Podcasts about diabetes prevention program

The information in this podcast does not provide medical advice, diagnosis or treatment. It should not be used as a substitution for health care from a licensed healthcare professional. Consult with your healthcare provider for individualized treatment or before beginning any new program.  Living with a chronic condition takes more than willpower—it requires resilience, support, and access to the right programs. In this episode, we explore how people in Wisconsin are building that resilience while managing health challenges like prediabetes. We will highlight the state's Diabetes Prevention Program (DPP), a proven lifestyle change program that helps people live healthier, longer lives. We will hear from Pam Geis with the Wisconsin Department of Health Service, Division of Public Health, who coordinates Wisconsin's Diabetes Prevention Program, and Debb, who has lived the experience, and is a Diabetes Prevention Program graduate. Together, they will share the tools, mindsets, and community connections that foster long-term health and resilience. Resources Discussed During Interview:https://www.dhs.wisconsin.gov/prediabetes/index.htm https://www.cdc.gov/diabetes-prevention/index.html  WebMD Coaching and DPP Program, call 1-800-821-6591 or visit www.webmdhealth.com/wellwisconsin

Investor Nancy Brown joins us at Aspen Ideas Health to share her blueprint for impactful investments. Identify public health breakthroughs that deliver measurable cost and quality improvements — then show how they can thrive in the marketplace. You don't have to look far to see this playbook in action. One of the year's biggest health exits, Omada Health, is a digital version of the CDC's Diabetes Prevention Program. At Oak HC/FT, Nancy has partnered with entrepreneurs who are redefining how America stays healthy — and she's eager to see more people with public health roots take the leap into building impactful companies.Please note: this conversation happened before HR1 was passed, so big Medicaid cuts were a threat but not yet a reality when we spoke.In this episode, we discuss:Lessons from Todd Park in the early days of athenahealthHow to turn good ideas into great businessesNancy's advice in an era of policy disruption: keep on building and proving valueThe lesson Kaiser Permanente is still teaching usNancy reminds us that in reality, even a brilliant idea needs to have ROI built in:“We look for entrepreneurs, for innovators, who have really defined a way in which to find a cohort of patients, it could be pregnant Medicaid moms... And they have identified if they apply a certain clinical process consistently to that population, they will get a consistently good outcome, quality outcome, and they can do it in a sustainable [way] at a sustainable price.”Relevant LinksRead Oak HC/FT's AI Investment PolicyExplore businesses Nancy mentioned from Oak HC/FT's investment portfolio:Maven ClinicOshi Health About Our GuestNancy Brown is a General Partner at Oak HC/FT, a leading venture and growth equity firm investing in transformative healthcare and fintech companies. Since joining Oak HC/FT at its inception in 2014, Ms. Brown has focused on identifying and supporting technology-enabled healthcare services that deliver measurable clinical and financial impact. She focuses on growth equity and early-stage venture investments in healthcare, serving on the boards of innovative companies such as Firefly Health, Groups Recover Together, InterWell Health, Maven Clinic, Oshi Health, Regard, Unite Us, and Wayspring. Her portfolio also includes Noom, TurningPoint Healthcare Solutions, Limeade (ASX: LME), OncoHealth, and OODA Health.Ms. Brown brings over three decades of operational and leadership experience to her investment role. Prior to Oak HC/FT, she was Vice President of Strategy and Business Development at McKesson Technology Solutions and Chief Growth Officer at MedVentive (acquired by McKesson in 2012). Previously, she served as Senior Vice President of Clinical Services and Corporate Development at athenahealth, and earlier held senior roles at McKesson and Harvard Community Health Plan. She also co-founded Abaton.com, one of the first web-based clinical solution companies, which was later acquired by McKesson.A graduate of the University of New Hampshire (B.S. in Zoology) and Northeastern University (MBA), Ms. Brown is an active mentor and advisor. She serves on Northeastern's D'Amore‑McKim School of Business Dean's Executive Council and is involved in the Roux Institute's Future of Healthcare Founder Residency program.

After an extended break, Shelley Swapp returns to The Wellness Restoration Project with a fresh focus and an exciting new direction.In this energizing kickoff episode, Shelley shares why she's relaunching the show to explore nutrigenomics — the rapidly growing science that reveals how the foods we eat and the nutrients we absorb influence the way our genes express.She reflects on decades of shifting diet trends — from low-fat and Atkins to today's high-protein craze — and explains why one-size-fits-all nutrition has failed so many of us. You'll hear a powerful story from Shelley's time launching the national Diabetes Prevention Program and how it led her to question conventional approaches to women's health.This episode will leave you hopeful, curious, and ready to rethink what it means to eat for your body instead of against it.In this episode, you'll learn:What nutrigenomics is — and why it's changing the future of personalized nutrition.Why some diets seem to “work” for one person and not another.How stress, hormones, and individuality shape your results.The difference between following rules and building alignment with your biology.Tune in if you're ready to:Move past generic health advice.Understand your unique genetic blueprint.Begin your own wellness restoration — from restriction to alignment.

NEW! Support your strength and muscle goals with PUORI Creatine+ — a clean, effective creatine monohydrate supplement enhanced with taurine. Get 20% off at puori.com/VANESSA In today's episode, Vanessa sits down with one of the most influential figures in obesity and metabolism research — Dr. James Hill, Professor of Nutrition Sciences at the University of Alabama at Birmingham and co-founder of the National Weight Control Registry. Dr. Hill has spent over four decades studying how people successfully lose weight, maintain it long-term, and preserve their lean mass and metabolic health. Dr. Hill has led landmark clinical trials such as the Diabetes Prevention Program, Look AHEAD, and the Beef WISE Study on high-protein diets. His decades of work reveal why weight loss is only the beginning — and why the real secret to success lies in learning the completely different skill set of maintenance. OneSkin is powered by the breakthrough peptide OS-01, the first ingredient proven to reduce skin's biological age. I use the OS-01 Face and Eye formulas daily—they've transformed my skin's smoothness, firmness, and glow. Visit oneskin.co/VANESSA and use code VANESSA for 15% off your first purchase In this conversation, you'll hear: The protein “lever” Dr. Hill uses to curb appetite and protect muscle during a cut—plus why the source may matter less than you think Three habits most long-term maintainers share (and one that surprised even him) The moment your “diet” must flip into “maintenance”—and a simple sign you're ready The smallest daily tweak from his research that predicts whether you'll regain or not What exercise actually changes in your metabolism beyond calorie burn—and how much you really need The simple resistance-training + protein formula he gives midlife women to keep muscle while losing fat His three-bucket framework (diet, activity, mind state) and a 60-second self-check to find which bucket is breaking your results The mindset shift that moves people from “I always regain” to “this is who I am” — plus a quick exercise to uncover your real why The step-by-step exit plan he uses when patients come off GLP-1s—starting with what to do in week one to avoid rebound If you've ever lost weight and struggled to keep it off, this episode shows you which levers matter most—and how to pull them so your results stick while your metabolism and muscle thrive. Get delicious high protein meal recipes! Connect with Vanessa on Instagram @ketogenicgirl Free High-Protein Keto Guide  Get 20% off on the Tone LUX Crystal Red Light Therapy Mask or the Tone Device breath ketone analyzer at https://ketogenicgirl.com with the code VANESSA Follow @optimalproteinpodcast on Instagram to see visuals and posts mentioned on this podcast. Link to join the Facebook group for the podcast Mentioned in this episode: • Dr. James Hill's upcoming book: Losing the Weight Loss Meds: A 10-Week Playbook for Stopping GLP-1 Medications and Keeping the Weight Off — now available for pre-order • The National Weight Control Registry; The Diabetes Prevention Program (DPP); The Look AHEAD Study; The Beef WISE Study The content provided in this podcast is for informational purposes only and should not be construed as medical advice. Consult with a healthcare professional before making significant changes to your diet or exercise regimen.

On our Wednesday health focus, Lana Kunik discussed the National Diabetes Prevention program offered at the Sight Center of Northwest PA. The conversation touched on how uncontrolled diabetes can lead to vision loss and blindness.

Full shownotes, transcript and resources here: https://soundbitesrd.com/294                  Make America Healthy Again (MAHA) is a public health-oriented slogan and initiative aimed at addressing the health challenges facing Americans led by the Secretary of Health and Human Services, Robert F. Kennedy, Jr. Scientists, medical professionals and public health officials have criticized the movement, citing concerns about Robert F. Kennedy Jr.'s past remarks and views regarding vaccines and public health. Tune in to this episode to learn about: ●       a nutrition and public health expert's reflection on the first 6 months of MAHA ●       funding cuts to various nutrition programs, research and landmark trials such as the Diabetes Prevention Program ●       the administration's focus on food dyes, seed oils and the FoodPyramid ●       how health professional societies are responding so far ●       opportunities for meaningful changes in public health nutrition ●       what the new DGAs might look like ●       resources for more information

Reshare from September 1, 2024:Hawaii Matter's guest is Elia Titiimaea, the Program Coordinator for the Hawaii Department of Health - Diabetes Prevention Program. Diabetes can lead to serious health problems including kidney failure and amputation. We'll learn what diabetes is, its symptoms, how to battle it, and more. Lei Jardine-Kanahele, a recent participant in the Diabetes Prevention Program is our second guest. She tells us how the program works and how she succeeded. Host: Michael THawaii Matters, a Pacific Media Group program

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. Welcome to diabetes core update where every month we go over the most important articles to come out in the field of diabetes. Articles that are important for practicing clinicians to understand to stay up with the rapid changes in the field.  This issue will review: 1.    Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes 2.    Lorundrostat Efficacy and Safety in Patients with Uncontrolled Hypertension Meta-Analysis 3.    The Diabetes Prevention Program and Its Outcomes Study: NIDDK's Journey Into the Prevention of Type 2 Diabetes and Its Public Health Impact 4.    Comparative effectiveness of alternative second‐line oral glucose‐lowering therapies for type 2 diabetes: a precision medicine approach applied to routine data 5.    Phase 3 Trial of Semaglutide in Metabolic Dysfunction– Associated Steatohepatitis   For more information about each of ADA's science and medical journals, please visit Diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health

Sponsored by Harford County Health DepartmentIn this inspiring episode of Conversations with Rich Bennett, we sit down with Kenneth Kunken, a man whose journey redefines resilience and determination. After a tragic football injury left him paralyzed in 1970, Ken refused to let his circumstances define him. He became the first quadriplegic to graduate from Cornell University, earned multiple Ivy League degrees, and went on to have an impressive 40-year career as an Assistant District Attorney. Ken shares how he transitioned from an aspiring engineer to a motivational speaker, disability advocate, and father of triplets—all while overcoming the odds. His memoir, I Dream of Things That Never Were: The Ken Kunken Story, details his incredible journey of breaking barriers and proving that a positive mindset and a strong support system can change everything. This episode is sponsored by the Harford County Health Department, promoting their free 12-month Diabetes Prevention Program, designed to help individuals manage weight, diet, stress, and physical activity. Learn more at HarfordCountyHealth.com/diabetes-prevention. https://kenkunken.com/ Sponsor Message:This episode of Conversations with Rich Bennett is proudly sponsored by the Harford County Health Department. Did you know that 1 in 3 adults in the U.S. is pre-diabetic, and most don't even know it? Taking charge of your health starts with awareness—and action. The Harford County Health Department's Diabetes Prevention Program is a FREE, 12-month program designed to help you:·         Lose weight and maintain a healthy lifestyle·  Send us a textHarford County Health DepartmentTo protect, promote, and improve the health, safety, and environment of Harford County residents.Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the showFollow the Conversations with Rich Bennett podcast on Social Media:Facebook – Conversations with Rich Bennett & Harford County LivingFacebook Group (Join the conversation) – Conversations with Rich Bennett podcast group | FacebookTwitter – Conversations with Rich Bennett & Harford County LivingInstagram – Harford County LivingTikTok – CWRB (@conversationsrichbennett) | TikTok Sponsors, Affiliates, and ways we pay the bills:Recorded at the Freedom Federal Credit Union StudiosHosted on BuzzsproutRocketbookSquadCast Contests & Giveaways Subscribe by Email ...

Erica Hill, a Diabetes Prevention Program Lifestyle Coach at the UK Barnstable Brown Diabetes Center, discusses warning signs of prediabetes and the center's Diabetes Prevention Program. To sign up for virtual classes, visit https://ukhealthcare.uky.edu/form/diabetes-prevention-program-info

Diabetes affects many families in Newfoundland and Labrador. We hear about a program at the Ches Penney Family YMCA looking to prevent that. It's called Small Steps for Big Changes, and we get details from the Eastern Canada Regional Research Lead with the program. (Guest-host Heather Barrett with Dr. Katie Wadden)

La berberina es uno de los suplementos alimenticios más usados hoy en día. Pero, ¿sirve de algo? ¿hay investigación de calidad que le respalde? ¿sirve para bajar de peso y controlar la glucosa? Esto y más, aprenderás en este episodio de Doctor Mau Informa. Suscríbete a mi podcast en tu plataforma favorita. Anda, hazlo ahora mismo.   #doctormauinforma Suscríbete a mi boletín informativo en: www.drmauriciogonzalez.com/ ⁣ Redes sociales: ⁣ ⁣ YouTube: /@doctormauinforma Instagram: www.instagram.com/dr.mauriciogonzalez TikTok: www.tiktok.com/@drmauriciogonzalez Twitter: www.twitter.com/DrMauricioGon CONTACTO ► booking@drmauriciogonzalez.com ¡Nos escuchamos pronto!⁣ Fuentes:    Li Z, Wang Y, Xu Q, et al. Berberine and health outcomes: An umbrella review. Phytother Res. 2023;37(5):2051-2066. doi:10.1002/ptr.7806 Dong H, Wang N, Zhao L, Lu F. Berberine in the treatment of type 2 diabetes mellitus: a systemic review and meta-analysis. Evid Based Complement Alternat Med. 2012;2012:591654. doi:10.1155/2012/591654 Diabetes Prevention Program Research Group. Long-term Effects of Metformin on Diabetes Prevention: Identification of Subgroups That Benefited Most in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study. Diabetes Care. 2019;42(4):601-608. doi:10.2337/dc18-1970 Diabetes Prevention Program Research Group. Long-term safety, tolerability, and weight loss associated with metformin in the Diabetes Prevention Program Outcomes Study. Diabetes Care. 2012;35(4):731-737. doi:10.2337/dc11-1299   Learn more about your ad choices. Visit megaphone.fm/adchoices

Sponsored by Harford County Health DepartmentIn this episode of Conversations with Rich Bennett, Rich is joined by award-winning journalist and author Roni Robbins to explore her powerful novel, Hands of Gold. Roni shares the incredible story of her grandfather, whose resilience through the Holocaust, a workplace shooting, and personal tragedies inspired her fictionalized account of his life. Together, they discuss themes of love, family, perseverance, and the importance of preserving history. This heartfelt conversation delves into the impact of past generations on shaping our present and highlights the relevance of these stories in today's world.This episode is proudly sponsored by the Harford County Health Department, promoting healthier lifestyles through their Diabetes Prevention Program. Visit harfordcountyhealth.com to learn more.Home - Roni RobbinsSponsor Message:This episode of Conversations with Rich Bennett is brought to you by the Harford County Health Department, dedicated to building a healthier community. Are you at risk for type 2 diabetes? The Harford County Health Department's Diabetes Prevention Program can help. This free, year-long program offers practical guidance on nutrition, physical activity, and lifestyle changes to reduce your risk and support long-term health. Don't wait to take charge of your well-being—visit harfordcountyhealth.com tSend us a textTar Heel Construction Group Harford County Living Stamp of Approval for Roofing, Siding and Exterior Services Harford County Health DepartmentTo protect, promote, and improve the health, safety, and environment of Harford County residents.Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the showFollow the Conversations with Rich Bennett podcast on Social Media:Facebook – Conversations with Rich Bennett & Harford County LivingFacebook Group (Join the conversation) – Conversations with Rich Bennett podcast group | FacebookTwitter – Conversations with Rich Bennett & Harford County LivingInstagram – Harford County LivingTikTok – CWRB (@conversationsrichbennett) | TikTok Sponsors, Affiliates, and ways we pay the bills:Recorded at the Freedom Federal Credit Union StudiosHosted on BuzzsproutRocketbookSquadCast Contests & Giveaways Subscribe by Email ...

