Helping People Who Have Diabetes Improve Health and Reduce Complications

Helping People Who Have Diabetes Improve Health and Reduce Complications

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DR RODGERS: Well hello, and thank you for joining us. We're here to talk about diabetes research and how people with diabetes and those at risk can manage their disease and related health complications. Diabetes research supported by NIDDK has led to many ground-breaking discoveries to help adults and youth prevent, delay and manage this chronic condition. I'm Dr Griffin Rodgers, Director of the National Institute of Diabetes, Digestive and Kidney Diseases, or NIDDK at the National Institutes of Health or NIH. I'm joined by my colleague, Dr William Cefalu, who is the Director of the Division of Diabetes, Endocrinology and Metabolic diseases at NIDDK, part of NIH.

Dr. Cefalu is a physician and scientist who specializes in diabetes research and optimal ways to prevent and/or manage the disease. Throughout the video, we are watching for questions from viewers to answer some of them during this video.

If you submit a question, please tell us if you're a healthcare professional, a patient or a researcher. And if we don't answer your question during this live video, please check our social media feed @NIDDKgov, where we will continue to try to answer your questions. DR RODGERS: Thank you for joining me today, Dr. Cefalu. Your expertise involves preventing and managing diabetes for various populations, can you tell us more about the different types of diabetes, what causes them, and who is at increased risk for diabetes? DR CEFALU: Yes, thank you, Dr. Rodgers. Diabetes is really a heterogeneous condition with many different sub-types.

However, the vast majority of diabetic patients can be classified into one or two broad categories: type 1 and type 2 diabetes. Type 1 diabetes is caused by an absolute or near absolute deficiency of insulin from destruction of the pancreas. This used to be referred to as juvenile onset diabetes.

Individuals that develop this type of diabetes are generally younger, and when diagnosed need to start on insulin immediately and remain on insulin for life. Type 2 diabetes is the most common form of the disease and accounts about 90% to 95% of diagnosed diabetes in the United States. This type of diabetes is generally associated with obesity; these individuals make insulin, but it's inadequate to meet the body's needs. The risk factors for developing type 2 are older age, obesity, family history, history of gestational diabetes and physical inactivity. Type 2 also occurs at higher rates among racial and ethnic minority populations in the United States, and unfortunately, we're seeing an increase in type 2 diabetes developing in youth and adolescents.

In addition, women who develop diabetes during their pregnancy are classified as having gestational diabetes. These women also have a greater chance of developing type 2 diabetes. That's about half the women diagnosed with gestational diabetes will develop type 2 diabetes within five to 10 years after giving birth. They're also a variety of the more uncommon and diverse types of diabetes, there's a condition called latent autoimmune diabetes or LADA; it's generally a slowly progressing form of autoimmune diabetes, like type 1, but generally it occurs in individuals over the age of 30. And then there are diabetes caused by specific genetic defects, and we call them monogenic diabetes. DR RODGERS: Well, thank you.

That's very helpful information. For those of you who are watching us on Facebook, NIDDK offers free online information about the forms of diabetes that Dr. Cefalu just mentioned, as well as information about risk factors and current treatments.

You can find this information at our website: And for the people who are watching us with diabetes or at higher risk for the disease, what are some of the things that they can do to manage diabetes, improve their health and avoid related complications? DR CEFALU: Well, one of the most important things an individual can do to help manage their disease is to be very informed and educated about their condition, and realize they need to work with their providers and play an active role in the final decision for their treatment. Individual should know that diabetes, if left uncontrolled can affect any part of their body.

We refer to those problems of diabetes as the complications of diabetes, essentially the eye, the kidney, the nerve, and the heart problems. However, because of research advances, we have very good news in that adequate control of blood glucose and control of the risk factors, you can prevent or delay these complications. So those listening to this Facebook Live segment should understand that they can reduce complications by following the simple ABCs of diabetes. So A, is for the A1C test. The A1C test essentially reflects your average blood sugar level for the past two to three months.

