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Managing diabetes after incarceration: A difficult journey

For the average adult, a diabetes diagnosis is life-changing. Managing diabetes involves a daily routine that shifts toward remembering to take medication, check blood sugar, and monitor carbohydrate intake.

Frequent trips to multiple doctors’ offices become the norm, as regular foot checks, dental appointments, eye exams, and primary care visits are crucial for avoiding the complications of poorly managed disease.

These complications can include gum disease, cardiovascular problems, nerve damage, kidney failure, blindness, and even amputation. Individuals who receive an early diagnosis and manage the disease well can expect to live as long as those without diabetes, but research has linked poor disease management to reduced life expectancy of up to 8 years.

For someone reentering society after being in prison, managing diabetes can be quite difficult. In the United States, more than 2 million people are incarcerated in jails and prisons on a given day, and nearly 5% of them have diabetes.

These individuals typically do not serve life sentences; rather, 95% eventually return to community settings that may not readily embrace them or their medical needs.

For example, taking medication every day requires having a safe place to live and store medications. This is not a given for formerly incarcerated people, many of whom often struggle simply to find a place to live.

In the U.S., individuals who have been inmates in jails or prisons just once are seven times more likely to experience homelessness than the general population. Meanwhile, those who have been incarcerated two or more times are 13 times more likely than other people to lack housing.

Individuals with a criminal history face numerous collateral consequences of conviction — legal restrictions that disqualify them from accessing a range of resources and opportunities upon release.

Unemployment is a major concern for people with a criminal history. According to the Prison Policy Initiative, individuals with a criminal history are nearly five times more likely to be unemployed than the general population.

Many employment sectors bar those with a criminal history, limiting their ability to earn the money necessary to afford adequate housing. Those who turn to low-income housing programs often face being denied access, as many public housing programs have strict eligibility criteria that exclude individuals with a criminal history.

This is true even for older adults. Many low-income senior housing assistance programs deny access to individuals with recent criminal convictions and permanently ban those with a history of criminal sexual conduct, even if the crime occurred decades earlier.

Additionally, food insecurity complicates diabetes management for formerly incarcerated adults. Access to adequate quantities of nutritious food is crucial for effective diabetes management.

A diabetes-friendly diet restricts carbohydrate intake, as carbohydrate-rich foods often raise blood glucose levels higher and faster than foods rich in protein and fiber.

Formerly incarcerated individuals, however, often report great difficulty in accessing healthful foods. Estimates of food insecurity among formerly incarcerated individuals returning to community settings are as high as 91%.

Among the many collateral consequences of criminal conviction in the U.S. are limitations on the receipt of federal supplemental nutrition assistance program benefits (i.e., SNAP or food stamps) for individuals convicted of certain criminal offenses.

While most states have eliminated lifetime bans on food assistance, more than 30 states still place some restrictions on food assistance for individuals with felony drug convictions.

Faced with an inability to afford nutritious foods, food-insecure individuals often turn to cheap, high calorie foods, which can lead to weight gain, poor blood glucose control, and an increased risk of diabetes-related health complications.

Likewise, poor healthcare access and utilization negatively affect diabetes management among formerly incarcerated adults. Access to affordable health insurance is crucial for disease management, as the self-management of diabetes requires visits to primary care doctors and specialists; the ongoing use of medication, such as insulin and oral medications; and daily use of testing supplies, including glucose test strips and glucose meters.

Uninsured adults with diabetes engage in fewer preventive healthcare activities than their insured counterparts, including less daily blood glucose monitoring, reduced participation in diabetes education classes, and fewer foot and eye exams.

Historically, a lack of health insurance has been a significant barrier to healthcare access for formerly incarcerated individuals. Given the difficulties of finding employment after incarceration, employer-based health insurance is typically not an option.

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Traditionally, Medicaid coverage has been limited to pregnant women, parents with a low income, and those under the age of 65 with disabilities. Notably, this does not include men (who make up about 93% of the U.S. state and federal prison population), unless they care for minor children or have disabilities.

At the end of their sentence, individuals with diabetes may have trouble obtaining health insurance, depending on where they live. Since the Affordable Care Act of 2010, 39 U.S. states (including the District of Columbia) have expanded Medicaid to include all adults with a low income, regardless of gender, disability, or parenting status.