Today's guest is Elia Titiimaea. He's the Program Coordinator for the Hawaii Dept. of Health Diabetes Prevention Program. Diabetes can lead to serious health problems including kidney failure and amputation. We'll learn what diabetes is, its symptoms, how to battle it, and more. We'll also talk to Lei Jardine-Kanahele, a recent participant in the Diabetes Prevention Program. She tells us how the program works and how she succeeded. Michael T is your host.

In this episode of Conversations with Rich Bennett, we're joined by experts from the Harford County Health Department to discuss a critical health issue: diabetes prevention. Rich and his guests share personal insights and professional advice on the importance of diet, exercise, and lifestyle changes to prevent diabetes. Listeners will hear real success stories from participants in local diabetes prevention programs and learn about evidence-based strategies to improve their health. Sponsored by the Harford County Health Department, this episode offers invaluable tips for those looking to take control of their health and make lasting lifestyle changes.» Diabetes Prevention (harfordcountyhealth.com)Sponsor Message:This episode of Conversations with Rich Bennett is proudly sponsored by the Harford County Health Department. Did you know that 1 in 3 American adults has prediabetes, and most don't even know it? The Harford County Health Department is here to help with their CDC-recognized Diabetes Prevention Program. This free, year-long lifestyle change program is designed to help you take control of your health through expert guidance on healthy eating, physical activity, and weight loss, all while providing community support. Participants who complete the program reduce their risk of developing type 2 diabetes by over 58%.Don't wait! Visit harfordcountyhealth.com/diabetes-prevention today to learn more and register for this life-changing program.Send us a Text Message.EMILY ANNE PHOTOGRAPHY – "everyday is a day worth capturing all of life's precious moments, one photo at a time." (emilyadolph.com)Harford County Health DepartmentTo protect, promote, and improve the health, safety, and environment of Harford County residents.Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the Show.Follow the Conversations with Rich Bennett podcast on Social Media:Facebook – Conversations with Rich Bennett & Harford County LivingFacebook Group (Join the conversation) – Conversations with Rich Bennett podcast group | FacebookTwitter – Conversations with Rich Bennett & Harford County LivingInstagram – Harford County LivingTikTok – CWRB (@conversationsrichbennett) | TikTok Sponsors, Affiliates, and ways we pay the bills:Recorded at the Freedom Federal Credit Union StudiosHosted on BuzzsproutRocketbookSquadCast Contests & Giveaways Subscribe by Email ...

In this episode of “Conversations with Rich Bennett,” Rich sits down with Stephen Marks, author of the Braxton's America trilogy. Stephen shares his personal journey inspired by his niece's battle with Type 1 diabetes, which led him to write a series blending humor, satire, and political commentary. They discuss the importance of raising awareness for diabetes, the challenges in finding a cure, and Stephen's efforts to adapt his story for a streaming series. This episode is sponsored by the Harford County Health Department's Diabetes Prevention Program, helping individuals take control of their health.Steve Marks | Author | Join the Fight (stephenrmarksauthor.com)Sponsor Message:This episode of “Conversations with Rich Bennett” is brought to you by the Harford County Health Department. Discover their free Diabetes Prevention Program, designed to help you lose weight, eat healthier, manage stress, and increase physical activity. This 12-month program offers the tools and support you need to develop lifelong healthy habits and reduce your risk of developing diabetes. To learn more or to sign up, go to » Diabetes Prevention (harfordcountyhealth.com). Take control of your health today with the Harford County Health Department.Send us a Text Message.EMILY ANNE PHOTOGRAPHY – "everyday is a day worth capturing all of life's precious moments, one photo at a time." (emilyadolph.com)Harford County Health DepartmentTo protect, promote, and improve the health, safety, and environment of Harford County residents.Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the Show.Follow the Conversations with Rich Bennett podcast on Social Media:Facebook – Conversations with Rich Bennett & Harford County LivingFacebook Group (Join the conversation) – Conversations with Rich Bennett podcast group | FacebookTwitter – Conversations with Rich Bennett & Harford County LivingInstagram – Harford County LivingTikTok – CWRB (@conversationsrichbennett) | TikTok Sponsors, Affiliates, and ways we pay the bills:Recorded at the Freedom Federal Credit Union StudiosHosted on BuzzsproutRocketbookSquadCast Contests & Giveaways Subscribe by Email ...

In today's episode with Dr. Melody Hartzler, you'll hear us take a deep dive on: 1. What is type 2 diabetes, and what causes it? 2. What is insulin resistance? 3. Medications and lifestyle interventions for type 2 diabetes 4. The role of gut health in type 2 diabetes 5. Nutrients and natural remedies in the management of type 2 diabetes Dr. Hartzler has developed a passion for functional medicine and treating the underlying causes of disease. Her focus areas are functional gastrointestinal disorders, nutritional deficiencies, metabolic conditions, and autoimmune conditions. She is also a nationally recognized speaker on diabetes and functional medicine. Dr. Hartzler is currently Board Certified Ambulatory Care Pharmacy Specialist (BCACP) and is Board Certified in Advanced Diabetes Management (BC-ADM). She is also the owner of PharmToTable and the Director of Clinical Services for Profero Team. Order tests through Rupa Health, the BEST place to order functional medicine lab tests from 30+ labs - https://www.rupahealth.com/reference-guide

Kathy Williams has an MBA from Goizueta School of Business, Emry University and Mechanical Engineering from the University of Cincinnat. She has also been certified by the University of Pittsburgh's Diabetes Prevention Program. As CEO of Williams ConsultlingGroup, Kathy is an author, speaker, health strategist and diabetic prevention advocate. She also has a private coaching practice where she helps clients eliminate their cravings and sugar addiction in 90 days.   Like many of us in the field, Kathy has her own personal story. From being prediabetic, she halted her prediabetic progression back to a normal blood sugar level, which she has maintained for over 10 years.  Notably - She was even able to help her son, a type ONE diabetic to reduce his insulin and greatly improve his blood sugar levels. This is far and beyond what most doctors can achieve. She did this with changing his diet. Clearly she has found a way to reach out to children as well as adults. Of interest to us at Food Junkies:, what can Kathy tell us about how to encourage and support families to live a sugar free life - in a world that equates love with sugar?  Follow Kathy: Connect with Kathy "Sugar Free Girl" Williams, your SUGAR SHRINK Free Health Transformation Call: https://link.pipelinepro.co/widget/booking/IIjTGPR0qpvImRcg69N2 Link to free resources: https://ilivesugarfree.com/links Website: https://ilivesugarfree.com/ Purchase the Book "Oh So Sweet to Live Sugar Free": https://ilivesugarfree.com/my-book The content of our show is educational only. It does not supplement or supersede your healthcareprovider's professional relationship and direction. Always seek the advice of your physician or other qualified mental health providers with any questions you may have regarding a medical condition, substance use disorder, or mental health concern.        

One in three U.S. adults are pre-diabetic, yet 80% remain unaware of their condition. In this episode, Laurence Girard, the CEO and founder of Fruit Street Health, shares his journey as a healthcare entrepreneur, raising over $33 million in equity financing and delivering the CDC's Diabetes Prevention Program via telehealth. Initially offering telemedicine software for dietitians, Fruit Street pivoted to diabetes prevention based on advice from a Fitbit executive, resulting in a program that reduces the risk of type 2 diabetes by over 58% and is more effective than metformin. Despite facing a setback from a competing distributor, Fruit Street's program, which includes live group video chats with dietitians, food tracking, and partnerships with LabCorp and Modified Health, has received Medicare funding and a grant from the American Diabetes Association. Laurence emphasizes the importance of good science, patient experience, and prevention in healthcare and encourages providers and payers to support CDC-recognized diabetes prevention programs to reverse prediabetes. Tune in and learn how Fruit Street is making strides in diabetes prevention and public health! Resources:  Watch the entire interview here. Connect and follow Laurence Girard on LinkedIn. Learn more about Fruit Street on their LinkedIn and website.

What is MDPP coverage for Medicare? Why is it important to catch diabetes early? Does Medicare cover A1c for prediabetes? Does Medicare cover diabetes prevention program? Our guest is Colleen Barbero, PhD, MPPA, model lead with the Centers for Medicare & Medicaid Services Innovation Center, and Kate Kirley, MD, MS, director of chronic disease prevention and programs at the American Medical Association. AMA CXO Todd Unger hosts.

In this episode of iCantCU, I focus on web accessibility, the National Federation of the Blind of Pennsylvania, and a unique raffle ticket sale to support the NFB of PA.  I detail the raffle, explaining the process, the prizes, and the significance of the funds raised for the NFB of Pennsylvania. This initiative highlights the podcast's commitment to the visually impaired community and offers listeners a chance to contribute meaningfully. Most of the episode is dedicated to meeting ADA-Expert.com representatives and discussing advancements in web accessibility tools and strategies. I share insights from this meeting, emphasizing the importance of making digital spaces accessible to all. I shared my feelings with the group on how they should proceed to market with their accessibility widget.  Additionally, I provide a brief update on Ziggy, the Golden Menace. He seems to be doing well and wants to eat EVERYTHING. Show notes at https://www.iCantCU.com/258    Links Mentioned Support Stacie Leap in her effort to launch a nonprofit to support blind parents: https://www.venmo.com/stacieleap  Buy raffle tickets to support the NFB of PA! Tickets are $5. Email iCantCUPodcast@gmail.com  Find this episode on YouTube: https://www.youtube.com/@iCantCU Dr. Carolyn Peters's book on Amazon: https://amzn.to/49hz1aA  The new BenQ PD3420Q monitor I bought for my new Mac mini: https://amzn.to/4bAcOGv  Support iCantCU When shopping at Amazon, I would appreciate it if you clicked on this link to make your purchases: https://www.iCantCU.com/amazon. I participate in the Amazon Associate Program and earn commissions on qualifying purchases. The best part is, you don't pay extra for doing this! White Canes Connect Podcast Episode 097 In episode 097, Lisa and I explore the Diabetes Prevention Program with special guests Joani Schmeling from the Health Promotion Council and NFB of PA President Lynn Heights, a diabetes coach. The program, developed by the CDC, is designed to support individuals with pre-diabetes through lifestyle changes over a year, emphasizing the importance of diet, exercise, and stress management. Lisa told us that she would start the program this month and promised to give us regular updates on her progress.  Find the podcast on Apple Podcasts https://podcasts.apple.com/us/podcast/white-canes-connect/id1592248709  Spotify https://open.spotify.com/show/1YDQSJqpoteGb1UMPwRSuI IHeartRadio https://www.iheart.com/podcast/263-white-canes-connect-89603482/ YouTube Https://www.youtube.com/@pablindpodcast White Canes Connect On Twitter Https://www.twitter.com/PABlindPodcast My Podcast Gear Here is all my gear and links to it on Amazon. I participate in the Amazon Associates Program and earn a commission on qualifying purchases. Zoom Podtrak P4: https://amzn.to/33Ymjkt Zoom ZDM Mic & Headphone Pack: https://amzn.to/33vLn2s Zoom H1n Recorder: https://amzn.to/3zBxJ9O  Gator Frameworks Desk Mounted Boom Arm: https://amzn.to/3AjJuBK Shure SM58 S Mic: https://amzn.to/3JOzofg  Sennheiser Headset (1st 162 episodes): https://amzn.to/3fM0Hu0  Follow iCantCU on your favorite podcast directory! Apple Podcasts: https://podcasts.apple.com/us/podcast/icantcu-podcast/id1445801370/  Spotify: https://open.spotify.com/show/3nck2D5HgD9ckSaUQaWwW2  Audible: https://www.audible.com/pd/iCantCU-Podcast-Podcast/B08JJM26BT  IHeart: https://www.iheart.com/podcast/256-icantcu-podcast-31157111/ YouTube: https://www.youtube.com/davidbenj  Reach out on social media Twitter: https://www.twitter.com/davidbenj Instagram: https://www.instagram.com/davidbenj Facebook: https://www.facebook.com/davidbenj LinkedIn: https://www.linkedin.com/in/davidbenj Are You or Do You Know A Blind Boss? If you or someone you know is crushing it in their field and is also blind, I want to hear from you! Call me at (646) 926-6350 and leave a message. Please include your name and town, and tell me who the Blind Boss is and why I need to have them on an upcoming episode. You can also email the show at iCantCUPodcast@gmail.com.