The higher your A1C level, the poor your blood sugar control and the greater your risk of diabetes complications. Studies have shown that an A1C less than 7% resulted in much less complications. Secondly, in addition, you need to manage the other risk factors like blood pressure and cholesterol. So B, is for blood pressure and C is for cholesterol. Control of your blood pressure and cholesterol in an individual with diabetes greatly lowers the risk for heart disease.

And if you smoke, talk to your doctor about smoking cessation programs or never start. Finally, if you're overweight, even losing a modest amount of weight can lower your blood sugar and other risk factors. Modest weight loss means 5% to 7% of body weight, that's just 10 to 14 pounds for someone who is 200 pounds. So weight loss and to get physically active along with the simple ABCs of diabetes. DR RODGERS: Well thank you very much. I guess we could have expected this.

We have a question. And the question is, "As an individual with diabetes, am I at a higher risk for having greater problems if I get infected with COVID-19?" DR CEFALU: That's an excellent question, Griff, and is very timely. And yes, we understand there are many risk factors that increase the severity of COVID-19 infection once you're infected. And these risk factors are: if you're older, if you have diabetes, if you're overweight, if you have heart disease, kidney disease, if you're male or if you have hypertension, you may have a more severe course with COVID-19.

Now, we don't know specifically why someone with diabetes has a higher risk, but it's felt there are some underlying characteristics of diabetes and obesity that may be related to a condition called inflammation. And with these conditions, that interacts with the virus making the illness worse. Also, we're learning that control of blood glucose may be important to improve recovery from COVID-19. So really, if you have diabetes, prevention of COVID is really important at this particular time.

DR RODGERS: Thank you. We're getting several questions now, and this is a follow-up to that last question: "What can I do as a person with diabetes to lower my risk of getting infected with the coronavirus?" DR CEFALU: Well, another important question, and there's a lot we're still learning about this virus, but the most important thing you can do right now, is really to follow the public health guidelines from the CDC and your local public health official. So, this means social distancing, hand washing and wearing masks to reduce your chances of getting it. If possible, avoid touching high-touched surfaces in public places, wash your hands after touching surfaces in public places, avoid touching your face, nose and eyes. Cover your nose when you cough and sneeze; avoid crowds.

So, your risk for exposure is going to be increased in these particular conditions. The important thing right now is prevention of the disease. DR RODGERS: Excellent, good. Here's a question that goes back to the different types that you mentioned, and the question, this is from a patient, and it is, "What is the difference in the management of type 2 diabetes and LADA you mentioned?" DR CEFALU: That's an excellent question, and type 2 diabetes as stated is generally associated with obesity and condition called insulin resistance, and you can begin to treat type 2 diabetes initially with a lifestyle, nutrition and exercise, and may go for many years just on that treatment. Then you'll be prescribed a single agent, the most commonly used agent in the world is Metformin, but as the disease progresses, you may be on two pills or three pills, and then with insulin, and may go on to insulin only. So, as the disease progresses, you proceed from just nutrition, exercise and one pill, and it may take 10, 15, 20 years before you're on insulin.

A person with LADA has a process very similar to type 1, but it may be that they may not need insulin right away, but over years will develop insulin. And again, they may not have the obesity you see with type 2. So, LADA is basically an autoimmune disease, like type 1, but not treated like type 2.

They may use medication for a few years, but more likely are going to go to insulin sooner than later. DR RODGERS: Thank you very much. I'd like to thank the participants for those great questions. Now as people with diabetes, including children and youth, face challenges managing their diabetes, what can healthcare providers and diabetes care teams do to help their patients stay healthy? DR CEFALU: Well, as we've stated, diabetes is a disease that affects every part of a body, so it's important you have a healthcare team that's made up of specialists that can address every aspect. So, your core healthcare team will consist of your primary care provider, which could be a primary care physician, it could be a nurse practitioner, but along with a certified nurse educator and nutritionist.

