Posts Tagged ‘diabetes’

Diabetes, Health Literacy & Antidepressants

Tuesday, May 28th, 2013 by American Senior Fitness Association   View This Issue of Experience!

Adult patients with diabetes who don’t understand basic health information are significantly less likely to take newly prescribed antidepressant medication, according to a new Kaiser Permanente study published in the Journal of General Internal Medicine.

In this study conducted by the Kaiser Permanente Division of Research and the University of Washington School of Medicine, 72 percent of the 1,366 study participants had limited health literacy, and had significantly poorer adherence to newly prescribed antidepressants, compared to patients with no limitations.

“Research shows that those with health literacy limitations are more likely to have poor control of their chronic medical conditions such as diabetes, congestive heart failure and HIV,” said Andrew Karter, PhD, research scientist at Kaiser Permanente and senior author on the study. “However, this is the first study to examine the association between health literacy and antidepressant adherence among patients with diabetes. This type of research gives our health care systems important feedback because, as providers, we often remain unsure whether the critical health information we convey to our patients is fully understood.”

The Institute of Medicine defines health literacy as the capacity for patients to “obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Because nearly 90 percent of Americans have some difficulty using routine health information, the U.S. surgeon general has identified the improvement of health literacy as a national priority.

Adequate adherence for antidepressants is particularly important for patients with diabetes and other chronic medical conditions. Depression occurs twice as frequently among adults with diabetes compared to adults without diabetes, and has been associated with an increased risk of the serious diabetic complications, dementia and mortality.

In the study, health literacy was based on a self-reported scale in which participants with type 2 diabetes responded to three questions:

1. How often do you have problems learning about your medical condition because of difficulty understanding written information?
2. How confident are you filling out medical forms by yourself?
3. How often do you have someone like a family member, friend, hospital or clinic worker or caregiver, help you read health plan materials?

The study examined medication nonadherence during the 12 months after the initial antidepressant prescription, and researchers found that many patients failed to adhere to their treatment. Although most patients filled the prescription at least once, 43 percent failed to fill the prescription a second time, and nearly two-thirds had discontinued the antidepressant by the end of the 12-month period.

Poor adherence to antidepressant medications has been described previously, but what was not known is that those with health-literacy limitations were significantly less likely to take their antidepressant medications. In fact, diabetes patients with limited health literacy were much less likely to refill their antidepressant medications in a timely fashion than patients with no limitations. These patterns were not explained by other factors known to be associated with medication nonadherence, including age, race/ethnicity, English proficiency and income, which were accounted for in the study.

Depression in adults with diabetes is frequently chronic, suggesting the need for long-term antidepressant therapy. “The high rates of early discontinuation that were observed among adults with diabetes who had any health literacy limitation suggest that few of these individuals received an adequate course of antidepressant therapy. Getting that sufficient treatment is critical in preventing relapse and recurrence of depression,” said lead author Amy Bauer, MD, of the University of Washington School of Medicine. “Physicians should be aware of this. For antidepressant treatment to succeed, patients with limited health literacy may require more intensive counseling and clearer explanations about use of antidepressant medications and closer follow-up.”

The researchers said the study findings underscore the importance of national efforts to address healthy literacy, simplify health communications regarding treatment options, improve public understanding of the importance of depression treatment, and monitor antidepressant adherence.

This research was supported by funding from the National Institutes of Health.


American Diabetes Association “Superfoods”

Friday, July 27th, 2012 by American Senior Fitness Association   View This Issue of Experience!

The ADA recommends that persons with diabetes focus on nutrient-dense foods that have a low glycemic index. As recently reported by HealthDay, an affiliate of the National Institutes of Health, these ADA "superfoods" include:

  • Various types of beans (for example, pinto beans and kidney beans);
  • High-fiber citrus fruits (for example, lemons, oranges and grapefruit);
  • Berries;
  • Sweet potatoes;
  • Tomatoes;
  • Dark green, leafy vegetables (for example, spinach, kale and collard greens);
  • Nuts;
  • Whole grains;
  • Non-fat yogurt and milk;
  • Fish that are high in omega-3 fatty acids (for example, salmon).
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    Temperature Fluctuation Concerns

    Friday, June 22nd, 2012 by American Senior Fitness Association   View This Issue of Experience!

    Research conducted at the Harvard School of Public Health in Boston suggests that temperature swings may place elderly persons who have chronic conditions (for example, diabetes, heart failure and lung disease) at a higher risk for death during the summer months. Published recently in the online edition of the Proceedings of the National Academy of Sciences, the study found that for every 1-degree Centigrade* increase in summer temperature variability, there was a corresponding increase of from 2.8 to 4 percent in the death rate of elderly people with chronic diseases.

    In a news release about the study, Harvard researcher Antonella Zanobetti stated: "We found that, independent of heat waves, high day-to-day variability in summer temperatures shortens life expectancy. This variability can be harmful for susceptible people."