In this episode of White Canes Connect, hosts  Lisa Bryant and David Goldstein explore the Diabetes Prevention Program with special guests Joani Schmeling from the Health Promotion Council and NFB of PA President Lynn Heights, a diabetes coach. The program, developed by the CDC, is designed to support individuals with prediabetes through lifestyle changes over a year, emphasizing the importance of diet, exercise, and stress management.  Lisa shares her commitment to participating in the program, highlighting its potential to prevent the progression from prediabetes to diabetes, a leading cause of blindness. The episode also addresses the flexibility and accessibility of the program, including virtual options and support for a wide range of participants.  Success stories from the program illustrate its effectiveness in improving health outcomes, such as significant A1C reductions. The discussion emphasizes that while the commitment may seem daunting, the potential health benefits far outweigh the perceived challenges, encouraging listeners to consider joining the program to take control of their health. Show notes at https://www.whitecanesconnect.com/097    Join the Program If you are interested in joining a Diabetes Prevention Program, reach out to Alexandra at info@accessiblepharmacy.com. More on Health Promotion Council  Call or text the Referral Hub at (215) 608-1477. You can also email programinfo@phmc.org.  An Easy Way to Help the NFB of PA Support the NFB of PA with every purchase at White Cane Coffee Company by going to https://www.whitecanecoffee.com/ref/nfbp. When you use that link to purchase from White Cane Coffee, the NFB of PA earns a 10% commission! Share the link with your family and friends! Listen to Erin and Bob Willman from White Cane Coffee on episode 072 of White Canes Connect. Donate to the NFB of PA If you would like to make a monetary donation to the National Federation of the Blind of Pennsylvania, go to https://www.NFBofPA.org/give/. Give Us A Call We'd love to hear from you! We've got a phone number for you to call, ask us questions, give us feedback, or say, "Hi!" Call us at (267) 338-4495. You have up to three minutes for your message, and we might use it on an upcoming episode. Please leave your name and town as part of your message.  Follow White Canes Connect Apple Podcasts | Spotify | Amazon | YouTube Connect With Us If you've got questions, comments, or ideas, reach out on Twitter. We are @PABlindPodcast. You can also email us at WhiteCanesConnect@gmail.com.

Pre-PA Club Podcast Interview: Joy Moberly Discusses the Joint PA and Public Health Degree Program at Touro University, CaliforniaIn this episode of the Pre PA Club Podcast, host Savannah Perry is in conversation with Joy Moberly, the program director of Touro University, California. They delve into the unique offerings of the university's physician assistant (PA) program and its inclusivity towards all students. Besides offering public health field study opportunities in areas like criminal justice, community health, and global health, Touro stands out for its joint PA and public health degree program. The institution also uniquely equips all its students as lifestyle coaches via the Diabetes Prevention Program. On the flip side, Joy, as a practicing PA, talks about her own journey from aspiring to be a physical therapist to becoming a passionate advocate for diabetes education. She also discusses the value of self-reflection for PA students during their application process and interview phase. Savannah ends by probing into Joy's thoughts on the future of PA education.00:00 Introduction and Welcome00:18 About the Host and the Podcast01:51 Introduction to the Pre PA Academy04:06 Interview with Joy Moberly Begins04:11 Joy's Journey to Becoming a PA09:19 Joy's Transition into Academia11:49 Joy's Continued Practice as a PA15:14 Unique Aspects of Touro University's PA Program21:00 The Importance of Authenticity in PA Programs21:56 Understanding the Mission of Your Chosen Program22:43 Being Genuine and True to Your Career Goals23:23 The Role of Personal Mission in Choosing a Specialty24:45 Overcoming Imposter Syndrome in PA School25:24 The Art of Self-Reflection in PA Applications26:32 The Importance of Being Different in Your Application27:10 Understanding the Interview Process28:55 Reevaluating Your Application: What to Do If You Don't Get In32:20 The Future of PA Education: Thoughts on Doctorate Programs38:14 Getting Involved in Your State Society38:55 Closing Thoughts and Contact InformationPre-PA Academy - https://thepaplatform.thrivecart.com/pre-pa-academy/ Touro University California Admissions website: https://tu.edu/programs/mspas-mph/admissions/Info sessions: https://tu.edu/news--events/events/search/?types[]=Open%20House&keywords=physician%20assistantMappd - https://app.mappd.com/register?code=paplatform Pre-PA Workbook - https://amzn.to/3H80G1O PA School Interview Guide - https://www.thepaplatform.com/book PA School Personal Statement Guide - https://www.thepaplatform.com/pa-school-personal-statement-guide Pre-PA Essay Review - https://thepaplatform.thrivecart.com/pre-pa-essay-review-2500-5000/ Mock Interview - https://www.thepaplatform.com/mock-interview Pre-PA Counseling -

In this episode of the "This is Y" podcast, we talk about all things diabetes prevention. Host and Muskegon YMCA CEO Gabe Gerlach talks with Ashley Brage, program director of the Diabetes Prevention Program, and Kathy, a program participant. Hear Kathy's story and learn more about the things you can do to delay or prevent the onset of type 2 diabetes. Ashley speaks to the Diabetes Prevention Program at the Muskegon YMCA, which is a main provider of the program across the state of Michigan. Learn how you can get involved by visiting muskegonymca.org.

In the US, approximately 37.3 million people have been diagnosed with diabetes, and 96 million more have pre-diabetes. Proper management can help prevent diabetes, and even reverse pre-diabetes. Linh Gordon, a certified diabetes care and education specialist at Sarasota Memorial, talks about the Diabetes Prevention Program at SMH.You can also watch the video recording on our Vimeo channel here.For more health tips & news you can use from experts you trust, sign up for Sarasota Memorial's monthly digital newsletter, Healthe-Matters.

Episode 100: Diana Fransis, RD | Becoming an Empowered Eater Show Notes: On this episode of the Alix Turoff Nutrition podcast, Alix sits down with Diana Fransis, RD. Diana Fransis is a registered dietitian and lifestyle coach, specializing in empowering individuals to make informed choices about properly fueling their bodies. Holding a bachelor's degree in Nutritional Sciences from Rutgers University, she completed her dietetic internship at the University of Medicine and Dentistry of New Jersey (now Rutgers). In addition, Diana has earned a certification as a lifestyle coach from the Diabetes Prevention Program. With extensive experience and a commitment to guiding others toward optimal well-being, she started her career as a corporate dietitian for a major grocery chain and has now established her own private practice. Residing in New Jersey with her husband and three children, she values family time and delights in sharing her expertise by creating delicious recipes.   Some of the topics we covered in this episode include: How parents can model a positive body image for their kids Navigating the balance between wanting to lose weight but also having to work through disordered eating How to break the generational cycle of yo-yo dieting How to talk to your kids about their own weight …and more!   Connect with Diana on instagram (@wellnessfromwithinrd)   Resources: Submit your questions for upcoming podcast episodes Get the 5 week Flexible Nutrition Starter Kit Apply for Alix's 12 week small group coaching program Apply for Alix's 1:1 coaching program Follow Alix on Instagram  Join Alix's private Facebook group Download your FREE Happy Hour Survival Guide Buy Alix's book on Amazon Shop my favorite products on Amazon Contact Alix via email   Be sure you're subscribed to this podcast to automatically receive your episodes!!!    If you enjoyed today's episode, I'd love it if you would take a minute to leave a rating and review! Subscribe to The Alix Turoff Nutrition Podcast   Discount Codes: Built Bar: Use the code ALIX for 10% off your order Legion Athletics: Use the code Alix for 20% off your order  

In today's episode with Dr. Melody Hartzler, you'll hear us take a deep dive on: 1. What is type 2 diabetes, and what causes it? 2. What is insulin resistance? 3. Medications and lifestyle interventions for type 2 diabetes 4. The role of gut health in type 2 diabetes 5. Nutrients and natural remedies in the management of type 2 diabetes Dr. Hartzler has developed a passion for functional medicine and treating the underlying causes of disease. Her focus areas are functional gastrointestinal disorders, nutritional deficiencies, metabolic conditions, and autoimmune conditions. She is also a nationally recognized speaker on diabetes and functional medicine. Dr. Hartzler is currently Board Certified Ambulatory Care Pharmacy Specialist (BCACP) and is Board Certified in Advanced Diabetes Management (BC-ADM). She is also the owner of PharmToTable and the Director of Clinical Services for Profero Team. Order tests through Rupa Health, the BEST place to order functional medicine lab tests from 30+ labs - https://www.rupahealth.com/reference-guide

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-335 Overview: In this episode, we review recent updates from the Diabetes Prevention Program (DPP) trial and Diabetes Prevention Program Outcomes Study (DPPOS). Join us as we discuss the impact of the updates on diabetes prevention strategies for cardiovascular outcomes. Episode resource links: Goldberg RB, Orchard TJ, Crandall JP, Boyko EJ, Budoff M, Dabelea D, Gadde KM, Knowler WC, Lee CG, Nathan DM, Watson K, Temprosa M; Diabetes Prevention Program Research Group*. Effects of Long-term Metformin and Lifestyle Interventions on Cardiovascular Events in the Diabetes Prevention Program and Its Outcome Study. Circulation. 2022 May 31;145(22):1632-1641. doi: 10.1161/CIRCULATIONAHA.121.056756. Epub 2022 May 23. PMID: 35603600; PMCID: PMC9179081. Galaviz KI, Weber MB, Suvada K BS, Gujral UP, Wei J, Merchant R, Dharanendra S, Haw JS, Narayan KMV, Ali MK. Interventions for Reversing Prediabetes: A Systematic Review and Meta-Analysis. Am J Prev Med. 2022 Apr;62(4):614-625. doi: 10.1016/j.amepre.2021.10.020. Epub 2022 Feb 10. PMID: 35151523. Guest: Jillian Joseph, MPAS, PA-C   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-335 Overview: In this episode, we review recent updates from the Diabetes Prevention Program (DPP) trial and Diabetes Prevention Program Outcomes Study (DPPOS). Join us as we discuss the impact of the updates on diabetes prevention strategies for cardiovascular outcomes. Episode resource links: Goldberg RB, Orchard TJ, Crandall JP, Boyko EJ, Budoff M, Dabelea D, Gadde KM, Knowler WC, Lee CG, Nathan DM, Watson K, Temprosa M; Diabetes Prevention Program Research Group*. Effects of Long-term Metformin and Lifestyle Interventions on Cardiovascular Events in the Diabetes Prevention Program and Its Outcome Study. Circulation. 2022 May 31;145(22):1632-1641. doi: 10.1161/CIRCULATIONAHA.121.056756. Epub 2022 May 23. PMID: 35603600; PMCID: PMC9179081. Galaviz KI, Weber MB, Suvada K BS, Gujral UP, Wei J, Merchant R, Dharanendra S, Haw JS, Narayan KMV, Ali MK. Interventions for Reversing Prediabetes: A Systematic Review and Meta-Analysis. Am J Prev Med. 2022 Apr;62(4):614-625. doi: 10.1016/j.amepre.2021.10.020. Epub 2022 Feb 10. PMID: 35151523. Guest: Jillian Joseph, MPAS, PA-C   Music Credit: Richard Onorato

Melanie Seiler is the founding Executive Director of Active Southern West Virginia, with 20 years of experience in business ownership and management. Melanie has an Associate's degree in Adventure Sports and a Bachelor's in Adventure Recreation Management. She is also certified in CDC Work@Health T3, Diabetes Prevention Program, American Canoe Association stand-up paddle boarding, Professional Ski Instructors of America telemark skiing, and a WV Division of Natural Resources river guide. Melanie was named one of West Virginia Executive Magazine's Generation Next 40 Under 40 professionals in 2017 and a 2019 West Virginia Living Wonder Woman.  

Lindholt JS, Søgaard R, Rasmussen LM, et al. Five-year outcomes of the Danish cardiovascular screening (DANCAVAS) trial. N Engl J Med 2022;387(15):1385-1394.     Study design: Randomized controlled trial (nonblinded) Looking to see if intensive screening protocol for cardiovascular disease reduce cardiovascular events or mortality in older men? Danish study, 46,611 men aged 65 to 74 years were randomly assigned to receive an invitation to screening or usual careThe screening program included non-contrast electrocardiographically gated CT to measure coronary artery calcium, look for aneurysms, and detect atrial fibrillation; ankle-brachial index measurements for peripheral arterial disease (PAD) and hypertension; and blood tests for diabetes and hyperlipidemiaThose who accepted screening were more educated, more likely to be employed, and had a somewhat lower rate of hospitalization for cardiovascular events in the previous 5 years. (the rich white gullible ceo male)The screened group was more likely to be given lipid-lowering drugs and antithrombotics, and they were more likely to have repair of an aortic aneurysm.In the entire population, stroke was less likely (HR 0.93; 0.86 - 0.99) but there were no significant differences in myocardial infarction, aortic dissection, or aortic rupture. The authors estimated that 97.4% of men who received preventive therapy of some kind as a result of screening experienced no mortality benefit after almost 6 yrs of follow up. This is basically a really small absolute benefit which we could also see in just placing a pt on a statin. We don't need vip medicine we need pcp that have time to calculate risk and place pt on statin when indicated.     Goldberg RB, Orchard TJ, Crandall JP, et al, for the Diabetes Prevention Program Research Group. Effects of long-term metformin and lifestyle interventions on cardiovascular events in the diabetes prevention program and its outcome study. Circulation 2022;145(22):1632-1641. Study design: Randomized controlled trial (nonblinded) What is the long-term impact of treating prediabetes on mortality and cardiovascular outcomes? Go way back original Diabetes Prevention Program study randomized 3234 overweight or obese adults with impaired glucose tolerance ("prediabetes") to receive metformin 850 mg twice daily, an intensive exercise program, or placebo and followed them for 3 years Patients were invited to participate in a long-term open-label follow-up study This article reports long-term cardiovascular and mortality outcomes for each group. Patients in the intervention groups were less likely to have been given a diagnosis of T2DM (55% for metformin and 53% for lifestyle vs 60% for placebo; P = .001; number needed to treat [NNT] = 17) There was no difference between either intervention group and placebo with regard to the risk of cardiovascular death, nonfatal stroke, or nonfatal myocardial infarction. There was also no significant difference in the composite of all 3 outcomes for the original metformin group versus the placebo group (hazard ratio [HR] 1.03; 95% CI 0.78 - 1.37) or for those in the original lifestyle group versus the placebo group (HR 1.14; 0.87 - 1.50). More is less or rather more meds is less diagnosis but no difference in things we actually care about     Skjerven HO, Lie A, Vettukattil R, et al. Early food intervention and skin emollients to prevent food allergy in young children (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet 2022;399(10344):2398-2411. Study design: Randomized controlled trial (single-blinded) Does the early introduction of allergenic foods prevent the development of food allergy? investigators randomized healthy newborns, singletons or twins, with at least 35 weeks' gestational age (concealed allocation) to receive no intervention (n = 597), a skin intervention (n = 575), a food intervention (n = 642), or a combined intervention (n = 583). The skin intervention consisted of 5- to 10-minute baths with added petrolatum-based emulsified oil followed by topical cetirizine cream applied to the face. This intervention was to occur at least 4 days per week from age 2 weeks to 8 months, The food allergy intervention consisted of sequentially adding allergenic foods (peanuts, cow's milk, wheat, then eggs) to the infants' regular diet at weekly intervals starting at age 3 months. Overall, 95% of the infants in each group were breastfed at 3 months The researchers had final data on 99.9% of the participants!   based on structured parental interviews, skin testing, and oral challenges  The researchers classified the development of food allergy at 36 months as probable, none, or unclear.  There was no significant difference, however, between the infants who were exposed to skin interventions and those who were not exposed (2.1% vs 1.6%). BUT BUT BUT Food allergy occurred in 1.1% of infants in the interventions using food (food intervention and combination intervention) compared with 2.6% in not using food (no intervention and skin intervention; number needed to treat = 63; 95% CI 37-196).   Lewis E, Merghani K, Robertson I, et al. The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: the PEAK randomized controlled trial. Bone Joint J 2022;104-B(6):663-671. Study design: Randomized controlled trial (double-blinded) Allocation: Concealed recruited adults with at least 4 months of knee pain (with or without swelling) who had mild degeneration on their x-rays (if plain x-rays found no signs of degeneration, they used magnetic resonance imaging to confirm the diagnosis). The participants were randomized to receive 3 weekly saline injections (n = 28), or a single PRP injection followed by 2 weekly saline injections (n = 47), or 3 weekly PRP injections (n = 27). . The clinician performing the injections was unmasked but had no other involvement in the study procedures. the participants were evaluated at 6 weeks, 12 weeks, 6 months, and 12 months after enrollment Using intention-to-treat analysis looking at pain, function, and quality of life, at no point in the study were PRP injections, singly or serially, superior to saline injections.