And one of the main goals of the healthcare team is to help you manage your diabetes and inform and educate you of your goals and how to stay healthy. A key part of any treatment regimen for diabetes is nutrition and exercise. So, a nutritionist, a dietitian is needed to help with diet, weight loss or for that matter, manage carbohydrate intake with insulin injections.

The healthcare team should also have a certified nurse educator who can teach about diabetes self-management, education and support. This nurse educator can help you understand the basics of diabetes, work to instruct in glucose monitoring, continuous glucose monitoring, insulin injections, even instruct you on how to use an insulin pump. But given that diabetes can cause complications, other specialists may be part of a team. DR CEFALU: You may be referred from your core team to specialists, such as an ophthalmologist or an eye doctor to address vision problems with diabetes. They may refer you to a podiatrist to help with foot care or, for that matter, given the heart disease with diabetes may refer you to a cardiologist as the need arises.

Importantly, we also know that diabetes places a huge burden on not only the patient, but the family. So, a counselor or a mental health professional may be needed for issues related to depression, stress or anxiety. But important in managing your diabetes, prevention is an important part of taking care of your diabetes.

So your health care team can talk to you about prevention with vaccines such as the flu shot and pneumonia shot. And given the COVID-19 pandemic and know that those individuals with diabetes may be at higher risk, the healthcare team will talk to you about COVID-19 vaccines as they become available. DR RODGERS: Gotcha. Well, we have one question from a researcher, and it is a research question that relates directly to your last statement, and it goes, "Do we know yet whether COVID-19 can cause new onset diabetes?" DR CEFALU: That is an excellent question and one that is a great interest to us and we don't know just yet.

So that is a research question, and it's important to know, and it's important to know because we do know that individuals with diabetes have a higher risk. We do know that many of these individuals develop hyperglycemia with COVID-19 and in the hospital, but we don't know what happens whether the COVID-19 unmask a preexisting diabetes state or whether it causes new onset diabetes, so that is a very important research question, and we're very interested in addressing that question. DR RODGERS: Excellent, good.

Here's a question from a healthcare professional, "What is your opinion about transitioning to a plant-based diet to reduce weight, inflammation and the ABCs?” And it seems like there's a related question from a patient about, “Are there benefits and diabetes-protected benefits from certain types of foods?" DR CEFALU: Well, let me just say that as far as diet, there are many different dietary regimens: there's the vegan, vegetarian, Mediterranean, low-carb, and in most cases, nutrition recommendations for people with diabetes are pretty similar to recommendations for eating for all adults. Again, a mix of carbohydrate, protein and fat should work for each patient to meet their goals, but this is why it's important that you discuss your dietary preference and your dietary regimen with your nutritionist and diabetes educator. There are a lot of considerations in deciding the best diet for you.

And I will point this question and whoever posed this question to a recent American Diabetes Association scientific statement that really suggested all these diets work, and the key finding is, which one works best for you? So the challenge with diets in general is they tend to be short-term because they are hard to stick to. So there's a saying that the best diet for a patient with diabetes is the one that works for that patient with diabetes. So it's important that you work with a dietitian to find a dietary regimen that is one that you can follow, works to control your blood glucose and risk factors and can help you with weight loss. DR RODGERS: Thank you. Well, you talked about the forms of diabetes earlier and some of the studies. Can you tell us a little bit more about the current diabetes research and the specific aims of some of these studies? DR CEFALU: Yes.

We actually have a lot of ongoing studies of ongoing diabetes. Let me just take a few examples. If we start with type 1 diabetes, we're very excited about the data on the artificial pancreas. As you know, the artificial pancreas advances diabetes management by measuring blood glucose levels, using a continuous glucose monitor, or what we call a CGM, and automatically sends a signal to a pump and it delivers insulin when needed.

By contrast, usual management of diabetes may be with use of multiple injections a day of insulin or use of a pump, but an insulin pump does not adjust insulin levels automatically. A first-generation artificial pancreas was approved by the Federal Drug Administration in 2016, and researchers have continued working to develop new and improved systems. Studies have shown that these systems actually increase glucose levels in a healthy range for more time during the day.

