve tissue at the back of the eye—and result in incomplete or blurry images. This damage is called diabetic retinopathy. In the early stages, there may be few or no obvious symptoms; however, your eye doctor can detect early damage during a dilated eye exam, so annual eye exams are critical for diabetic patients.

Cataracts
Cataracts—a clouding of the lens—typically develop in older adults, but people with diabetes tend to get cataracts at a younger age than the general population and have them progress faster than is typical in non-diabetic patients.

Scratch Protection
Protects the lenses from everyday wear and tear. Polycarbonate, highindex and several new plastic lens materials have scratch-resistant protection.

Glaucoma 
Glaucoma occurs when pressure builds up inside the eye. People with diabetes are 40 percent more likely to suffer from glaucoma than people without diabetes. The longer someone has had diabetes, the more likely he or she will develop glaucoma.

Don’t Wait for Symptoms

Often there are no symptoms in the early stages of diabetic eye disease, so it is important that you don’t wait for symptoms to appear before having a comprehensive eye exam. However, if you suddenly see specks or spots floating in your vision, experience blurred or double vision, pain or a feeling of pressure in your eye or notice any change in your vision that lasts for more than a couple of days, you should see your eye doctor immediately.

TREATMENT

Laser surgery is the most common form of treatment for diabetic retinopathy. There are also medications that can be injected directly into the eye to shrink abnormal blood vessel growth and decrease swelling within the retina.

• Cataracts are commonly treated by surgically removing the clouded natural lens within the eye and replacing it with a clear, artificial lens. Cataract surgery is the most common vision surgery in the United States and is typically performed on an outpatient basis.
• Glaucoma treatment may consist of the use of medications delivered daily in eye drop form, or may be treated surgically through the use of a laser or other surgical procedure.

Have a Yearly Eye Exam

If you have been diagnosed with diabetes, you should have a comprehensive dilated eye exam at least once a year, and more often if you have been diagnosed with some form of diabetic eye disease. Early detection and treatment of diabetic eye disease will dramatically reduce your chances of sustaining permanent vision loss.

A vision-robbing condition called diabetic macular edema can strike people with diabetes.

Now, a new study compared three leading drugs for the condition -- Avastin, Eylea and Lucentis -- and found that Eylea came out on top, at least for patients with "moderate" vision loss.

The study, funded by the U.S. National Eye Institute (NEI), "will have a dramatic impact on patient care," said Dr. Mark Fromer, an ophthalmologist at Lenox Hill Hospital in New York City. He was not involved in the new research.

According to the NEI, about 750,000 Americans suffer from diabetic macular edema. The condition occurs in people with a type of diabetes-related eye disease called diabetic retinopathy.

"Diabetic macular edema is the most common reason for visual loss in the 7.7 million Americans with diabetic retinopathy," Fromer noted.

"Macular edema occurs when abnormal blood vessels in the retina leak into the central area of the retina causing distorted vision," he said.

According to the NEI, the disabling illness can impair vision and interfere with everyday tasks such as reading, driving and watching television.

"Currently, the mainstay of treatment consists of monthly intraocular [within the eye] injections of Avastin, Lucentis, or Eylea," Fromer said. "Laser therapy is also used to decrease macular edema."

The new study included 660 people, averaging 61 years of age, with diabetic macular edema. All of the patients had been diagnosed with either type 1 or type 2 diabetes for an average of 17 years.

Patients were randomly assigned to take one of the three drugs and had their vision assessed a year later. Among patients whose vision was 20/50 or worse at the start of the trial, those who took Eylea had greater vision improvement than those who took Avastin or Lucentis, the study found.

However, the researchers stressed that all three drugs offered similar vision improvement in patients whose vision at the start of the study was rated as anywhere from 20/40 to 20/32. The three drugs were also similar in terms of safety.

"This comparative effectiveness study will help doctors and patients make informed decisions when choosing treatments for diabetic macular edema," NEI director Dr. Paul Sieving said in an agency news release.

According to Fromer, all of the drugs decreased the need for laser therapy, "with Eylea requiring the least laser therapy."

Dr. Ronald Gentile is professor of ophthalmology at the New York Ear and Eye Infirmary of Mount Sinai, in New York City, and was an investigator on the trial. He said that "the importance of this study can't be overstated. These one-year results highlight the fact that all the drugs studied -- Eylea, Avastin and Lucentis -- are potentially effective [treatment] options."

So, Gentile suggested, "these results will help doctors and patients make informed decisions when choosing treatments."

But Fromer added that the findings have financial implications, too, especially since Eylea costs so much more than the other two medicines.

"Eylea costs about $1,900 per injection, Lucentis about $1,200, and Avastin costs about $70 for each monthly treatment for diabetic macular edema," he explained. Currently, "Avastin is used worldwide much more readily than the other drugs because of cost, and in most cases Avastin will accomplish the same goal."