Prediabetes is one of the least discussed yet most common conditions in the world! We're going over what the heck prediabetes means, who is most likely to get it, and what this diagnosis means for your health. We're also discussing if its possible to keep prediabetes from developing into type 2 diabetes and any treatments that can help people with prediabetes. Plus Dr. E tells us about his 10-year study with the NIH called the Diabetes Prevention Program and what he learned. Questions We'll Cover in This Episode: What causes prediabetes? What are the symptoms of prediabetes? How do you diagnose prediabetes? Who is at increased risk of developing prediabetes? Is diabetes genetic? What are the risks associated with prediabetes? Are there any treatments for prediabetes? Can you keep prediabetes from turning into type 2 diabetes? What are our recommendations for someone diagnosed with prediabetes? Show notesGLP 1 Receptor Agonists: Ozempic, Mounjaro, Trulicity SGLT2 Inhibitors: Jardiance, Farxiga ★ Support this podcast ★

Today on the podcast, Paul talks with John Abramson, American physician, lecturer at Harvard, and author of the books, Overdosed America: The Broken Promise of American Medicine and Sickening: How Big Pharma Broke American Health Care and How We Can Repair It. They have the important conversation about the problems with profit-driven pharmaceutical companies, conflicts of interest in the medical world, and how changing medical education and the system at large is integral for a patient-focused path forward. A note from Paul: Throughout my training and practice as a physician I have come to one very disappointing conclusion:  Western medicine isn't helping people lead better lives. Now that I've realized this, I've become obsessed with understanding what makes us healthy or ill. I want to live the best life I can and I want to be able to share this knowledge with others so that they can do the same. This podcast is the result of my relentless search to understand the roots of chronic disease. If you want to know how to live the most radical life possible I hope you'll join me on this journey. Time Stamps: 00:09:57 Podcast begins  00:10:58 John's backstory as a physician 00:17:40 The inner workings of pharmaceutical companies 00:28:00 John's experience with the FBI 00:29:30 Details on the Vioxx case 00:37:35 Directed consumer marketing of pharmaceuticals 00:44:10 Details about the most recent Vioxx trial  00:46:10 Conflicts of interest in the medical world and thoughts on Statins 00:51:30 The Diabetes Prevention Program 00:59:45 Pharmaceutical companies' spending 01:10:10 What is the way forward and how can we change medical education? Get in touch with John at john_abramson@hms.harvard.edu Sponsors: Heart & Soil: www.heartandsoil.co Carnivore MD Merch: www.kaleisbullshit.shop Make a donation to the Animal Based Nutritional Research Foundation: abnrf.org  White Oak Pastures: www.whiteoakpastures.com, use code CarnivoreMD for 10% off your first order or Carnivore5 for 5% off subsequent orders Higher Dose: www.higherdose.com/paul, or use code PAUL for 15% off your order Lets Get Checked: 20% off your order at www.TRYLGC.com/paulsaladino for 25% off Colima Salt: drpaulsalt.com, for a free bag of Colima Sea Salt

In this episode of Medicare Simplified. we focus on the Sanford Health Plan Diabetes Prevention Program. 