So they represent a real advance toward an artificial pancreas. I'm also excited about studies looking at prevention of type 1. As you know, there's no current treatment to cure type 1, however, studies supported by NIH and our institute have recently shown that a particular agent called teplizumab slowed insulin loss in people people who are recently diagnosed.

And over the recent past, this drug was tested in people at the early stage of diabetes before clinical symptoms, and thus it was designed to present clinical disease onset. This study showed we can delay onset of type 1, in fact, type 1 was delayed by two years or more among these people at high risk, and this is an incredible finding. If you think about it, what this means to the patient: this means two more years without insulin, two years without checking blood glucose levels, two additional years of less patient burden, less expense of insulin, and two more years of better glucose control and good health toward preventing or delaying complications. There's also a new research in pregnancy. We've learned that abnormal glucose levels during pregnancy are associated with adverse outcomes for the infant and at delivery. And we also know importantly that abnormal blood glucose during pregnancy are associated with long-term concerns, including the development of obesity and type 2 in youth and adolescents.

DR CEFALU: So it's important that we truly understand how to treat diabetes during pregnancy, and what glucose levels are really considered normal. So we actually have an ongoing study called the GO MOMs study, and the purpose of this study is to use new technology, continuous glucose monitoring, and to truly characterize glucose levels throughout pregnancy, first to determine if we can predict diabetes during pregnancy, and secondly, to better understand what levels contribute to these poor outcomes. So this will allow us to identify and treat diabetes in pregnancy very early to prevent complications at birth and address the long-term concerns.

DR RODGERS: Absolutely. And that's such an important study because as I've heard you say before, diabetes during pregnancy is not only a risk factor for the mother, who might go on to develop diabetes, but also for that infant. And the exposure puts them at a high risk for developing obesity and potentially diabetes later in life. So, benefits to this study and what we learn may have enduring effects in fact, transgenerational effects. Well, that's very, very outstanding. So, here's a question from a patient, and I guess we hear this often in the lay press, but the question simply is, "Can diabetes be reversed?" DR CEFALU: That's another important question, and actually, we have a lot of information recently over the past many years, and I wouldn't say the condition can be reversed.

And there's been discussions on what the proper term is, but many of us feel the correct term is remission. And remission is basically the term used when people who have type 2 diabetes have their condition revert to normal glucose levels and stay in that range for at least six months. That's the current definition of remission, and at that particular time, they aren't taking any other diabetes medication. Now, we know who is more likely to go into remission, and studies have shown that you're more likely to be successful to go onto remission if you've only had diabetes for a few years. So essentially, earlier in your diabetes process.

We also know the most important factors for achieving remission. And that's weight loss and keeping it off. So significant weight loss, whether you do it from diet and exercise or even surgery and sustaining it for years is the key to keep people in remission. DR CEFALU: Now, the reason it's called remission is that as long as you stay in this state and keep the weight off, you're most likely to maintain normal glucose levels, but if you gain the weight again, you will probably... The glucose will probably swing back into the diabetic range and you will not be in remission. So we term it remission and yes, there are predictive factors of who will achieve remission, but the most important factor is losing the weight and keeping it off for years.

DR RODGERS: Gotcha. Now here's a question from a healthcare provider, and that is, "What is the latest in the development of an oral insulin?" DR CEFALU: That's an interesting question. A few years ago, first of all, for now, let's just say that the insulin molecule, as it's injected, if there are issues whether you haven't ingested orally or inhaled, and a few years ago, as you know, we did have an inhaled insulin, which is taken off the market.

But the problem with an oral insulin is the stomach is a very hostile environment for protein and insulin is a protein. So number one, how does the insulin stay intact in the stomach in this acid environment? And secondly, if insulin is absorbed in the gastrointestinal tract, how is it absorbed effectively and not modified? So, there is a lot of interest in the oral insulin. But once again, it being a protein, barriers such as the stomach, barriers such as the lung and even the skin are barriers to insulin absorption.