Insurance coverage issues will also be key, Fromer said. "If a patient has a problem, the insurance companies have to be notified for a pre-authorization to obtain the drugs," Fromer explained. "This causes a significant delay in treatment and they do not always allow the doctor to use the drug of his/her choice."

The care of type 1 diabetes has evolved rapidly over the past few decades, but not all racial and ethnic groups seem to be benefiting from the latest treatments, a new study indicates.

The researchers found that black children with type 1 diabetes were less than half as likely to receive treatment with an insulin pump than white children were -- and that difference persisted even when the researchers adjusted the data to account for income, education and insurance. Hispanic children were also far less likely than white youngsters to be on an insulin pump.

Black children also had higher average blood sugar levels compared to white and Hispanic children, the researchers found. Higher blood sugar levels can indicate problems with blood sugar management.

"It's been shown that insulin pump use is associated with [better blood sugar management]. And our study is the first step in assessing what barriers exist to motivating someone to [try] newer technologies," said study co-author Kellee Miller, assistant director of the T1D Exchange Clinic Network Coordinating Center, and an epidemiologist at the Jaeb Center for Health Research in Tampa, Fla.

Results of the study were released online Feb. 16 in the journal Pediatrics.

Type 1 diabetes is an autoimmune disease that destroys the insulin-producing cells in the pancreas. Insulin is a hormone that's needed to help use the sugar (also called glucose) from foods as fuel for the cells in the body and brain. Without insulin, you cannot survive.

Because people with type 1 diabetes produce no, or very little, of their own insulin, they must take insulin shots every day, or use an insulin pump. While an insulin pump doesn't require daily injections, the small tube that delivers insulin into the body must be changed every few days to prevent infections and scar tissue.

Getting the right amount of insulin is very hard to do. People with type 1 diabetes must try to estimate how many carbohydrates are in the food they eat, because carbohydrates are processed into sugar that's released into the blood. The right amount of insulin helps that sugar get into cells. Too much insulin, however, can cause dangerously low blood sugar levels, according to the American Diabetes Association (ADA).

Yet, too little insulin is also a problem because that allows blood sugar levels to rise. Over time, high blood sugar levels can cause serious complications, such as heart disease and eye problems. Additionally, factors such asexercise and stress also affect insulin needs, making insulin dosing a difficult balancing act, according to the ADA.

The new study included nearly 11,000 children, under the age of 18, from 73 endocrinology clinics across the United States. They all had type 1 diabetes, and had dealt with the disease for an average of almost four years. The group was 48 percent female. The average age was nearly 12. Just over 80 percent were white, 7 percent were black and 11 percent were Hispanic. Additionally, the group included 214 high-income black and Hispanic families.

Nearly two-thirds of white youngsters were on insulin pumps. Just 26 percent of the black children made use of the newer technology, and slightly more than one-third of the Hispanic youngsters used insulin pumps, the researchers found.

Cost is undoubtedly one factor considered when thinking about using an insulin pump for managing type 1 diabetes. The actual cost varies based on insurance plans -- or in the case of Medicaid, the coverage offered by a particular state -- but a new pump can be more than $5,000, according to published reports. Additional disposable supplies are needed each month as part of insulin pump management.

But, cost didn't seem to be a guiding reason for the racial disparities, the study found.

Black children "were far less likely to be using pumps for insulin delivery, even after adjusting for socioeconomic status. When we broke it down by annual household income, 45 percent of children in black families with more than $100,000 in household income were using an insulin pump. That was the same percentage [of children on pumps] in white families earning $50,000 or less," Miller noted.

Dr. Stuart Chalew, the section head of endocrinology and diabetes at Children's Hospital of New Orleans, wrote an editorial that accompanied the study. He suggested that "despite similarities in the way the kids are treated, our education systems may just not be adequate. For whatever reason, there seems to be some intangible that we still haven't broken through."

The researchers also found racial differences in the children's hemoglobinA1c levels -- a test that estimates average blood sugar levels over the past two or three months, according to the ADA. The result is expressed as a percentage. The ADA recommends that A1c levels in children be 7.5 percent or less.

In the new study, none of the groups met that target. The average A1c for white children was 8.4 percent. For black children, it was 9.6 percent. And, for Hispanic children, the average A1c was 8.7 percent, the study authors found.

"There's the possibility that there may be a biological difference in how African-American patients respond to glucose," Chalew explained. "If you look at non-diabetic individuals, African-Americans have higher A1c levels, and in people with type 2 diabetes, African-Americans have higher A1c levels. There's something independent of blood glucose that affects A1c in African-Americans," he suggested.

This difference is referred to as the "glycation gap," according to Miller. She said it's possible that this plays a role in the A1c differences, but "I don't think it explains the whole difference," she added.

Miller's group is currently designing a study to better assess this difference. The study would continuously monitor daily blood sugar levels over three months in whites and blacks to see how those levels compared to the A1c findings.

The bottom line, said Chalew, is that "this was an eye-opening study that shows we still have challenges ahead."