This week, please join author Ronald Goldberg, Editorialist Hertzel Gerstein, and Guest Editor Rury Holman as we discuss the article "Effects of Long-term Metformin and Lifestyle Interventions on Cardiovascular Events in the Diabetes Prevention Program and Its Outcome Study" and the editorial "Shouldn't Preventing Type 2 Diabetes Also Prevent Its Long-Term Consequences?" Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-host. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Centre and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, Associate Editor, Director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Today. Oh, this feature discussion involves the glance of diabetes. Truly this interview, I felt like I was sitting among gurus and just learning so much about diabetes, the history and the whole topic is about long term metformin and lifestyle interventions on cardiovascular events in the Diabetes Prevention Program and its outcome study. Now, way more than that, we discussed. You have to have to listen. But okay, before that, let's summarize today's issue for our listeners. Shall we, Greg? Dr. Greg Hundley: You bet Carolyn. So the first paper that I've got to discuss today really comes to us from the world of interventional cardiology and it's led by Dr. William Fearon from Stanford University Medical Center. Well, Carolyn previous studies have shown quality of life improves after coronary artery revascularization, more so after coronary artery bypass grafting than after PCI. Now this study aimed to evaluate the impact of fractional flow reserve guidance, and current generation zotarolimus drug-eluting stents on quality of life after PCI compared with CABG. Dr. Greg Hundley: Now the study emanates from fractional flow reserve versus angiography for multi vessel evaluation or the fame three trial. And Carolyn, that's a multicenter international trial that included 1500 patients with three vessel coronary artery disease who were randomly assigned to either CABG or FFR guided PCI. Now, what did they assess? So quality of life was measured using the European Quality of life Five Dimensions. And we're going to abbreviate that EQ-5D questionnaire baseline, one, and then 12 months following the procedure. Also, Canadian cardiovascular class angina grade and working status were assessed at the same time points, and then also an additional time point in six months. And the primary objective was to compare the EQ-5D summary index at 12 months, and secondary endpoints included angina grade and work status. Dr. Carolyn Lam: Ooh, interesting Greg. So quality of life in the theme three trial. All right. So what did they find? Dr. Greg Hundley: Right, Carolyn. So the EQ-5D, so that... European Quality of life Five Dimensions summary index at 12 months did not differ between the PCI and CABG groups, but the trajectory over the 12 months at the one month time interval between PCI and CABG did differ. Now, the proportion of patients with the Canadian cardiovascular class or CCS2 or greater angina 12 months was 6.2% versus 3.1% respectively in the PCI group compared with the CABG group. Additionally, a greater percentage of younger patients, so those less than 65 years old were working at 12 months in the PCI group compared with the CABG group. So in summary, Carolyn, in the fame three trial, quality of life after fractional flow reserve guided PCI with current generation DS compared with CABG was similar in one year. And the rate of significant angina was low in both groups and not significantly different. However, the trajectory of improvement in quality of life was significantly better with PCI as was working status in those less than 65 years old. Dr. Carolyn Lam: Wow. Thanks Greg. Hey, guess what? It's time for Greg quiz. The next paper is about the Chocolate Touch Study. So, Greg, is this about, A, the benefits of eating chocolate? B, the benefits of chocolate mud baths? Or C, the benefits of a second generation drug coated balloon? Dr. Greg Hundley: So, Carolyn, I just have one question. Where in the world do we get the benefits of chocolate mud bath? I don't think that's right. I do love eating chocolate, but I am going to go with the benefits of the second generation drug coated balloon. Dr. Carolyn Lam: Yeah, yeah, yeah. I made it easy for you. All right. So first generation drug coated balloons have significantly reduced the rate of restenosis compared to balloon angioplasty alone. However, high rates of bailout stenting and dissections persist. The chocolate touch drug coated balloon is a nitinol constrained balloon designed to reduce acute vessel trauma and inhibit neointima formation and restenosis, so you were right, Greg. In today's study led by Dr. Shishehbor, from University Hospital's Harrington Heart and Vascular Institute at Cleveland, Ohio. They studied 313 patients with claudication or ischemic rest pain, and superficial femoral or popliteal disease. And randomized them one to one to the chocolate touch or Lutonix Drug Coated Balloon at 34 sites in the United States, Europe and New Zealand. The primary efficacy endpoint was drug coated balloon success defined as primary patency at 12 months. The primary safety endpoint was freedom from major adverse events at 12 months. A composite of target limb related death, major amputations, or reintervention. Both primary endpoints was assessed for non-inferiority and have met sequential superiority testing for efficacy was pre-specified. Dr. Greg Hundley: Interesting, Carolyn. So this nitinol constrained balloon designed to reduce acute vessel trauma. So, what were the results of this study? Dr. Carolyn Lam: So in this trial, the second generation chocolate touch drug coated balloon met both non-inferiority endpoints for efficacy and safety. And was more effective than the Lutonix Drug Coated Balloon at 12 months for the treatment of femoral popliteal disease. Cool, huh? Dr. Greg Hundley: Very interesting. Great summary, Carolyn. So Carolyn, my next paper comes to us from the world of preclinical science. And the impact of three dimensional chromatin topology on transcriptional dysregulation and pathogenesis in human dilated cardiomyopathy remains elusive. And so these authors led by Professor Lei Jiang from Guangdong Provincial People's Hospital, and Guangdong Academy of Medical Science, generated a compendium of 3D epigenome and transcriptome maps from 101 biobank human dilated cardiomyopathy, and non-filing heart tissues and mouse models to further interrogate the key transcription factor implicated in 3D chromatin organization, and transcriptional regulation in dilated cardiomyopathy pathogenesis. Dr. Carolyn Lam: Oh, wow. Sounds like a lot of work. What did they find, Greg? Dr. Greg Hundley: Right, Carolyn. So they found that enhancer promoter connectomes are extensively rewired in human dilated cardiomyopathy, which reside in pre accessible chromatin size and also hand one drives the rewiring of enhancer promoter connectome to induce dilated cardiomyopathy pathogenesis. Dr. Carolyn Lam: Okay, Greg. So what are the clinical implications? Dr. Greg Hundley: Right, Carolyn. So first, dilated cardiomyopathy enriched enhancer promoter loops identified in this study could be developed as novel 3D genomic biomarkers for dilated cardiomyopathy. And then second Carolyn, targeting hand one might be used as a novel approach for therapeutic intervention in patients with dilated cardiomyopathy. Dr. Carolyn Lam: Oh, nice. Greg. Well, also in today's issue, there's an On My Mind paper by Dr. Brook, entitled, “The Doctor is Out, New Tactics and Soldiers For our Losing Battle against Hypertension.” In another paper, we have Molly Klemarczyk bringing us highlights from the Circulation Family of Journals. Dr. Greg Hundley: Right, Carolyn. And also from the mailbag, there's a Research Letter from Professor Baggish, entitled, “Cardiovascular Outcomes in Collegiate Athletes, Following SARS-CoV-2 Infection: The 1-Year Follow Up From the Outcomes Registry for Cardiac Condition in Athletes.” Well, Carolyn, how about now we get onto that feature discussion and learn a little bit more about the long term metformin and lifestyle interventions on cardiovascular events in the Diabetes Prevention Program. Dr. Carolyn Lam: Hold on to your seats, everyone. Here we go. We know that lifestyle intervention and metformin have been shown to prevent diabetes. However, what is their efficacy in preventing the cardiovascular disease associated with diabetes development? Well, guess what? We're going to have data on that through today's feature paper and what a star crowd I'm talking to today. We have Dr. Ron Goldberg and he's a first end corresponding author from the University of Miami Diabetes Research Institute. We have the editorialist Dr. Hertzel Gerstein from McMaster University Population Health Research Institute. And a guest editor for this paper, Dr. Rury Holman from University of Oxford. I have to admit I'm starstruck. You gentlemen have totally defined the field. I cannot wait to learn more, but shall we start with you, Dr. Goldberg? Could you tell us a little bit more about your paper, what you did, what'd you found? Dr. Ronald Goldberg: So the background is that the Diabetes Prevention Program started in 1996 was a Diabetes Prevention Program to test the effects of intensive lifestyle intervention versus metformin, versus placebo on the prevention of diabetes in over 3000 individuals with impaired glucose tolerance, a form of prediabetes. And after demonstrating the efficacy of those interventions over about three years, we went on to do a follow up study in which the metformin group continued to receive it. Everybody got lifestyle because it worked so effectively. And we are now reporting after a further 18 years of follow up on the question of whether these interventions, now 21 years later, had any effect on cardiovascular outcomes. The background to that of course, is that people with prediabetes have a somewhat increased risk for heart disease and that rate increases as diabetes develops, particularly with severity of hyperglycemia and duration of diabetes. So, that was the study and we're now reporting on whether these interventions had a significant effect on the major cardiovascular. Dr. Carolyn Lam: Well, first Dr. Goldberg, congratulations on the foresight to get the informed consent and to plan ahead to be able to get these valuable data. But because I know this is going to be a critical point later. Could you tell us a little bit about the completeness of follow up and perhaps surveillance for outcomes before you share the results? Dr. Ronald Goldberg: Absolutely. So, 86% of the original randomized group of participants agreed to continue with a follow up study, so there was a loss at that point. And then of course, over 18 years of follow up, there's going to be a further loss. Some due to death and some due to loss to follow up. But despite that, I would say the group that entered the follow up study, we were able to maintain follow up in 85%. Dr. Carolyn Lam: Fantastic. And the results? Dr. Ronald Goldberg: The findings were that we found no significant effect of either of the two active interventions on our primary cardiovascular outcome, which was nonfatal myocardial infarction, stroke and fatal cardiovascular disease. We also had an extended outcome with more events in it, and similarly found no significant benefit or harm from either of those two intervention. Dr. Carolyn Lam: Oh, I love that paper. What a great, great, perhaps surprising conclusion that Dr. Gerstein loved the title of your editorial, you crystallize it. Shouldn't preventing type two diabetes also prevent long term consequences? So please tell us what was your thoughts when you saw this paper and how you frame it? Dr. Hertzel Gerstein: Thanks very much, Carolyn. And first of all, I was very impressed by the extensive amount of work and analysis done by Dr. Goldberg and his team. I thought that it's wonderful to see this sort of long term follow up. I've had the privilege in the past of speaking together with the DPP team on their trial and in their long term follow up. And I continue to be impressed by the extensive amounts of work and data collected and a rigor and academic value of the analysis. So, that was my very first impression and obviously it's a pleasure to write on this. I think the findings are clearly important and they both highlight the importance of long-term follow up as well as highlight the difficulties of long-term follow up in a study like this. Dr. Hertzel Gerstein: So this was a study done in a trial, originally done in a fairly young cohort of individuals who had very low risk for cardiovascular events. And over their 18 year follow up that Dr. Goldberg Ron described, the actual annual event rate for the primary outcome was 0.6% per year in that ballpark. Now, anybody... I've had the privilege as Ron Avery of doing many cardiovascular trials and we all know that we would never start a trial recruiting people with an event rate of 0.5% per year, 0.6% per year, because we would have to recruit 30,000 people and follow them for seven years in order to accrue enough events to be able to detect a clinically relevant benefit of the therapy. So because of this low event rate, the advantage was the long term follow up, the 26th year, I think it was in the end follow up. No, it was a 21 year median follow up period, because of the long follow up, you get a little bit away from the advantage of the low event rate. Dr. Hertzel Gerstein: But even then, over the course of the 21 years, there were only about 310 first cardiovascular events and most cardiovascular outcomes trials, for instance, we need close to at least a 1000, 500 to a 1000 is what we like to see. So that being said, it's perhaps not surprising that we didn't see a benefit of diabetes prevention because even if diabetes reduces the risk of a cardiovascular event by a quarter, by 25%, there would've only been a 50, 50 chance of detecting that with this particular cohort of people. Dr. Hertzel Gerstein: So I would say that the most conservative assumption is that diabetes prevention doesn't reduce the event rate by 25% or less or 30, but it's certainly... pardon me, by 25% or more, it could reduce it by 20%, 15% we would not have detected at all, or Ron would not have detected and his team would not have detected it with this thing. So I think that to me is the most important caveat in interpreting this does not mean that diabetes prevention has no effect on cardiovascular outcomes. Dr. Hertzel Gerstein: It means that diabetes prevention doesn't have a moderate or smaller effect. So, that's I think the most important message to take and as is even mentioned in the paper by Ron and the team is that there has been at least one diabetes prevention trial conducted in China many, many years ago that showed clearly that people who were randomly assigned to the diabetes prevention arm, 26 years later did have lower cardiovascular events and even death than people who were in the control arm. So, I think this adds to the story but it's clearly like everything, not the final word in this, but it certainly adds a lot of important data. Dr. Carolyn Lam: Oh, I would love to hear Dr. Goldberg's response to that. But before that, Dr. Holman, could I ask you to weigh in as well? Dr. Rury Holman: Yes. Sure. So, I agree with Hertzel that this is underpowered, but this is a question I've long wanted to see the answer to. And I congratulate Ron and his team for actually doing the work. All major studies should have long term follow up. People should be consented for life so that we can answer these questions. And Hertzel even though the power is perhaps minimal, we still need to do this analysis. Dr. Rury Holman: And if there had been a dramatic result, then we'd have all been very excited. I think one of the issues... one, if I could just bring it up, you mentioned the look ahead study in your discussion as being a negative dietary intervention. But I have a slightly different take on that. When you look at that paper in detail, what you see is that the people in the usual care group forgot quite a lot more risk factor reduction medications, and that's because their usual care physicians spotted the fact that their risk factor levels were higher than in the intensive care group, of course it was blinded at that point. But there's a whole point here is, in your paper you show an increase in the statin proportion, which is higher in the placebo group compared with the metformin and your intensive lifestyle, significantly so for the lifestyle one. So I'm just wondering whether even the low power was further blunted by the drop in effects of these other medications. Dr. Ronald Goldberg: Thanks very much for those comments guys, I think they're spot on. Let me first respond Hertzel with my thoughts on this, and then go over to your point, Rury. I think it's really interesting to look back over time and realize how much medical management has changed. And that goes right to your point, Rury, that doing a clinical trial like this where the primary care physicians are informed about what we're doing, what... communicated with on a regular basis, particularly when their patients develop diabetes, it just heightens the entire level of medical management. And I think you're absolutely right, but it's interesting to see what's happened to cardiovascular disease over the last 25 years, both in the general population and in the prediabetic population, the risk of cardiovascular disease has gone down. And then on top of that, we've got this very intensive cardio prevention intervention by primary care physicians, with high rates of statin usage, high rates of any hypertensive treatment, even the placebo group to your question, really lost weight. Dr. Ronald Goldberg: And they knew full well what was... and this was a very hands on type of study where our participants were really followed now for all these years, really became integrated with the research team. And so everybody knew what everybody else was doing. And so I'm sure the placebo effect was very strong, but I think nevertheless... Oh, and the last point I wanted to make was of course, the severity of the diabetes, even though 60% are developed diabetes, the severity of the diabetes was relatively mild. Even in those who developed diabetes, we know their average A1C was only about 6.7. And so I think that has a lot to do with blunting the acceleration effect of diabetes on cardiovascular disease. So, I think all of these factors contributed together to produce a negative result. But I think an important message, nevertheless. Dr. Hertzel Gerstein: I can highlight that point, that Ron was saying is that if diabetes prevention is going to prevent cardiovascular outcomes, it's going to do that because of a difference in glycemic exposure. The diabetes is by definition a disease of an elevated blood sugar. So if diabetes prevention prevents cardio, it means that the blood sugar's going to be lower than it would otherwise be. So if there's very little difference over the long term follow up in blood sugar because of co-intervention and therapy of all the treatment groups, then that would eliminate a lot of the benefits of diabetes prevention, because these are patients who are in this trial, who are being scrutinized even more than they would be if they were out there free range without being involved in any follow up. So, that's a spot on point. Rury, you wanted to comment. Dr. Rury Holman: Yeah. So, Hertzel just to expand on that. Obviously the glycemic impact on macrovascular disease is relatively modest compared to the impact on microvascular disease, which of course is what we all saw originally with type 2 diabetes. In fact, in KPDS35, when we looked or calculated what 1% reduction in A1C would do, it would only reduce stroke or MI by about 12 to 14%. So it's quite a shallow slope if you like. And your point is spot on is if that glucose levels are kept low by good treatment and good management role tell us about the great team they have. Then there was no room for a glycemic impact in this particular study. It's another question, whether you think metformin acts by different mechanisms to reduce cardiovascular disease, that's another question I had for Ron that he might like to address, is if there was a magic effect of metformin, why didn't we see that? Dr. Ronald Goldberg: And that's a really interesting question, Rury, because you may be aware that we published a paper a few years ago on our assessment of coronary calcification in a subgroup, in about 60% of the population who agreed to do this and who were eligible. And interestingly found that metformin did was accompanied by a reduction in the prevalence of coronary calcium in men, not women. Dr. Ron Goldberg: And the effect was actually when we did subgroup analysis, we found it was particularly strong in young men. And actually that gave us some sense of optimism that we might see something when we came to actual events. And of course, as you all know, metformin has beneficial effects on several cardiovascular risk factors. And so the question is whether there is some effect of metformin that might yet be identified, a coronary calcium after all is a surrogate of events and may take time, or it may be that... And we are really interested in the idea that both prediabetes and diabetes are heterogeneous. There's more and more interest in looking at subgroups of individuals who may be more predisposed. And it may be that metformin might have beneficial effects in some of those subgroups. Dr. Hertzel Gerstein: But also remember on the other hand, there was a lot of co-intervention with metformin in all groups after the trial was over. So all groups were offered metformin, et cetera. So even if metformin had an effect, it could have easily been washed out by the exposure of all the other groups to metformin during follow up. But Ron, you also touched on both the hope and the frustration too, because if we start thinking about subgroups, we can always think of subgroups. Yeah. But then the problem with subgroups is you have a study, let's say you have a cohort study with 7,000 or 10,000 people and it followed for five years and, oh, well the effect isn't in all 10,000, it's only in 20% of them. So now you have a study of 2000 people, that's not enough to detect an effect in a subgroup. Dr. Hertzel Gerstein: So, subgroups just eat away at power in an exponential, not a linear way, so that you just rapidly lose any ability to detect anything. And so, yes, this is going to work in people with these three snips on this gene, in this subpopulation. Good luck, that's the difficulty and the challenge of... We need to find sometimes better or more efficient ways of identifying outcome protective therapies, because we can't keep drilling into some groups because we just don't have the resources to find it really. I don't know what other people feel about that, but. Dr. Carolyn Lam: I'm personally so enjoying this conversation as I know the audience is and we covered a lot. I'm sure everyone wants to pick up the paper and the editorial. Now, we talked about being underpowered for the number of studies. We talked about profitable dilution of things like statins, antihypertensive agents, even the crossover of potential treatment in the placebo arm and so on. And then we started talking about, or is it the how you got there and the drug that was used. And here, please don't shoot me, but I just know I have the answers on behalf of everyone else's thinking it. What do you say of people who go, "Well, it's because it's metformin. What if it was an SGLT2 inhibitor? What if it was a GLP-1 receptor agonist?" And as you know, a lot of people say those would in spite of the effect on glucose. Dr. Hertzel Gerstein: I can quickly jump in. It's very clear. We've learned this in the last 10 years, is that there are glucose lowering drugs and there are glucose lowering drugs with benefits. And the GLP-1 receptor agonist and the SGLT2 inhibitors are glucose lowering drugs with benefits. They lower glucose, but they seem to have a separate cardioprotective effect. And with the SGLT2 inhibitors that cardioprotective effect does not seem to be related to the glucose lowering. There are a few meta regression analyses that suggest that with the GLP-1 receptor agonist, part of the cardioprotective effect is related to glucose lowering and part is not. And clearly mediation analysis with some of the trials have shown the same thing with the GLP-1 receptor agonist, not really with the SGLT2 inhibitors. So, maybe, that's my spin on this. Dr. Carolyn Lam: Dr. Holman. Dr. Rury Holman: Yeah. I was going to echo what Hertzel said in that regard, these other agents do have multiple effects. They change weight, they change blood pressure. And so other risk factors are brought into play other than glucose lowerings. We've already agreed, glucose lowering impact on cardiovascular disease is quite modest. I'd rather have it than not, but it wouldn't be my primary way to treat cardiovascular disease. And coming back to Ron's study, which is crucial today, the issue here is whether we could untangle an impact particularly of metformin, which has been foundation drug for type 2 diabetes for so long. Dr. Rury Holman: But clearly within the dataset we have here, underpowered it is. There are no clear messages in that respect, which is disappointing, but it doesn't mean that there isn't an effect. With longer follow up, with more data than you might see it. When the study... I'm coming for you Hertzel, was stopped for futility then the hazard ratio has changed, that often the way, not for the right way, but it's often what happens when you stop studies. I wondered if you wanted to comment on that aspect, because I know it's something that you've talked a lot about. Dr. Carolyn Lam: Dr. Gerstein. Did you want to? Dr. Hertzel Gerstein: I agree with what Rury said. I think the point you're making Rury goes back to power, and the ability to have enough people and enough events to detect and effect and that's clearly true, so... Dr. Carolyn Lam: Well, I hate to be the one to break the party up, but we have gone over time and intentionally so, there's just so much learning here. But Dr. Goldberg, could I give you the last say please? What do you think is the important clinical take home message of your paper? Dr. Ron Goldberg: Well, I think that the fact that we demonstrated that our study has been able to maintain really low levels of cardiovascular risk factors, low levels of A1C, even though that likely contributed to the negative finding still leaves the physician where the recognition that it is important to identify individuals with prediabetes to Institute Diabetes Prevention Programs, because I think it's entirely possible as I said earlier, and we've begun to identify them, subgroups of individuals who do progress more rapidly and who do warrant a more effective treatment, which would come from an early intervention program. Dr. Carolyn Lam: Wow. Thank you so, so much for that. Thank you so much. All three gentlemen for this amazing discussion. Well, audience, you heard it right here on Circulation on the Run from Greg and I thank you for joining us today and don't forget to tune in again next week. Speaker 6: This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.