So there's been a lot of interest in alternative means to deliver insulin, be it nasal insulin, buccal insulin, inhaled insulin, oral insulin, for that matter, transdermal insulin. And unfortunately, we're not at that place in time yet that we've been able to work out the real problems and nuances with insulin absorption in these other conditions. DR RODGERS: Good, thank you. Here's a question that I know you and I discussed frequently.

I suspect it's from a researcher, but I can't guarantee, didn't identify himself. But the question goes, "What community-based diabetes programs have been disrupted by COVID, and do we have thoughts about when and how we can restore these activities?" DR CEFALU: Well, let me just say, I don't know of any aspect of research or clinical that's not disrupted from diabetes and the problem that we're having now, particularly in our research settings, how do you conduct research or how do you conduct clinic visits in a pandemic? And I think it's important now that we as a medical community adapt, whether we do so with telehealth or what we're doing with those Zoom meetings, and I know at this particular point, it's still important to get the care, but we're going to have to think outside the box and these digital platforms that we have now are going to be so important. Griff, one of the things we talked about as far as individual diabetes, not only preventing COVID infection now, but how do they manage their diabetes in a pandemic, if they're not having face-to-face meetings, whether it's a telephone call or whether it's a face-to-face call with a physician? So these are hurdles we still need to address, and I actually think it's going to be a new normal moving forward, how we interact with patients clinically because of the pandemic and how we do research moving forward with less face-to-face meetings. DR RODGERS: Yeah. Well, we don't like to generally give individual advice, here's a question though, so maybe you can answer this more in generic terms.

It's from a patient, and they said, "If your blood sugar rises each afternoon, is there something that you can do?" Or maybe said another way, "What is that potentially an indication of, if it rises each afternoon?" DR CEFALU: Well, there's many important things to consider. So, first of all, I'm happy that someone is testing their blood sugars frequently throughout the day, but it also means to address that, what is your treatment? And depending on how high the treatment is, so first of all, if you were my patient, I'd want to know what your hemoglobin A1C is, because that's a good average for what your blood sugar is over time. And if the A1C is elevated, the afternoon sugar may be a target we would go after to just therapy. Secondly, are you on oral medication only? It may be a little harder to adjust oral medication if the blood sugar rises in the afternoon because it doesn't have the precise mechanism as we'd see with insulin to just hour to hour.

DR CEFALU: Third thing, how high is the blood sugar in the afternoon, how near is it to the meal? If it's immediately two or three hours after meal, that they be one way to address with insulin before the meal, if it's late in the afternoon before supper, maybe a different way to address, but if you're on insulin again, if it's before supper and three to four to five hours from lunch, perhaps you can increase your basal insulin in the morning, whether you're on an NPH or a longer acting insulin, if it's a couple hours after meals, maybe insulin before the meal. So, there's a lot of factors that we need to know before we address it, but glucose monitoring, knowing your treatment, whether you're on insulin, what your A1C is - all those factors have to be accounted for before we can suggest treatment and how to treat that elevated blood glucose. DR RODGERS: So here's a question, it goes back to something you said in some of your introductory remarks, and it's simply, "How do you know if you have prediabetes, not diabetes, but prediabetes?" DR CEFALU: Well, first of all, prediabetes, let's just define it. It's a blood glucose level that's higher than normal, but not high enough to be diagnosed as type 2.

And the unfortunate thing, most people with prediabetes don't know they have it. Prediabetes, unfortunately, put you at an increased risk of developing type 2 diabetes, heart disease, and stroke. Now, again, you may have prediabetes and not have any clear symptoms, and the only way to know if you have prediabetes is with the blood test.