    The study’s lead author Joel Schwartz said in the news release: "People adapt to the usual temperature in their city. That is why we don’t expect higher mortality rates in Miami than in Minneapolis, despite the higher temperatures. But people do not adapt as well to increased fluctuations around the usual temperature. That finding, combined with the increasing age of the population, the increasing prevalence of chronic conditions such as diabetes and possible increases in temperature fluctuations due to climate change, means that this public health problem is likely to grow in importance in the future."

    Additional, more specific study findings included:

    • The risk of death for persons with diabetes rose 4 percent for each 1-degree C increase in summer temperature variability.
    • The risk of death for persons with a previous heart attack rose 3.8 percent for each 1-degree C increase in summer temperature variability.
    • The risk of death for persons with chronic lung disease rose 3.7 percent for each 1-degree C increase in summer temperature variability.
    • The risk of death for persons with heart failure rose 2.8 percent for each 1-degree C increase in summer temperature variability.
    • Temperature-related mortality risk was 1 to 2 percent higher for persons living in poverty and for black persons.
    • Risk of death was greater for elderly persons living in hotter climes.

    The researchers concluded that greater summer temperature variability in the U.S. alone could result in over 10,000 additional deaths per year. Areas that may be particularly affected include the mid-Atlantic states. Elsewhere in the world, areas that may be particularly affected include parts of France, Spain and Italy.

    *approximately 1.8 degrees Fahrenheit


    Research and Practical Health Care

    Friday, May 6th, 2011 by American Senior Fitness Association   View This Issue of Experience!

    The great universities of the world produce important research findings and provide practical medical care as well. Below are three current news releases from the University of Florida that demonstrate such centers’ value — and that will be of great interest to those involved in older adult health and fitness.


    Exercise Cuts Older Adult Health Costs

    Friday, May 6th, 2011 by American Senior Fitness Association   View This Issue of Experience!

    While most senior health-fitness professionals already advocate insurance coverage of structured physical exercise programming for older adults, the following news release strongly reinforces that position:

    Structured exercise and physical activity programs should be covered by insurance as a way to promote health and reduce health care costs, especially among high health-risk populations such as those who have diabetes.

    So says Marco Pahor, M.D., director of the University of Florida Institute on Aging, in an editorial Wednesday, May 4, in the Journal of the American Medical Association. Pahor’s paper accompanies an analysis of multiple clinical trials that examined the effect of exercise and physical activity on the control of blood glucose levels.

    “Cumulative work over the past few decades provides solid evidence for public policymakers to consider structured physical activity and exercise programs as worthy of insurance reimbursement,” Pahor said.

    A host of studies have linked exercise programs with improved health measures related to blood pressure, lipid levels — including cholesterol and triglycerides — cardiovascular events, cognition, physical performance, premature death and quality of life. People who take part in programs that contain both aerobic and resistance training are likely to get the greatest benefit, compared with people who do only resistance exercises.

    The study that Pahor’s editorial accompanied, conducted by Daniel Umpierre, M.Sc., of the Hospital de Clinicas de Porto Alegre, Brazil, and colleagues, compared the association between physical activity advice and structured exercise programs, respectively, and markers of diabetes.

    Analyses of interventions to promote physical exercise in adults have found that compared with no intervention, exercise programs are cost-effective and have the potential to improve survival rates and health-related quality of life.

    Some insurance providers already include a fitness benefit for members, such as monthly membership at certain fitness centers or access to personal trainers or exercise classes at reduced cost. Use of such health plan-sponsored club benefits by older adults has been linked to slower increases in total health care costs.

    In one study, older adults who visited a health club two or more times a week over two years incurred $1,252 less in health care costs in the second year than those who visited a health club less than once a week. Programs among people with lower incomes can also pay off, because people in that group are otherwise more likely to forego health-promoting physical activity because of economic constraints or safety concerns.

    “People are willing to invest in improved health, but if you have a fixed amount of resources then you want to choose where you get the most health for the dollar,” said Erik Groessl, an assistant professor of family and preventive medicine at the University of California, San Diego, and director of the UCSD Health Services Research Center. Groessl was not involved in the current analysis.

    Group training or walking programs, for example, can be cost-effective, sustainable forms of physical activity that don’t require expensive health care professionals or equipment. But more costly interventions that yield dramatic results might also be worth the expense.

    With respect to type 2 diabetes, Medicare reimburses for approved self-management education and medical nutrition therapy programs. But no specific reimbursement is given for any physical activity or exercise program, despite evidence that such programs can help improve health and cut costs.

    Questions remain as to what format reimbursable exercise and physical activity programs should take, what population group should be targeted, and at what stage of life or health status would a lifestyle intervention be most cost-effective to implement.

    Various studies, including the UF Institute on Aging Lifestyle Interventions and Independence for Elders, or LIFE study, are aimed at answering those questions through randomized controlled trials that can provide data about the efficacy and cost-effectiveness of structured activity programs with respect to a range of health outcomes. Funded by the National Institute on Aging, the LIFE study is the largest of its kind to examine physical activity and health education as a way to prevent mobility disability among older adults, and accounts for the largest federal award to the University of Florida.

    The institute will break ground on May 26 for a 40,000-square-foot complex within UF’s new $45 million, 120,000-square-foot Clinical and Translational Research Building, which will serve as headquarters for this research and others aimed at speeding scientific discoveries to patients.