Much attention has been paid recently in both scientific circles and in the media to a drug for weight loss newly approved by the FDA. A flurry of articles in the media hailed this drug as a breakthrough. This was prompted by the publication of a landmark article in the New England Journal of Medicine addressing the impact of this medication in a large clinical trial. Today's guest is one of the authors of that paper. Another flurry of media attention occurred as the drug became available, with news that supply couldn't keep up with demand. Dr. Thomas Wadden is the Albert J. Stunkard Professor and former Director of the Center for Weight and Eating Disorders at the University of Pennsylvania School of Medicine. He is one of the most highly regarded experts on treatments for obesity, having done some of the most important research on very low-calorie diets, a variety of medications, bariatric surgery, intervention in primary care settings, and more. Interview Summary   You and I grew up together in this profession, having spent some early years together working on treatments for obesity. You're one of the people in the field I admire most, both for the quality of your work and the breadth of your knowledge across various treatments for obesity. So let me begin by asking something regarding our former mentor, Albert Stunkard. So one of the most famous quotes of all time in our field came from Mickey Stunkard in 1959, no less, way before the field was really paying attention to obesity. He wrote that "most obese persons will not stay in treatment. Most will not lose weight. And of those who do lose weight most will regain it." There was a stark honesty to this, and it motivated Stunkard to help overweight people. So if we fast forward to today, do you think this is essentially still true?   Well, first, let me say that Dr. Stunkard's statement sounds somewhat critical. Today, we might say stigmatizing people with obesity. You know, they won't stay in treatment, they won't lose weight, they'll regain it. And Stunkard, as you know perhaps better than anybody, was an extremely compassionate, empathic person. To clarify that, he knew that the limitations to success were with the treatments available and not with the people who had obesity. So to answer your question, the first two parts of Stunkard's statement that people won't stay in treatment and people won't lose weight were probably no longer true by the early to mid-1980s. And pioneers like yourself showed that if you gave people a structured program of diet and physical activity, and most importantly, if you gave them behavioral strategies to improve their treatment adherence, then 80% of people would stay in treatment for 16 to 26 weeks. They'd lose an average of 6% to 10% of their weight. So what remained, however, and remains today, was that people have trouble maintaining the weight loss. And that's something that still challenges us.   Well, it's nice to start on that optimistic note with the hope that people will go into treatment. Let's talk about the drug. So what is the new drug, and how does it work?   Well, the new drug is called semaglutide. It comes in a dose of 2.4 milligrams and is injected subcutaneously once per week. The drug at the retail level is known as Wegovy. Some people will know about semaglutide for the management of type 2 diabetes. It is used at a dose of 1.0 milligrams and it's called Ozempic. So Ozempic was approved first many years ago. Now, semaglutide is a glucagon-like peptide 1 receptor agonist, and that's a mouthful. But glucagon-like peptide 1, GLP-1 for short, is a naturally occurring hormone that is released by the body when food, particularly carbohydrates, hits the stomach. GPL-1 is released by cells in the small intestine, and it does several important things. First, it signals the pancreas to release insulin to pick up the glucose that's coming in. And then it also slows gastric emptying, which as you know, leads to greater feelings of fullness. And then finally, these GLP-1 receptor agonists are hitting a part of the hypothalamus that stimulates fullness or what's known as satiation receptors, so people feel full earlier when they're eating and don't eat as much food. I think you may remember, Kelly, that naturally occurring GLP-1 has a very short life when it's released. It's active for about two to three minutes, so you have a temporary feeling of fullness. But these new drugs, semaglutide 2.4 milligrams, have a seven-day half-life. So people are feeling greater fullness and less hunger sort of around the clock, and as a result, they are just eating less. And to use your terms, they are less responsive to all the cues in the toxic food environment that are saying come on, it's time to eat more. It's time to have a large serving of ice cream or sugar-sweetened beverages, whatever it is. People don't seem to be as vulnerable to the toxic food environment.   I really appreciate that you've taken a pretty complex subject, namely the physiology of this drug, and made it come alive in terms that most of us can understand. So thanks for that. So before you talk about the weight losses that the drug produces, you mentioned that some treatments are producing weight loss of 5-6% of body weight. Can you place that in context for us? I mean, is that enough to produce medical benefits? Are the people losing weight happy with that degree of weight loss?   Sure, most individuals who go through a behavioral treatment program will lose about 7% to 8% of their weight on average. And those weight losses are associated with significant improvements in health. The landmark study in this area is the Diabetes Prevention Program published in 2002. People with pre-diabetes lost seven kilograms, about 7% of their weight, and they exercised 150 minutes per week. And those individuals with pre-diabetes reduced their risk of developing diabetes over 2.8 years by 58% compared to the control group. So that's a really important finding that modest weight loss, and modest physical activity prevents the development of type 2 diabetes. And weight loss is also going to improve blood pressure, and it can improve sleep apnea, so modest weight losses have benefits. But two things. First, larger weight losses have greater improvements in health. That's important to know. It's in a linear relationship there. The more you lose usually, the better the health improvements. And two, most people seeking to lose weight want to lose about 20% of their body weight. So if you're a 200-pound female, a 250-pound male, you want to lose 40 to 50 pounds, respectively. And so, larger weight losses are highly desired.   So how do you deal with that psychologically when somebody's goal is far beyond what treatment typically produces? Can people come around to the fact that the smaller weight losses are really good for me, and I've accomplished a lot even though I may not get to my goal?   Well, I always tell people, I know you want to lose 40 pounds. So let's start with the first 15 to 20. Let's focus on that because you have to go through 15 to 20 to get to 40, and let's see how you feel after you've lost the initial weight. And I can't promise you you're going to get to 40 pounds for potential genetic or biological reasons, but let's try to achieve what we can achieve and focus on larger weight loss. And many people are more satisfied than they'd imagined with a more modest or moderate weight loss, even though the dream is to lose more than that.   Okay, so back to the drug then. This big clinical trial you were involved with, published in the New England Journal of Medicine, can you quickly explain the trial and tell us what you found?   There were four big clinical trials of this medication that were presented to FDA for approval, but the seminal paper published in New England Journal treated about 1,961 participants. And everybody got lifestyle modification every month with a dietician for 15 to 20-minute visits. And then on top of that, half the participants got assigned semaglutide 2.4 milligrams, and the other half got a placebo. And they were followed for 16 months. And the reason it's a 16-month trial is that you have to introduce the drug slowly over four months to control gastrointestinal side effects. So as you start to take this drug, you're likely to experience a little bit of nausea. About 45% to 50% of people do so. So some patients, about 20%, will experience vomiting. Constipation and diarrhea also occur in response to the drug. So if you slowly introduce the drug, you can prevent some of those symptoms. And so it's not till four months that you're on the full dose of the drug, and that's why they run the trial for 16 months, so people have been on the drug for one year. And so what happens at the end of these 16 months is that the participants who get lifestyle light with placebo lose 2 1/2 percent of their weight. That's about what we'd expect. Those who get semaglutide, lose 15% of their body weight. So a remarkably robust weight loss. And when you break it down a little bit further, what happens is that 69% of the people on semaglutide are losing 10% or more of their weight. And then 50% are losing 15% or more of their weight. So that's a substantial loss. And this is something that I'd never seen in this kind of a trial. One-third have lost 20% of their body weight. And those weight losses are cumulative. So the 69% who lost 10% of their weight include the people who lost the 15% and 20% of their weight. But as you well know, those are substantial losses where the average loss is 15%, and that's achieved by 50% of the people. That is double what we get with our best behavioral treatment, and it's about double what you get with most weight loss drugs.   Yeah, that's pretty darn impressive to double the impact. I mean, most people will be excited with a a little bit of improvement. That's a lot of improvement. So certainly, we have to take note based on that. When you talked about the side effects, you were talking about the fairly immediate side effects of beginning to take the drug. And then it takes four months for people to get up to the full dose. Are there side effects that exist beyond those four months?   Well, most people will be through those gastrointestinal side effects within the four months. But, if you go out to 16 months, there will be a small percentage of people who have nausea, diarrhea, et cetera, throughout the trial. And you try to help those people with their side effects by doing things like chewing their food more thoroughly, eating smaller meals but more of them, and drinking more water. All of that can help them control their nausea if it's persistent. I think that the most serious side effect, Kelly, is that about 4% of people will develop gallstones or need to have a gallbladder removed. That is just a consequence of the large weight loss. Anytime you have large weight loss, whether it's from a very low calorie diet, from bariatric surgery, or these medications, you will find that a small percentage of people have gallstones and will need attention.   And what about the fact that people need to get this by injection? Are people able to do that okay, or is that a deterrent for people using it on a broad scale?   It's an excellent question. I can tell you that I have injected myself on several occasions just to see what it's like. You find a fat fold in the stomach and inject yourself. The needle is so small that you can't feel it. So once people try it, there's really very little hesitancy. I think certainly some people would think, "I don't want to be injecting myself with this thing," They may not even come in, but once you try it, there's no problem. And right now, there is an oral version of Ozempic. It's called Rybelsus. So it's the same medication for type 2 diabetes but in oral form rather than sub-q injection. And a trial is currently underway to see if we can make an oral version of semaglutide injectable drug, and I think that's going to prove acceptable. So that barrier should be eliminated over time.   So what happens if people stop taking the drug?   I think you know the answer. People who stop taking the medication are vulnerable to regaining their weight. And some people would say, well, that illustrates the drugs a failure because you take it and you lose weight, and you regain it, and you're no better off. But I am on a medication for high blood pressure and on a medication for high cholesterol. I can assure you that if I stop taking those medications, my cholesterol and blood pressure would go up. So this speaks to a very important issue which we have to look at obesity is probably a majority of persons as being a chronic health condition for which they're going to need long-term ongoing care and you would need to take these medications indefinitely just like I take my hypertensive or cholesterol medication indefinitely.   You know, the description of the cholesterol and blood pressure drugs is a great example. And I think this really speaks to the issue of obesity stigma, doesn't it? Because if you have these blood pressure, cholesterol drugs, and lots of others, if people are taking them and they're effective and then they stop taking them and then the medical condition comes back, it's even more evidence that a drug works. But in the case of some of these obesity drugs, people say, well, if you stop taking it and you regain the weight, it's proof the drug doesn't work. So how do you think that might be bound up with kind of general social attitudes about people with obesity?   It's such an important point. So persons with obesity are still stigmatized, as you, Rebecca Puhl, and many people have shown. And there's just so much unrelenting stigmatization of people saying, you know you should be able to control your weight by exercising more, cutting down on what you eat, push back from the table. You see, it's your problem, your shortcomings in self-control. So people with obesity are stigmatized. Similarly, obesity medications are stigmatized. Anytime I give a talk to physicians, I'll ask how many would consider prescribing an obesity medication? And only about 10% of hands go up at most. Then I'll ask, would you prescribe a drug for hypertension or cholesterol? Everybody's hand goes up, and I say, what's the difference here? And people invariably say, well, people should be able to control their eating and exercise with their willpower. And I say, well, it's an illness, it's a disease partly caused by this toxic food environment, so why are you treating that differently? You allow diabetes medications. That's caused by eating behavior to some extent. So I think you're correct. There's this profound stigmatization of people with obesity and of the medications. And I think that view is beginning to change. One of the most important things about this new medication semaglutide, and there'll be a new drug from Eli Lilly called tirzepatide, is that doctors, endocrinologists, and primary care physicians, are comfortable with these glucagon-like receptors because these are diabetes drugs that they prescribe. They're willing to prescribe that long-term. Now they may be willing to recognize obesity disease, which requires long-term treatment. They feel comfortable with the drug and that it's not going to have adverse side effects. So I hope this is a turning point in stigmatizing persons with obesity and obesity drugs.   Tom, how much does the drug cost, and is it covered by insurance? And what about people on Medicare and Medicaid?   This medication, if you go to your pharmacy and ask for it, I think is currently priced at about $1,300 per month. And so that is a very high barrier to the vast majority of people who would want to take this drug. It's possible, and I hope that the price will come down, but I haven't seen any indication of that. Some insurers and some employers cover the medication so that some people will benefit from it. But I think, as you know, Medicare and Medicaid do not cover any obesity medications at this time. There's a very important piece of legislation in the Senate and in the House called the Treat and Reduce Obesity Act, and part of that bill is to get Medicare to cover obesity medication. So even though they've got a terrific new medication, most people who would benefit from it, and particularly people of color who have higher rates of obesity, minority members, will have a very difficult time getting this drug to use it appropriately.   You mentioned that Eli Lilly may be coming out soon with a competitor drug. Do you think the competition will reduce the cost?   I would hope it would reduce the cost, but I can't say that I have any advanced knowledge of that or any assurance that that will happen. Eli Lilly has put a lot of money into producing their medication. Their medication tirzepatide looks like it will be as effective as semaglutide if not more effective by two or three percentage points. So I think probably the best bet for having a cost reduction is that another medication very similar in its mechanisms of action to semaglutide, it's called liraglutide 3.0 for obesity. It is a GLP-1 receptor agonist, it's just not as effective, it produces an 8% weight loss, it's going off patent, I believe in 2023 or '24 and when it goes off patent, I think that there will be generics to at least make that drug available at a very reasonable cost. I believe that that drug currently is at about $600 to $700 per month, but it should come down dramatically when it goes off-patent, and there are generics.   And for people who have health insurance, are insurers covering the drug?   A smattering of people are covering the drug. I don't think there's universal coverage. If you're under Blue Cross Blue Shield or whatever your company may be, remarkably, the University of Pennsylvania is covering some of these medications, which I'm delighted to see. But you would have to check your insurance plan carefully. For people who do have coverage, there are coupons to get your costs down to as little as $25 a week. So it's really worth looking into. And I know that Novo Nordisk, which manufactures semaglutide, is trying to work with insurers to get more to pick up the coverage of the drug. Let's hope that they reach some insight that'd be important to reduce the cost of this drug to make it more available to people who really need it.   Let me ask a big picture question to end our conversation. So where does this drug fit in the broad scheme of various options for treatments for obesity and how would someone or their physician know if this medication would be a good option to pursue?   Sure, if we follow just the FDA guidance and the guidance of expert panels, this drug is appropriate for people who have a body mass index of 30. So you can go, and your doctor will measure your weight, calculate your height, and tell you what your BMI is. So at a BMI of 30, you're eligible for this drug if you've tried diet and exercise, which just about everybody will have, and you haven't been successful with that alone. I think that the drug is most appropriate for people with a body mass index of 30 or greater who have significant health complications, meaning they have type 2 diabetes or hypertension, or sleep apnea. If the drug's going to be limited in availability because of it's cost, I would try to get it to the people who have the most benefit in terms of improving their health. That's the primary reason to seek weight reduction, I think. Technically, to address your question, the drug's available to people with a body mass index of 27 who have a comorbid condition such as hypertension or type 2 diabetes. And if you've got a BMI of 30, you would like to get this drug to people who have the highest BMIs and have the greatest benefit to health. Those individuals with higher BMIs at 35 who have a comorbid condition are eligible for bariatric surgery, which is the most effective obesity treatment. If you look at the most popular surgical treatment right now, it's called sleeve gastrectomy, where you remove 75% of the stomach so you can't eat as much food, and it does have improvements in appetite-related hormones such as ghrelin, the hunger hormone. That is dramatically suppressed by the operation so people are less hungry, have less desire to eat. And so that operation produces about a 25% reduction in body weight in one year. And at three to five years, people still have 20% off. So a person who's got a BMI of 35 or more with a comorbid condition such as type 2 diabetes wants to talk with his or her physician and see if they might benefit from bariatric surgery. If the doctor and patient don't think that's the option, you would like to consider an obesity medication to help you just control your feelings of appetite, hunger, and satiation, to make it easier to eat a lower calorie diet, to make it easier to want to get out there in physical activity. So that is the big picture of the options: Diet and physical activity for people who have overweight and obesity without health conditions. And then you add medications for people at a BMI of 27, 30, or greater who have health complications. And then you add bariatric surgery when medications don't work.   Bio   Thomas A. Wadden, Ph.D. is Professor of Psychology in Psychiatry at the Perelman School of Medicine at the University of Pennsylvania. He served as director of the Center for Weight and Eating Disorders from 1993 to 2017 and was appointed in 2011 (through 2021) as the inaugural Albert J. Stunkard Professor in Psychiatry. He received his A.B. in 1975 from Brown University and his doctorate in clinical psychology in 1981 from the University of North Carolina at Chapel Hill. Wadden's principal research is on the treatment of obesity by methods that have included lifestyle modification, very-low-calorie diets, physical activity, medication, and surgery. He has also investigated the metabolic and psychosocial consequences of obesity and of intentional weight loss, the latter as represented by findings from the 16-year long Look AHEAD study. He has published over 500 scientific papers and book chapters and has co-edited seven books, the most recent of which is the Handbook of Obesity Treatment (with George A. Bray). His research has been supported for more than 35 years by grants from the National Institutes of Health.  