It's not in the diabetes level just yet, but it's above normal. But there are some risk factors that you can look at. Number one, Are you overweight? Are you 45 years or older? If you have a family history, a parent, a brother or sister with type 2? If you're a woman, did you have a history of gestational diabetes? And also, we recognize that race and ethnicity is a factor; if you're African American, Hispanic, you may be at higher risk. Now, the good thing about prediabetes is some of the more elegant studies and the longer-term studies have shown that we can prevent or delay diabetes. The Diabetes Prevention Program once again, showing if you have prediabetes as little as a 5% to 7% reduction in body weight, I gave an example earlier, 10 to 15 pounds if you're 200 pounds of weight, can delay or prevent type 2 diabetes for many, many years. In fact, we have data now going out to 15 and 20 years, showing the benefit of this intervention.

And so prediabetes is important, if you have risk factors, please get screened by your doctor, and this is where lifestyle modification has a huge impact on prevention. DR RODGERS: So related to diabetes, but not prediabetes, what are some of the signs and symptoms when your sugar levels are too high? DR CEFALU: Well, the symptoms, let's break it down into the symptoms that you will experience because of the high blood glucoses, high glucoses in the blood, and this could be first of all, increased thirst and urination, increased hunger, just feeling fatigued. You may have blurry vision because of the elevated sugar. You may have numbness and tingling in the feet, sores that do not heal, unexplained weight loss.

Now, if you have these symptoms and it's type 1 diabetes, these symptoms can progress pretty quickly. Again, type 1 diabetes is a deficiency of insulin, insulin is needed to maintain your metabolism. So, if you have these symptoms and you have type 1, because of the lack of symptoms, this can lead to an acute condition called diabetic ketoacidosis and hospitalization.

So, don't ignore these symptoms if you have these. Secondly, these symptoms can appear in type 2 and develop very slowly over the course of many years, and many people may say, "Well, it's just age." So, you may be completely asymptomatic with type 2 diabetes.

And in that situation, again, a blood test will reveal the diagnosis. But these symptoms can come on pretty quickly if you have type 1 and they can come on very slowly for type 2 over many, many years. DR RODGERS: We have a question from a patient, and it probably is in relationship to answer to one of your previous questions. And that is, "Is there an A1C number that's considered diabetes in remission?" DR CEFALU: Yes. Right now, an A1C level to obtain for just treatment is less than 7.

But remission, most people are using the A1C of 6.5%, off medications for about six months, so that currently appears to be the consensus for what defines diabetes remission. DR RODGERS: Well, tell us Dr. Cefalu, what are some of the key lessons that you have learned as a result of your roles in setting research priorities as a director, as well as as a physician and scientist spending years in diabetes patient care? DR CEFALU: Well, one of the more important things I've come to understand are, is trying to understand the issues or condition that most impact our communities. And for me, the study of diabetes remains as a top concern.

So in this regard, we really need to understand more about the condition just from the questions today, so we can prevent it and effectively treat it. And because of research, we made tremendous progress in reducing the rates of many of the complications. But because diabetes is so common, the burden of the disease for those who have it remains great. So it's important now to make sure our advances in the lab and in the clinics are effectively translated to the community.

The other important lesson is that we need to understand how to effectively design research studies. We have to listen to patients and we have to learn from patients as to what issues are important. For example, it is important for a study using a new treatment to focus on the effect of that treatment on a blood test. That effect on the blood test tells us how that treatment works, but there are other factors to consider, such as, how does this treatment make the person feel? How does it improve the quality of life, how satisfied is the person with the treatment? So in this way, not only can we develop treatments at work on the blood test, we have treatments at the individuals or the patient will accept, and that hopefully will have greater adherence to the patient. DR RODGERS: Well, this sounds like a question that you may have answered before, but maybe not to this individual patient, it goes, "Are there some tips that I can follow now to help me manage my diabetes during the pandemic?" DR CEFALU: Yes, absolutely. The first thing right now is the most important thing you can do if you have diabetes in this pandemic, is to reduce your chance and that’s - do the social distancing, wear a mask and have hand washing as key behaviors.