Given the barriers that formerly incarcerated individuals face, ensuring adequate diabetes management in this population will require a host of system-level changes. Providing widespread access to health insurance for individuals with diabetes and a low income is crucial.

Without it, formerly incarcerated adults with diabetes will forego necessary medical care simply because they cannot afford it. This lack of treatment will only increase their risk of adverse disease-related complications.

The benefits of Medicaid expansion have been well-documented — if all remaining states fully implemented Medicaid expansion, nearly 4 million people would gain health insurance, decreasing the number of uninsured adults by 28%. The remaining states must be encouraged to expand their Medicaid programs to provide greater access to healthcare coverage in this population.

Additionally, there must be increased policy advocacy surrounding the health-related collateral consequences of criminal conviction. As they reenter community settings, individuals with a criminal history face countless barriers that adversely affect their ability to manage diabetes or any other chronic health condition effectively.

Most criminal justice advocacy work examines the impact of collateral consequences on economic security. However, policies that restrict employment, housing, and access to healthful food for those with criminal records also ultimately endanger population health.

Chronic disease management and population health must be a part of the conversation when advocating for criminal justice reform.

As the U.S. population ages, and chronic health conditions become more prominent, failure to integrate these issues into larger criminal justice policy discussions will just add to the difficulties that formerly incarcerated adults must deal with as they attempt to reintegrate into society.

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How do COVID-19 vaccines compare with other existing vaccines?

The novelty of the COVID-19 vaccines may seem daunting for some, and it is natural for questions to arise on their effectiveness. In this feature, we examine the difference between effectiveness and efficacy, compare the COVID-19 frontrunner vaccines to other vaccines, such as the flu shot, and compare their safety considerations.
As Pfizer/BioNTech roll out their COVID-19 vaccine throughout the United Kingdom and the United States, the world wonders how effective it will be.

Looking at the three leading vaccines that we have previously reported on, Pfizer/BioNTech boasts 95% efficacy, the Oxford/AstraZeneca vaccine candidate has an average of 70% efficacy, while the Moderna vaccine candidate reportedly has 94.1% efficacy.

But what does this say about their effectiveness? And how does it compare with vaccines against the flu, polio, and measles?

Effectiveness vs. efficacy — what is the difference?
Firstly, it is worth noting that “effectiveness” and “efficacy” are not the same. Despite news outlets frequently using them interchangeably, efficacy refers to how a vaccine performs under ideal lab conditions, such as those in a clinical trial. In contrast, effectiveness refers to how it performs in the real world.

In other words, in a clinical trial, a 90% efficacy means that there are 90% fewer cases of disease in the group receiving the vaccine compared with the placebo group.

However, the participants chosen for a clinical trial tend to be healthier and younger than those in the general population, and they generally have no underlying conditions. Furthermore, researchers do not normally include certain groups in these studies, such as children or pregnant people.

So, while a vaccine can prevent disease in a trial, we might see this effectiveness drop when administered to the wider population.

However, that is not in itself a bad thing.

Flu shot effectiveness
Vaccines do not need to have high effectiveness to save thousands of lives and prevent millions of disease cases.

The popular flu shot, for example, has an effectiveness of 40­–60%, according to the Centers for Disease Control and Prevention (CDC).

However, during 2018­–2019, it prevented around “4.4 million influenza illnesses, 2.3 million influenza-associated medical visits, 58,000 influenza-associated hospitalizations, and 3,500 influenza-associated deaths.”

It is also worth noting that the flu vaccine’s effectiveness varies from season to season, due to the nature of the flu viruses circulating that year. Determining the precise rate of effectiveness can be challenging.

Finally, it bears mentioning that the number of doses can also improve effectiveness for some vaccines. For the flu shot, two doses of the vaccine instead of one can offer a protection boost, but this benefit is limited to only a few specific groups, such as children or organ transplant recipients.

The booster dose does not seem to benefit people over the age of 65 or those with a compromised immune system.

By contrast, as we will see below, for vaccines, such as the ones against polio and measles, a higher number of doses is required to achieve peak effectiveness.