    “There is a lot of evidence that physical activity works, and I think it’s time to start putting it into practice more widely,” Groessl said.


    Although they have a higher prevalence of disease than their English counterparts, older Americans live as long or longer

    Thursday, November 4th, 2010

    American Senior Fitness Association Researchers have found that, although they have a higher prevalence of disease than their English counterparts, older Americans live as long or longer. The study found Americans have higher rates of diabetes, high-blood pressure, heart disease, heart attack, stroke, chronic lung diseases and cancer. Yet, Americans 55 – 64 lived as long as the English and those 65 and over lived even longer. The studies co-author, James P. Smith, noted “that at least in terms of survival at older ages with chronic disease, the medical system in the United States may be better than the system in England.” Co-author James Banks stated that “the United States’ health problem is not fundamentally a health care or insurance problem, at least at older ages. It is a problem of excess illness and the solution to that problem may lie outside the health care delivery system. The solution may be to alter lifestyles or other behaviors.” Click below for a report from ScienceDaily.


    Following a Mediterranean diet may lower the risk of type 2 diabetes

    Wednesday, November 3rd, 2010

    A Spanish study indicates that following a Mediterranean diet may lower the risk of type 2 diabetes. The study of 418 older adults also showed that benefits were obtained independent of weight change. Dietitian and diabetes educator, Constance Brown-Riggs, “cautioned against seeing olive oil, or any single component of the Mediterranean diet, as a magic bullet … what we’re talking about here is an overall eating pattern, and an overall lifestyle.” Please click below for a report from Medline Plus.


    Diabetes and AFib

    Thursday, July 1st, 2010 by American Senior Fitness Association   View This Issue of Experience!

    The American Senior Fitness Association (SFA) wants older adult health-fitness professionals to have a working knowledge of atrial fibrillation (AFib), a serious and increasingly prevalent heart rhythm disturbance that may affect aging physical activity participants. New research shedding light on the relationship between AFib and diabetes will be described below.

    SFA president Janie Clark, M.A., is the senior fitness expert on the AFib Support Team organized by sanofi-aventis U.S. (which is an affiliate of sanofi-aventis, a leading global pharmaceutical company). Clark serves along with a cardiologist specializing in heart rhythm disorders, a cardiovascular nurse, and a lifestyle gerontologist. Educational resources have been developed by the AFib Support Team to assist persons affected by atrial fibrillation and are available online at

    Recently AFib Support Team members were interviewed for an article published by EP Lab Digest (10:3; "Introducing the AFib Support Team"), a periodical that provides product, news and clinical updates for the electrophysiology professional. Clark’s quotes in the article include: "In my experience, it has always been possible to find a safe, beneficial and enjoyable form of physical activity for everyone of any age, including AFib patients." She counsels such patients to "… follow the advice provided by one’s medical team, insist on individualization, and pursue activities that are well-tolerated." To read the entire article, click here.

    Regarding the link between diabetes and atrial fibrillation, a new study has found that people with diabetes are at increased risk for AFib. Writing in the Journal of General Internal Medicine, online, scientists from the Group Health Research Institute of Seattle, Washington, reported their analysis of data involving 1,410 persons with newly-recognized atrial fibrillation and 2,203 persons without AFib. They concluded that diabetes is associated with a higher risk for developing atrial fibrillation, and that risk is higher with longer duration of treated diabetes and with worse glycemic (blood sugar) control. To read the abstract of this study, click here.


    Why Is the Mediterranean Diet So Heart-Healthy?

    Thursday, July 1st, 2010 by American Senior Fitness Association   View This Issue of Experience!

    Among other beneficial foods, the "Mediterranean diet" features virgin olive oil, which researchers believe may support heart health by repressing genes that promote inflammation. Scientists at the University of Cordoba, Spain, recently studied a small group of patients with metabolic syndrome — which increases one’s risks for both heart disease and type 2 diabetes — and published their findings in BMC Genomics (11:253), a journal of BioMed Central.

    Specifically, the researchers sought to learn more about how a diet abundant in "phenol compounds" (found in olive oil, especially the extra-virgin types) influenced the workings of genes. While acknowledging that other lifestyle factors may also contribute to the lower risk for cardiovascular disease in the Mediterranean region, the study’s authors wrote: "These results provide at least a partial molecular basis for reduced risk of cardiovascular disease observed in Mediterranean countries, where virgin olive oil represents a main source of dietary fat." To view this research article, click here.


    The Right Rice

    Thursday, April 1st, 2010 by American Senior Fitness Association   View This Issue of Experience!

    To lower one's risk for type 2 diabetes, choose brown rice over white. That's the word from a large-scale study recently presented during the American Heart Association's Nutrition, Physical Activity and Metabolism Conference.The analysis involved data on the long-term dietary consumption of more than 39,000 men and more than 157,000 women. Results:

    Those who had five or more servings of white rice a week were found to be 17 percent more likely to develop the condition, compared to those who had less than one serving of white rice a month.

    Those who had two or more servings of brown rice a week were 11 percent less likely to develop the condition, compared to those who had less than one serving of brown rice a month.