WDEL's Chris Carl speaks with Kat Luebke of the YMCA of Delaware about their Diabetes Prevention Program.

Mary Luebbert, a certified diabetes care educator, leads a discussion on what lifestyle changes you can make to help manage your diabetes.

Eric Harley interviewed Julie Dillon, Health and Wellness Manager for the St. Christopher Truckers Development and Relief Fund. She is promoting this year's Diabetes Prevention Program See omnystudio.com/listener for privacy information.

On our inaugural show we chat with, Lyndi Wieand, Weis Markets In-Store Registered Dietitian about her role in DSMES. Diet is a significant portion of diabetes management that is unfortunately sometimes overlooked. An article recently published in 2018, Diabetes and Diet: A Patient and Dietitian's Perspective, discusses the challenges that Type 2 Diabetes patients face when trying to lose weight, especially while taking insulin therapy. The dietitian plays a vital role in the management of carbohydrate awareness while concurrently minimizing the risk of hypoglycemia. Because of this, utilizing the dietitian in DSMES classes can have a positive impact on patients' health.  Isabelle Litvak, PharmD & Rachel Hay, PharmD are the new hosts of season 2 of Beyond the Sig for the DSMES Podcast Series powered by the Pennsylvania Pharmacists Association. The podcast's goal is to bring awareness to Diabetes Self-Management Education and Support and how individuals like you play a role in educating both patients and health care practitioners. Today we discussed the DSMES classes from the dietitian's perspective. We hear about Lyndi's DSMES successes, challenges, and personal stories overcoming patient barriers during her three-year experience. Reference Articles: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167292/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605030/ Today's guest is Lyndi Wieand, MHSc, RDN, LDN. Lyndi graduated from the University of Vermont in 2016 with a B.S. in Dietetics, Nutrition and Food Science, then completed her Dietetic Internship at Cedar Crest College in Allentown, PA in 2018. She passed her Registered Dietitian credentialing exam in June 2018 and was hired at Weis Markets as an In-Store Registered Dietitian in August of that year. Lyndi covers the Lehigh Valley regional area, but primarily work in the Allentown and Schnecksville stores. In May 2021, she graduated with her Master of Health Sciences degree from Cedar Crest College and volunteers as a preceptor for the Cedar Crest Dietetic Internship, volunteer with the Bethlehem YWCA Diabetes Coalition, and is a Certified Group Lifestyle Balance Coach for the Diabetes Prevention Program. Lyndi also serves as the President of the Lehigh Valley Dietetic Association. Lyndi Wieand, MHSc, RDN, LDN Lehigh Valley In-Store Dietitian Weis Markets, Inc. Our hosts: Dr. Isabelle Litvak, PharmD is a 2021 graduate from St. John's University College of Pharmacy and Health Sciences. Dr. Litvak is currently pursuing a PGY-1 Community-Based Pharmacy Residency with Weis Markets and Wilkes University Nesbitt School of Pharmacy where she participates in collaborative care in both the community and ambulatory care setting, caring for patients with chronic diseases like diabetes. Dr. Rachel Hay PharmD is a PGY-1 community pharmacy resident at Duquesne University and the Center for Pharmacy Care. She is a recent 2021 PharmD graduate from the University of Michigan. Rachel is passionate about diabetes management and education, especially in underserved populations. See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

If your blood sugar levels are high, but not high enough to be considered type 2 diabetes, your doctor may tell you that you have prediabetes. When you hear that news, you have a choice. You can stay on a path that may lead to type 2 diabetes, and all the complications that come with it. Or you can use the news as a catalyst for making healthy changes in your life. Led by Arna Vanebo, RD, and Melissa Morris, RD, CDE, Columbia Memorial Hospital's new Diabetes Prevention Program starts on July 14, 2021. This program is CDC-recognized and based on research. It is focused on healthy eating and physical activity. In Episode #33 of Hands on Health, Arna and Melissa talk about prediabetes and what you can do to prevent it from progressing to full-blown diabetes. # # # Diabetes Prevention Program You are eligible for this program if you: Have been diagnosed with prediabetes based on a blood test completed in the last year, Are a woman and have been diagnosed with gestational diabetes during pregnancy, or Have a positive screening for prediabetes based on the CDC Prediabetes Screening Test. CORRECTED: Starting July 14, 2021, this lifestyle-change program will be offered in-person. This first yearlong cohort will not be billed for the classes, so this is a good time to take advantage of working to improve your overall health and well-being. Call 503-338-7592 with questions, or to sign up. Learn more about CMH Diabetes Education. # # # "Hands on Health" is the podcast all about living your healthiest life on the coast. If you have a question or a comment, please call 503-338-4654 to leave us a message. We may include your question in an upcoming episode! Listen on: Anchor Apple Podcasts Google Podcasts Spotify Overcast CMH news

ResourcesFor additional resources on individualized care, visit DiabetesEducator.org/MinorityHealthMonth.To learn more about the Community Council of Greater Dallas visit ccadvance.org/community-wellness.

Can diabetes be prevented? Given the increasing rates of this condition in the islands, what research is being done locally to help? Dr. Mariana Gerschenson, Associate Dean for Research and Professor at JABSOM along with Dr. Marjorie Mau, principal investigator of the Diabetes Prevention Program in Hawaii and Professor of Native Hawaiian Health are on the show sharing the latest in what we are doing locally to prevent the diabetes epidemic right here at home.