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6 Reasons to Eat More Mushrooms

Mushrooms are a great example of “don’t judge a book by its cover.” Yes, they’re a fungi. And sure, some varieties look like something out of a Dr. Seuss story. But mushrooms deserve to be tossed into your shopping cart and added to meals a lot more often (not just ordered on pizza, though that’s yummy too!). Here are six reasons why:

1. They’re provide vitamin D: Mushrooms are the only produce item that delivers vitamin D, a nutrient that’s not easy to come by in many commonly eaten foods. That’s because mushrooms can make vitamin D when exposed to UV light. For instance, one portabella mushroom treated with UV light contains more than 100% of the Daily Value for vitamin D. Check the Nutrition Facts Panel for vitamin D content on portabella, white button, and brown cremini mushrooms (“baby bellas”). These varieties are more likely to be treated.

2. They taste meaty: The flavor of mushrooms has been described as “umami,” a Japanese word meaning “pleasant savory taste,” that’s referred to as the fifth taste sense. Portabella (and cremini) mushrooms have a meatier flavor, though the milder flavor of white button deepens with cooking. Portabella mushrooms also have a meaty texture, which is why you’ll see them grilled whole or served on buns in place of meat burgers.

3. They’re high in selenium: Mushrooms are one of the richest sources of selenium in the produce aisle. That’s a mineral that works like an antioxidant in your body, guarding cells against the kind of damage that can lead to disease. Selenium also plays a role in the immune system.

4. They vanish into ground meat: With their meaty taste and texture and ability to disappear into ground meat, they’re the perfect way to cut back on the amount of ground beef (or ground pork, chicken, or turkey) you use in recipes. With this trick, you’ll also reduce the number of calories and fat in your recipe too. (Here’s my recipe for Freezer-Friendly Beef Burritos that stretches ground beef with white button mushrooms.)

Keep in mind these ratio recommendations while you’re cooking:

Burgers and meatloaf: Use 25% mushrooms to 75% ground meat
Tacos: Use 50% each mushrooms and ground meat
Pasta sauces: Use 70% mushrooms to 30% ground meat
5. They may help with weight loss: Mushrooms are extremely low in calories. There are only about 20 calories in a serving of five white button mushrooms or one whole portabella mushroom! Yet mushrooms are also satisfying. In one study published in the journal Appetite, people who swapped mushrooms for meat at lunch reduced the amount of calories and fat they took in, but they reported feeling just as full and satisfied as those who ate meat.

6. They’re a sustainable crop: Mushrooms are grown in trays indoors and don’t require sunlight, farmland, or very much water. When you eat them in place of meat — or blend them so you’re eating less meat — you’re also lowering the overall carbon footprint of your meals.

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What Should I Eat Before Working Out?

If you’re eating a healthy diet and getting enough calories throughout the day to support your activities, you may not need to nosh before your workout. But if it helps keep your energy level up, snacking can be a good move.

Choosing the right foods helps. And make sure you’re well hydrated before working out. Experts recommend drinking 16-20 ounces of water 1-2 hours before starting your workout.

9 Pre workout Snacks to Try
Experts agree your best bet is a low-fat snack, about 100 to 300 calories, that gives you a mix of protein and complex carbohydrates.

The carbs give you fuel. The protein is for your muscles.

Try these tasty ideas:

  • Oatmeal with cinnamon and blueberries or dried cranberries
  • Whole wheat toast topped with nut butter and sliced bananas
  • Fruit smoothie with yogurt
  • Greek yogurt with low-fat granola and berries
  • Half of a turkey sandwich
  • Raw veggies with hummus for dipping
  • Whole-grain crackers with 1 ounce of low-fat cheese
  • Cottage cheese and sliced apples or bananas
  • Trail mix with nuts and dried fruit
  • What Not to Eat Before Exercise
  • Avoid foods that are high in fat or fiber — both of which can upset your stomach, take longer to deliver energy, and leave you feeling sluggish. Also avoid spicy or unfamiliar foods.
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How to Start Strength Training

Why Strength Training?
It’s not just to get big muscles and look buff. Your bones will get stronger, too. And it can help your balance and coordination, which means you’re less likely to fall and hurt yourself. More muscle also means you burn more calories when you’re doing nothing at all, which can help keep off extra pounds. You’ll appreciate these benefits as you get older and start to lose muscle mass.