So again, given the risk of COVID-19 and those individuals who have diabetes and obesity, prevention is going to be so important. However, it's also important despite social distancing, to keep in contact with your provider and what I'm concerned about is just a question that came up earlier. Even though you're social distancing you may not be making your clinic visits. Attempt to contact your physician, telehealth, through a phone, keep your regular appointment, if only by these digital means, it's so important to do that. It's important to the pandemic to make sure that at your disposal now, you have your medications, you have your glucose supplies, you have your insulin supplies as you need them while you're socially distancing. But the same principles apply: prevention, keeping your health visits with your physician.

But the same principles to the diabetes management apply: healthy eating, exercising, managing the simple ABCs of treatment. But again, importantly, practice behaviors to reduce the chance of getting infected and beyond that, manage the diabetes with the simple ABCs. DR RODGERS: Thank you. Well, thanks. I want to thank our participants so much for the questions thus far. As more questions come in, I just want to let you know that I'm Dr Griffin Rodgers, Director of the National Institute of Diabetes, Digestive and Kidney diseases at NIH.

And I'm talking with Dr William Cefalu, who is the director of Division of Diabetes, Endocrinology and Metabolic Diseases at NIDDK. We have a couple of more questions that have come in, one relates to therapy. And this patient asks, "Should one start pharmacotherapy as early as possible or delay medications as long as possible by optimizing lifestyle?" DR CEFALU: Well, again, it's going to depend on your individual condition. And the American Diabetes Association every year puts out its ADA Standards of Care.

And the ADA has an algorithm that looks at individual patient factors, and before you advance therapy, the first thing is the patient needs to be at the center of care, and you need to understand about the other condition. So I would ask the question, what is the initial A1C level? If the A1C level is markedly high, you may need to be on two medications initially, or for that matter, if you're symptomatic go on insulin. Even if your A1C is slightly above normal, most would suggest that nutrition and exercise is a cornerstone of therapy and may go on monotherapy with a medication called Metformin, which has shown other benefits. So I would suggest, number one, that for anyone with diabetes, nutrition and exercise is a cornerstone of treatment. And then other therapies would depend on your individual conditions. I would also suggest that now we've learned so much more about heart disease and kidney disease with diabetes.

And there's recommendations that even if your A1C is not above a certain level, and if you have heart disease, that you go on one of two classes of medication that can reduce heart disease. So it's extremely individualized and dependent on the conditions of that particular patient. But nutrition and exercise as a cornerstone, know your risk factors, know your blood glucose, know the other conditions and if heart disease or renal disease is part of the issue, then medication will be directed toward those conditions.

DR RODGERS: Absolutely. You mentioned a few times now about telemedicine, particularly in the area of the pandemic that we're living under. Here's a patient who asks, "What do you think about new technologies being developed to check your blood sugar using wearable devices such as a watch and these other devices.

Has NIDDK been involved in any of the development of those technologies and what's your general opinion?" DR CEFALU: Well, we've been involved, we have programs that take advantage of many technologies very early in the process, and we were instrumental in developing some of the initial technologies leading to the continuous glucose monitor. And even for that type of glucose sensing, I think we'll be there in a few years, I think it's a very exciting time. And again, the skin barrier, the skin is a barrier for glucose management, but I think technology over time, this is a very attractive way to monitor blood glucose.

Unfortunately, we're not there just yet, but I do think just the progress we've made in the artificial pancreas, which actually took research from the '80s and '90s and 2000s to the point now where we have a couple of systems that are commercially available, I do believe the same thing will occur in technology for glucose monitoring that you may be able to look at your watch and just look at glucose continually. So, a lot is going on in that particular field, and I'm excited about technology in that area. DR RODGERS: Absolutely. Well, before we answer the next question, I want to mention that we have information at available in English and Spanish, that's free, and it covers a range of topics from diabetes that Dr. Cefalu has talked about to kidney disease and even more.