Do You Need Lots of Equipment?
Not at all. Pushups, pullups, and other “body weight exercises” can help build up your muscles and make it easier for you to work out longer. Simple props like elastic resistance tubing and giant inflatable balls can help with some movements. And don’t be afraid to switch it up. More variety may help you get stronger.

Free Weights
“Free” doesn’t have to do with money. It means the weights aren’t attached to a machine. If you’d rather train at home, start small with a couple of hand dumbbells. You can always add weight or take it away. A larger barbell and weight bench put variety in your routine.

Be careful, though. It’s easier to injure yourself with free weights than weight machines, so make sure you learn how to use them the right way.

Read more…

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Can Gluten-Free Foods Fuel Your Kids?

When it comes to food trends, “gluten-free” (GF) is at the top of the heap. Some people claim that the meal plan has helped them lose weight, have more energy, and just feel better. But is it better fuel for your kids?

Unless your child has a specific medical reason to avoid gluten, there’s little proof that a GF meal plan is better than the healthy, balanced foods that all kids need. Before you start planning GF meals, it’s important to understand the basics of this approach to eating.

What It Means to Go Gluten-Free
Gluten is a protein found in some grains. If your child goes on a GF diet, they’ll avoid all food and drinks that have:

Wheat
Rye
Barley
Triticale (a cross between wheat and barley)
Instead, they’ll focus on foods that are naturally gluten-free. These include fruits, vegetables, meat, poultry, fish, beans, legumes, and most dairy products.

Some grains and starches are OK on a gluten-free diet, like:
Buckwheat
Corn and cornmeal
Rice
Soy
Quinoa
Tapioca
Special GF flours are also made from many of these grains.

Is a Gluten-Free Diet a Healthy Choice for Kids?
The only people who need to stick to a gluten-free diet are those with celiac disease, a condition in which gluten can damage the small intestine. Kids who are allergic to gluten, like those who have a wheat allergy, should avoid it, too.

For everyone else, gluten is not unhealthy. Avoiding it won’t make your kids “feel better” or have more energy. In fact, trying to cut it out of your child’s diet may make it harder for him to get enough key nutrients, like iron, zinc, calcium, vitamin B, and folate. Plus, since so many grains are off-limits, a GF diet can mean he’ll have a tough time getting enough fiber.

It’s still the overall quality of the foods your child eats that makes the biggest difference in how he feels. Focus on helping him choose a variety of whole, healthy foods and cutting out processed ones. (Packages of gluten-free cookies or potato chips aren’t any healthier than the regular kinds.)

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Artificial pancreas effectively controls type 1 diabetes in children age 6 and up

A clinical trial at four pediatric diabetes centers in the United States has found that a new artificial pancreas system — which automatically monitors and regulates blood glucose levels — is safe and effective at managing blood glucose levels in children as young as age six with type 1 diabetes. The trial was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. Results from the trial were published August 26 in the New England Journal of Medicine.

“Fewer than 1 in 5 children with type 1 diabetes are able to successfully keep their blood glucose in a healthy range with current treatment, which may have serious consequences on their long-term health and quality of life,” said Guillermo Arreaza-Rubín, M.D., director of NIDDK’s Diabetes Technology Program and project scientist for the study. “Earlier research showed that the system tested in this study was safe and effective for people ages 14 and older. This trial now shows us this system works in a real-world setting with younger children.”

The artificial pancreas, also known as closed-loop control, is an “all-in-one” diabetes management system that tracks blood glucose levels using a continuous glucose monitor (CGM) and automatically delivers the insulin when needed using an insulin pump. The system replaces reliance on testing by fingerstick or CGM with delivery of insulin by multiple daily injections or a pump controlled by the patient or caregiver.

The study enrolled 101 children between ages 6 and 13 and assigned them to either the experimental group, which used the new artificial pancreas system or to the control group which used a standard CGM and separate insulin pump. Check-ins and data collection were conducted every other week for four months.

Study participants were instructed to continue about their daily lives so that the researchers could best understand how the system works in the typical routines of the children.

The study found that youth using the artificial pancreas system had 7% improvement in keeping blood glucose in range during the daytime, and a 26% improvement in nighttime control compared to the control group. Nighttime control is of particular importance for people with type 1 diabetes, as severe, unchecked hypoglycemia can lead to seizure, coma or even death. The overall time-in-range goal for the artificial pancreas reflected a nearly 11% improvement, which translated to 2.6 more hours per day in range.

“The improvement in blood glucose control in this study was impressive, especially during the overnight hours, letting parents and caregivers sleep better at night knowing their kids are safer,” said protocol chair R. Paul Wadwa, M.D., professor of pediatrics at the Barbara Davis Center for Childhood Diabetes at the University of Colorado, Aurora (CU). “Artificial pancreas technology can mean fewer times children and their families have to stop everything to take care of their diabetes. Instead, kids can focus on being kids.”

Sixteen adverse events, all classified as minor, occurred in the artificial pancreas group during the study, with most due to problems with the insulin pump equipment. Three events occurred in the control group. No cases of severe hypoglycemia or diabetic ketoacidosis occurred during the study.

“For decades, NIDDK has funded research and technology development to create a user-friendly automated device that could ease the constant burden of type 1 diabetes, from the finger sticks and insulin injections, to the insulin dose calculations and constant monitoring while improving diabetes control outcomes and preventing both short- and long-term complications of the disease,” said Arreaza-Rubín.

“The artificial pancreas is a culmination of these years of effort, and it’s exciting to see how this technology may benefit children with type 1 diabetes and their families, and hopefully benefit everyone with diabetes in the future.”

The artificial pancreas technology used in this study, the Control-IQ system, has an insulin pump that is programmed with advanced control algorithms based on a mathematical model using the person’s glucose monitoring information to automatically adjust the insulin dose. This technology was derived from a system originally developed at the University of Virginia (UVA), Charlottesville, with funding support from NIDDK.

This four-month study was part of a series of trials conducted in the International Diabetes Closed-Loop (iDCL) Study. In addition to CU and UVA, study sites included Stanford University School of Medicine, Palo Alto, California; and Yale University School of Medicine, New Haven, Connecticut. Jaeb Center for Health Research served as the data coordinating center.

Based on data from the iDCL trials, Tandem Diabetes Care has received clearance from the U.S. Food and Drug Administration for use of the Control-IQ system in children as young as age six years.

“As we continue to search for a cure for type 1 diabetes, making artificial pancreas technology that is safe and effective, such as the technology used in this study, available to children with type 1 diabetes is a major step in improving the quality of life and disease management in these youth,” said NIDDK Director Dr. Griffin P. Rodgers.

The iDCL Study is one of four major research efforts funded by NIDDK through the Special Statutory Funding Program for Type 1 Diabetes to test and refine advanced artificial pancreas systems. The studies, with additional results forthcoming, are looking at factors including safety, efficacy, user-friendliness, physical and emotional health of participants, and cost.

This study was funded by NIDDK and Tandem Diabetes, Inc. Tandem provided the experimental closed-loop systems used in the trial, system-related supplies including the Dexcom CGM and Roche glucometer, and technical expertise.

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Drug Might Relieve Low Back Pain in Whole New Way

A new nonopioid pain reliever could be welcome news for people who have difficult-to-treat back pain.

Tanezumab is what’s called a monoclonal antibody. And it might offer extended relief from chronic lower back pain, a large, new study finds. However, a serious side effect remains a concern.

Tanezumab works differently from other treatments, as it blocks nerve growth factor, a protein that causes pain, researchers say.

“It appears that we are on the cusp of developing new drugs, which treat chronic pain by turning down the sensitivity of the nervous system, which is a whole new way of approaching the problem of chronic pain,” said lead researcher Dr. John Markman. He’s a professor of neurosurgery and neurology at the University of Rochester School of Medicine in New York.

“This is very important because we haven’t really had drugs with a new way of affecting chronic pain developed in maybe 100 years,” Markman said.