Please feel free to visit that website and use that very useful information. That's regularly updated based upon evidence that's generated from some of the clinical trials and clinical studies that we and other institutes here at NIH have supported. We have a question here about gestational diabetes and you mentioned pregnancy-related diabetes, "Can you be diagnosed with gestational diabetes and never develop type 2 diabetes?" DR CEFALU: Yes, you can. Basically, if you have gestational diabetes, you have a higher likelihood of developing type 2 diabetes 10 to 15 years later. That means you have a family history of the disease and with obesity, yes, you may develop it. And this is why it's important for a woman, who develops gestational diabetes to have good lifestyle habits after pregnancy, to try to get back to her pre-pregnancy weight, to make sure she has a good exercise regimen.

And it's important for that individual who had a history of gestational diabetes to make sure that they're monitored frequently with their provider. It's also important to recognize if that individual had a previous history of gestational diabetes and is thinking about conceiving that the provider knows that this can be monitored very soon in the next pregnancy. DR RODGERS: Over the years as a physician and a scientist studying diabetes and caring for patients with diabetes, what do you wish people who are watching knew about diabetes? DR CEFALU: Well, this is a very exciting time to be in diabetes in general, and diabetes research, in particular. So I would wish that individuals knew about all the research advances that can improve their lives, so they can take advantage of the research and the advances. So for example, we talked today about, just a little about the newer drugs, the drugs that have protection for heart and the kidney.

These have all come to play in the last couple of years. So they should know about the new therapies, they should know about the newer insulins, they should know about technology and just what we've discussed today with continuous glucose monitoring, and the artificial pancreas and even the considerations with further glucose monitoring are going to be important. So need to know about that, need to know about what we're doing with the newer studies, and incredible strategies, and as you've stated, they can learn about these research advances, not only from the healthcare team, from just reading from our website where all this is listed. But the most important thing I wish they would know is they actually have the power to completely control their blood sugar and control their risk factors, and they need to know that if they do this, they will greatly reduce their chance for having complications, and as such, live a completely healthy life with diabetes. So that's what I want individuals who are listening to us today to know that they have the power, they have the tools to control their diabetes and live a life free of the complications.

DR RODGERS: Well, thank you. Now that we're nearing the end of our event, can you just recap some of the things... You just already went into that a little bit, but can you just recap some of the things that you mentioned that adults and youth do to manage diabetes and improve their health? DR CEFALU: Yeah, so the most important thing I'll tell people listening is they need to be informed and educated about their condition.

They need to be at the center of the decision making, so they need to be educated first and foremost. Secondly, from your healthcare team, take advantage of the wonderful educational material available, take advantage of the expertise, take advantage of information as example from the NIDDK website about the research and advances. But importantly, know your numbers for the simple ABCs of diabetes. Know what your A1C level is, know what your blood pressure is, know what your cholesterol level is. Outside of that, maintain a healthy lifestyle. If you're overweight and obese, work with your healthcare team to lose weight and exercise, and remember when working with your healthcare team, you need to be involved in the decision making.

So those are the tips: education, know your numbers, lifestyle, be informed. DR RODGERS: Good, excellent. So we have one question here from a researcher, and it basically says, "How can I get involved or learn more about research advances at NIDDK?" DR CEFALU: Well, our website, you can go to our particular website and put in research and you could see the specific research advances that are made.

So most of these advances that we talk about are listed on our website and we can send you information if need be, but a lot of the research that we're doing is reflected in our recommendations. DR RODGERS: Well, if we don't have any additional questions from Facebook, we will wrap up, and thank you again, Dr. Cefalu, for joining me today for the Facebook Live event and for the very helpful information that you've provided for people living with diabetes or at risk for the disease. And thank you for watching on Facebook; we will post more information in the comments and we will watch for questions that we weren't able to answer during the Facebook Live event.

If you have any more questions after this event ends, please comment on this video. And once again, please visit us at for more information about diabetes. I'm Dr Griffin Rodgers and thank you again for watching. Have a great day.

Stay safe, stay well.

2021-01-11 05:38

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