This phase 3 trial was funded by drugmakers Pfizer and Eli Lilly and Co. Twelve-hundred patients were randomly assigned to one of two doses of tanezumab or placebo. Another 600 patients received the opioid tramadol.

The higher dose of tanezumab reduced pain and also improved function, the researchers said.

Currently, opioid painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are the only medications for chronic lower back pain. But opioids can be addictive, and NSAIDs can cause serious gastrointestinal bleeding.

If these drugs don’t work, the alternative is spinal fusion surgery, and that’s not always effective, Markman said.

Tanezumab is given by injection about every two months. It has none of the side effects of opioids or NSAIDs.

It does, however, have one very serious side effect that affects up to more than 2% of patients. The drug has been linked to joint deterioration that may require joint replacement.

This concern is the major focus of the U.S. Food and Drug Administration’s current review of the drug as a treatment for chronic pain from severe osteoarthritis, Markman said.

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China coronavirus vaccine may be ready for public in November: official

Coronavirus vaccines being developed in China may be ready for use by the general public as early as November, an official with the Chinese Center for Disease Control and Prevention (CDC) said.

China has four COVID-19 vaccines in the final stage of clinical trials. At least three of those have already been offered to essential workers under an emergency use programme launched in July.

Phase 3 clinical trials were proceeding smoothly and the vaccines could be ready for the general public in November or December, CDC chief biosafety expert Guizhen Wu said in an interview with state TV late on Monday.

Wu, who said she has experienced no abnormal symptoms in recent months after taking an experimental vaccine herself in April, did not specify which vaccines she was referring to.

A unit of state pharmaceutical giant China National Pharmaceutical Group (Sinopharm) and U.S.-listed Sinovac Biotech SVA.O are developing the three vaccines under the state’s emergency use programme. A fourth COVID-19 vaccine being developed by CanSino Biologics 6185.HK was approved for use by the Chinese military in June.

Sinopharm said in July that its vaccine could be ready for public use by the end of this year after the conclusion of Phase 3 trials.

Global vaccine makers are racing to develop an effective vaccine against the virus which has killed more than 925,000 people. Leading Western vaccine makers pledged earlier this month to uphold scientific study standards and reject any political pressure to rush the process.

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High-Protein Diet for Weight Loss

Going on a high-protein diet may help you tame your hunger, which could help you lose weight.

You can try it by adding some extra protein to your meals. Give yourself a week, boosting protein gradually.

Remember, calories still count. You’ll want to make good choices when you pick your protein.

If you plan to add a lot of protein to your diet, or if you have liver or kidney disease, check with your doctor first.

The Best Protein Sources
Choose protein sources that are nutrient-rich and lower in saturated fat and calories, such as:

Lean meats
Seafood
Beans
Soy
Low-fat dairy
Eggs
Nuts and seeds
It’s a good idea to change up your protein foods. For instance, you could have salmon or other fish that’s rich in omega-3s, beans or lentils that give you fiber as well as protein, walnuts on your salad, or almonds on your oatmeal.

How much protein are you getting? Here’s how many grams of protein are in these foods:

1/2 cup low-fat cottage cheese: 14g

3 ounces tofu, firm: 9g

1/2 cup cooked lentils: 9g

2 tablespoons natural-style peanut butter (7g) or almond butter (6.7g)

3 oz skinless chicken breast: 26g

3 oz fish fillet (depending on type of fish): 17-20g

1 ounce provolone cheese: 7g

1/2 cup cooked kidney beans: 7.7g

1 ounce almonds: 6g

1 large egg: 6g

4 ounces low-fat plain yogurt: 6g

4 ounces soy milk: 5g

4 ounces low-fat milk: 4g

Carbs and Fats
While you’re adding protein to your diet, you should also stock up on “smart carbs” such as:

Fruits
Vegetables
Whole grains
Beans and legumes (both also have protein)
Low-fat milk and yogurt (both have protein)
Also try healthy fats such as:

Nuts and natural-style nut butters
Seeds
Olives
Extra virgin olive oil and canola oil
Fish
Avocados
To help manage your appetite, it also helps to split your daily calories into four or five smaller meals or snacks.