Jan Stankiewicz and Nikki Johnson from NDSU Extension talk about Type 2 diabetes, how to reduce the risk of getting it, and how the Diabetes Prevention program can help.Resources Find out more about the Diabetes Prevention Program Connect to a community health class or program through the ND Community Clinical Collaborative TranscriptJan Stankiewicz: Welcome to Thriving on the Prairie a podcast exploring issues concerning families and communities that inspires North Dakota movers, shakers, and community difference makers to engage in lifelong learning. I'm Jan Stankiewicz, community health and nutrition specialist, and I with my colleague and friend, Nikki Johnson also a community health and nutrition specialist. Nicki is here to lead us in a conversation about the diabetes prevention program. A national program that is truly changing people's lives. Nikki, it's so nice to have you here today.Nikki Johnson: Thanks for having me, Jan.  Jan: Yeah. Great. So we're just going to again be talking a little bit about, umm, diabetes in North Dakota and something that's called pre-diabetes. And then a program we have that Extension offers that you, kind of, are in charge of, called the diabetes prevention program. So if you just want to kind of, like, open up a little bit about what diabetes is, the current state of diabetes in North Dakota, or maybe even the nation. So, what kind of information do you have to kind of start us off with?Nikki: Sure, so maybe let's just start off thinking nationally. So in the U.S. right now there are over 34 million adults with diabetes. On a more localized level, there's over 54,000 North Dakotan adults that have diabetes. Jan: 54,000. Okay. Nikki: 54,000. And if you put it into perspective, that's about 1 in 10 people. So when you think about going to the grocery store and you know standing in the produce aisle or in the produce section there, you know 1 in 10 people that you are being surrounded by likely has type 2 diabetes. Jan: And then I guess that's something to clarify it's Type 2 Diabetes right, Nikki?Nikki: Yes. Type 2 diabetes and that's going to be a little bit different than type 1 diabetes. Type 1 diabetes is an autoimmune disorder, nothing you can do about developing type 1 diabetes. Type 2 diabetes on the other hand has some preventable factors to it and it's more linked to lifestyle rather than genetics.Jan: Yeah and that's where the term chronic disease comes in, right?Nikki: Yes. So, type 2 diabetes is considered one of those chronic diseases. It's longer term. It has some adverse health effects if you're not managing it or you're not controlling it. And like I said, it is something that is preventable.Jan: Yeah, so when we're talking about type 2 diabetes what does that mean? So we've got a large amount of people in North Dakota with type 2 diabetes. What does that mean for those individuals, and then what does that mean for, you know, community members or the state? Why are we concerned about those kinds of things?Nikki: You know, it's going to be different for every individual, of course. Everybody's journey with any chronic condition is going to look a little bit different but there's a couple common pieces. So, an individual with type 2 diabetes is going to have to be very diligent about their health. Type 2 diabetes is categorized as having blood glucose are blood sugar levels that are outside of the normal range. And if you're not watching those your body can experience some very adverse health effects, right? And so they have to be very concerned. So that means they're going to have to go to the doctor more frequently. They're probably going to have to have a team of physicians that they're going to need to work with or of healthcare providers. So thinking they'll have to work with a dietitian. They need to get their eyes checked regularly. They need to have their feet checked. They're going to need to talk to their regular family care physician just to make sure that their blood levels are where they need to be. And that's going to mean that not only higher medical cost for them, but it's also going to affect their employers and potentially family members and things like that. Just thinking about the amount of days you have to be out of work, or maybe there's days that your blood sugar you just can't get it under control and say you have to miss because you're not feeling well. And if you're not feeling well you know who's taking care of you? You might need that support person in your life to help you out. So there are a lot of implications to developing type 2 diabetes. And maybe i'll go back just to the money piece for a second there. You know nationally, we spend over $327 billion on diabetes. Jan: And billion with a B? Nikki: Billion with a B. $327 billion. And that's not all direct medical costs. A good chunk of it is medical cost. I think a person spends 2.3 times more money annually if they have diabetes versus if they do not have diabetes.Jan: Okay.Nikki: And that's on a personal level, but you have to think about all those other medical costs and implications for that for your employer or health insurance companies, the healthcare system and things like that. And then part of that is going to be those indirect costs. So thinking about absenteeism from work or presenteeism for that matter. Jan: Umm hmm. Yeah. So the impacts kind of build upon each other and then you feel them further and further down the line, yeah. So our healthcare system is set up in a decent way to treat these kinds of things. So there's medications that folks can get on. But again taking a step back, looking at it, you know, more from a preventative side. So that's where pre-diabetes comes in right?Nikki: Yes. So prediabetes, I would say, is this newer….newer term. And maybe I use that in quotations. But it's one of those newer terms and it's really just stating that people are getting close to having type 2 diabetes. They've got these elevated blood sugar levels but they're not quite to the point of type 2 diabetes. And it's this stage in a person's life where you can make some lifestyle modifications and actually prevent developing type 2 diabetes. So you can prevent eventually getting that chronic condition.Jan: Yeah that is really something, especially going back to, you know, thinking about the numbers of people who are impacted by type 2 diabetes and the dollars that are associated with it. So if there's things that we can do to stop that from happening, yeah I think that would really peak some people's interest and I, yeah, I just find it it's so interesting that you know when the terms come up and I can...you know when you said…. you had your air quotes and we could hear it in your voice.Nikki: LaughingJan: When we, even if we can't see it. So yeah, so how does somebody know if they have prediabetes? Nikki: And that's the tricky part. So, prediabetes is not something that you're just going to all the sudden feel all of these symptoms. You know if you've got... you got a cold or you're running a fever you can…. you can feel those... those symptoms, right? Prediabetes, you're not going to... you're not going to notice those. The way you're going to be able to tell is really by going to see your healthcare professional and getting your blood glucose levels checked. But there are certain risk factors that you might be able to check off, that would maybe push you to go see a healthcare professional to get tested. You do need to have a blood glucose test to know whether or not you're not you have pre-diabetes.Jan: Okay, and so then that's usually like just one of those finger-prick things right and then you get the number?Nikki: It depends on. There's a couple different test sometimes it's a finger prick test, sometimes it's a full blood draw.Jan: Okay. Nikki:  But yes it does... it does include some blood.Jan: Okay. AlrightNikki: (Laugh)Jan:  So, so what are some of these risk factors? So if I...I'm hearing about prediabetes, I'm wondering if I might be at risk for something like that, what can I do or what are some of the risk factors?Nikki: Some of the risk factors, so we've got a whole list of them. Some are going to be modifiable risk factors. Some of them we just simply can't do anything about, they're just part of...of our genetics. Or the way life is. So age is going to be a risk factor.Jan: Okay.Nikki: The older we get the more likely it is that we might develop type 2 diabetes. so it's more likely that we would eventually have prediabetes.  So over the age of 45, your risk starts going up. Jan: Okay.Nikki: Family history is going to be another one and again something you're... you're not going to be able to change as well as your health background. So for example, if you've got a parent or sibling that had Type 2 diabetes, you would be at higher risk for developing type 2 diabetes or prediabetes. Same if you had gestational diabetes while pregnant or if you have polycystic ovary syndrome. It also places you at a greater risk.Jan: Okay.Nikki: Couple other things, high blood pressure, high cholesterol or high triglycerides are going to put you at greater risk. Your race, so some of our races puts us at a greater risk, just genetically. So if you are American Indian, African American, Latino, or Asian-American you're at greater risk for developing type 2 diabetes. And then here's where the modifiable risk factors come...come in.Jan: Yeah so the things that we maybe can do something about. Nikki: Exactly. Those little pieces that we might be able to change. Weight and physical inactivity. Jan: Okay.Nikki: So if we're overweight, um, and depending on how overweight you are or being physically inactive, can increase your risk for developing type 2 diabetes. So usually what I encourage people to do if they're curious whether or not they have prediabetes and they're just not sure. Do I go see my physician? I don't really know? We have a really quick risk test that we encourage people to take. It's about seven questions long. Takes a maximum of I would say thirty seconds to complete. But within that thirty seconds, you're going to know whether or not you would be considered high risk or not. And then I would say you know what that you hit that high risk on our risk test, schedule an appointment with your physician or your family practitioner and just get a blood test scheduled. It's pretty quick, fairly painless and then you'll know right then and there if you're at risk for developing type 2 diabetes or not.Jan: Yeah that risk test sounds pretty handy and it's just like yes or no questions right?Nikki: Exactly. Yeah it's yes or no questions, like I said, it's 7 questions long. Really it maybe takes thirty seconds total.Jan: Yeah and on your website that we'll have a link to in the show notes we can actually put the link in for that risk test, so it will be easier for people to find even. So…Nikki: Perfect. Jan: Yeah so we've talked a little bit about diabetes, we've got some risk factors for prediabetes. So then let's move into actually what we're here to talk about today, the Diabetes Prevention Program. So it's something that is across the nation right? Not just North Dakota.  Nikki: Right. So it's the National Diabetes Prevention Program and it is a…..I always chuckle when I have to talk about this, a lifestyle change program. And people are like, what!? And basically what it's saying is that this isn't some quick fix. It is going to take time but we want the changes that individuals are making to be sustainable and to last the duration of their life. Because really, they're not only going to help to lower the risk for developing type 2 diabetes but it's going to lower their risk for a lot of other chronic conditions as well.  Which is, I think, really exciting. Maybe you're going in for a one sole purpose but it's going to be tenfold what you're coming out with. Jan: Yeah because some of those risk factors, you know, for diabetes, are very similar to some risk factors for developing certain types of cancer or heart disease and other thingsNikki. Oh, absolutely. Yeah, I mean, when you look at it, a couple of those risk factors, you know, high cholesterol and high blood pressure. When you think about heart health, that's...those are...those are heart health problems. So if you're going into a program and it's going to help to lower those risk factors as well, I mean, it's exciting that it can do, this program really is helpful for more than just the prevention of diabetes. Jan: Umm hmm, yeah. Okay, so lifestyle change programNikki: Yes.Jan: So what does that entail? If somebody's interested in checking out DPP, what are they going to see? What are they going to find and what can they expect?Nikki: What they can expect, so the scariest part about this program, and its….okay...its the scariest part but it's also probably the most beneficial piece. It is a year-long program and when I tell people it's a yearlong program their eyes get really big and their like, oh my gosh I don't wanna…..I'm signing up for a whole year of my life, right? (Laughing) but the program is really designed to be slow baby steps. So change takes time. Change is scary. And when we take off too much at one time, people tend to not be successful. They tend to get overwhelmed and want to quit and that is the exact opposite of what this program is. We take small baby steps introduce small changes and little things that they can do week after week to make lifestyle changes that fit their lifestyle. So it's a very individualized program.Jan: That's so cool because there are, there's actual, like research associated with these like quick fix programs where they go hard for like 3 months or 6 months, they could see some amazing results and it's mostly like weight loss or behavior change like working out or smoking cessation and those kinds of things. And they have really great results in those 3 to 6 months. But then in the follow-up, they find that almost everybody is either back to their starting point or even a little bit worse off. Right?Nikki: Exactly. And we do not want to see that in this program. So it's really designed to take things slowly, to make changes manageable and again to make them sustainable. So that you know if you're making a change this week, it's something that you're going to be able to live with one year from now, five years from now, 20 years from now. Jan: Umm hmmm. Yeah, so then I'm assuming with the numbers that you've talked about before that it's like what so when somebody is signed up in a DPP class are they with and around other people? Is it an individual kind of a thing?Nikki: Great question. So it is meant to be a group class. Group sizes range from anywhere, I would say, between 6 and 20, just depends on. But what is great about that is you have a trained lifestyle coach or two that's kind of guiding you through the... through the program itself but then you got this wonderful support system around you with people who are going through the same or a similar journey. You know everyone's journey is a little bit different, but they're coming in joining the program with a lot of the same motivations that you probably are joining for. And I should point out so the program itself, we do focus around a couple main goals. Weight loss is one of them. Moderate weight loss, so like, 5 to 7%. And to put that into perspective, if you were a 200 pound individual, we're asking that you would try to lose 10 pounds. So it's not this really scary number I don't think it's a very moderate, easy to work towards number. Now that's not to say that's all you're allowed to lose. If you wanted to lose more you definitely could, but that's our jumping-off point. We look for that weight loss as well as incorporation of physical activity. So we're hoping to increase people's movement throughout the duration of the year. And again all of this happens really gradually it's not something we ask people to start making all of these changes at once. We do things little by little. And then in addition to that, we don't just go through those two pieces we really want to make sure everybody has the tools to be successful. So we go through, you know, stress reduction and problem-solving and going through all of the social and psychological issues that might come up when you're in... in a year right? You know, how do you handle the holidays? What do you do around birthdays? Or if you're having a really awful day at work are there certain triggers that cause you to be inactive or to choose certain foods. So we go through a lot of different pieces to make sure that people are really set up for success when their year with us is done. Jan: Yeah that's actually, you know, when you put it that way. You can see a lot of benefit for it, something lasting an entire year. You know, so you can actually go through the seasons of life, while you're in the program so you can apply things directly to from what you're learning. So I think that's actually pretty cool when you think of it like that. Nikki: It's such a fun program. That's the other thing too. I make it sound really formal but it's a really fun class too.  We've been teaching it in North Dakota, I would say for about seven years or so getting pretty close to 8, and participants absolutely love their year with us.  Like I said it sounds scary right away and people are like, oh my gosh do I really want to sign up for an entire year? But by the time the year ends people are wanting more. They're not….they don't necessarily want to leave the group that they've been apart of the last year of their life. And actually a lot of them still end up staying connected with their coaches and with the participants that they've gone through the program with.Jan: Yeah I can definitely see that bonding and then cohesion of those groups, kind of taking hold and and being one of the helpful factors and you know success,  individual success on whatever terms that they're kind of working towards. So that... that's kind of cool to see. So then  with some changes that we've had in the last several months across the nation, DPP is typically in person right so then you can build relationship and bond with people. So tell us a little bit about what,  like how different is DPP now than it was before the pandemic?Nikki: You know, before the pandemic, so okay, so you mentioned that most of our classes were happening in person. I think, in part it's just because we weren't necessarily ready to start things online. Not to say that we hadn't thought about it. It had been a part of our thought process I would definitely save for quite some time and and there were plenty of organizations across the nation who are offering DPP via distance or with an online platform of some sort. And I guess since the pandemic we transitioned to distance learning and it has still gone phenomenally. Our participants transitioned really really well and I have to say I got to sit in on a lot of classes that I wouldn't have normally just because I got to be that technical person that was running our Zoom sessions. But people really appreciated that additional connection that they were able to have via Zoom or via our online classes. They still got to see their classmates even if it was via the screen. They still got to, you know, we still got to do a lot of the same things you would do in a face-to-face class. So really right now, extension, as well as a good majority of our partner agencies are still going to be running their classes via distance. Once things change up again we will be offering in person as well. But we do plan on offering both options moving forward. So for some people it's just easier to join on their computer and hop online to….to take a class. We're going to have that option. Once things open up... open up and are safe enough we're going to have those in person classes. And then we're actually hoping to add a third option here in the coming... coming months. We'll have something called the HALT program. Where it's an online class that you can basically just check in whenever works out for your schedule. Which is really cool. So we're going to have three different options for people out there to check out and choose which fit is the right fit for them.Jan: Yeah, that's such a great thing for extension to be able to offer that. And yeah, so you're right, and I'm even thinking like in the winters in rural North Dakota how nice would it be, you know, if your class is at a 7 p.m. on a Thursday night and it's storming you can still get to class if it's held virtually or online without having to cancel or to, you know, brave the roads and head in to class. So I think that's so great to be able to partner with a lot of other people across the state who again we might not have had the option or or this soon might not have the option this soon I suppose.Nikki: Exactly. No, and you make a great point about the North Dakota winters are not exactly (laugh) always easy to navigate. So it's... it's great that we're going to have that option.Jean. Yeah. Very cool. Okay so if...if somebody's heard this information they're a little bit interested, what's the like... what's the first next step so you mentioned maybe a risk test but how does somebody sign up for a class or find out about things? Nikki: Sure, so like you said, the risk test is probably the number one thing that I would encourage people to do first. So check out the risk test and then I would say if you're interested in the class you want to sign out there's a couple different ways you can go about that. The first is going to be ndc3.org and I know Jan, I think you said you were going to include that link for people to be able to click on. Jan: Absolutely. Nikki: But that is a wonderful website that includes a variety of what we call evidence-based programs. Basically saying like, hey, these programs are successful. There has been research done around them saying like this is this is a positive program and you know, people can take it or should take it we encourage you to do so. We've got a variety of evidence-based programs on NDC3, including the diabetes prevention program. And all you have to do is go to NDC3.org  in the toolbar on at the top, type in diabetes prevention program or click that button and it will give you all of the offerings for the diabetes prevention program from across the state. So I mentioned extension teaches the classes but there are many partner agencies across the state that are also offering the program. I would say the second way, if they weren't sure about going to NDC3.org, I would just say to reach out to me. I would be happy to connect them with any lifestyle coach or program across the state. Jan: All right, great. Thanks Nikki, that's really helpful information and then to I guess the clarify maybe one thing. Do you need to have a doctor's referral like you have to go to the doctor and then schedule a class or how does that work?Nikki: Great question. So no, you do not need a doctor's referral in order to join the class. If you decided you just wanted to take the risk test, and yes you were a high-risk. We would absolutely welcome you into any diabetes prevention class.  Jan: Yeah, great. I think, yeah, that NDC3.org will have a lot of information for people and then yeah of course we'll link everything in the show notes so be sure to check that out to. All right Nikki, thanks so much for spending time with me today. This information is so important and impactful and it makes a difference for so many of us here in North Dakota. So truly I appreciate your time today.Nikki: Thanks for having me.Jan: Yeah. Thanks for listening to Thriving on the Prairie. To subscribe to the podcast and access a full transcript and resource links from this episode visit www.ag.ndsu.edu/thrivingontheprairie.  You can find more resources for families and communities at www.ndsu.edu/extension. This has been a production of NDSU Extension, extending knowledge, changing lives.

Health tech deals are just back to back this week! On Episode 139 of Health In 2 Point 00, Jess asks Matthew about Withings getting $60M in a new round to develop their connected devices & apps products, Neurovalens raising €5.5M to grow their headset technology that helps with obesity, insomnia, diabetes, & more, Pocket Health raising $6.5M to build out their image sharing platform within in EHRs, and Sidecar Health raises $20M for their price transparency direct pay option. I also talks about Livongo's new DPP program which provides users with diet tips & coaching sessions to offset diabetes in high-risk populations

To learn more about becoming a National DPP or MDPP provider, visit DiabetesEducator.org/DPP.

In our new episode of the PILL podcast, Trudi speaks with Dr. James Keck, a Family Medicine and Preventive Medicine board certified physician who cares for patients in the University of Kentucky Family Medicine Clinic. He supervises, trains, and educates medical students and Family and Preventive Medicine Residents at the UK clinic and UK hospital. Recently, Dr. Keck and colleagues implemented several strategies to promote Diabetes Prevention Program referrals from primary care colleagues to the UK Diabetes Prevention Program. He discusses the diagnosis of “prediabetes”, including who should be screened, how it is diagnosed, and next steps to avoid diabetes.  The National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations working to prevent or delay type 2 diabetes. Partners make it easier for people at risk for type 2 diabetes to participate in evidence-based lifestyle change programs to reduce their risk of type 2 diabetes. Kentucky has 55 recognized National Diabetes Prevention Program organizations serving 80 counties with in person classes. We also have online or distance learning locations covering all 120 counties. To find out more go to CHFS.KY.gov and search for Diabetes prevention programs.   If you need assistance with quality improvement call the Kentucky REC at 859-323-3090 or email us at kyrec@uky.edu. Check out our website at www.kentuckyrec.com. For specific Quality Payment Program assistance, enroll in our online resource center at www.qppresourcecenter.org.Royalty Free Music from Bensound 

We were in the studio talking money today with Karen Poff, Senior Extension Agent With Virginia Cooperative Extension's Northern Shenandoah Valley Financial Education Program. We talked about their Diabetes Prevention Program that starts on January 25 at the Warren County Government Center. The deadline to register is today, January 16, 2018 and registration is required. We also talked about their "Reality Store" event happening on Tuesday, January 23, 2018 at James Wood High School. You can help give students a firsthand look at the cost of daily life! During "Reality Store" students visit stations representing typical spending categories such as housing, transportation, child care, and food, making budget decisions based on their scenario. They need lots of adult volunteers to staff the booths and make this program a success! Karen also filled us in on their upcoming Money Management Series that starts in mid-February. We'll be doing a special podcast in the next few weeks to talk more in-depth about the different segments of the series, what you can learn and why it's important.

We were in the studio talking money today with Karen Poff, Senior Extension Agent With Virginia Cooperative Extension's Northern Shenandoah Valley Financial Education Program. We talked about their Diabetes Prevention Program that starts on January 25 at the Warren County Government Center. The deadline to register is today, January 16, 2018 and registration is required. We also talked about their "Reality Store" event happening on Tuesday, January 23, 2018 at James Wood High School. You can help give students a firsthand look at the cost of daily life! During "Reality Store" students visit stations representing typical spending categories such as housing, transportation, child care, and food, making budget decisions based on their scenario. They need lots of adult volunteers to staff the booths and make this program a success! Karen also filled us in on their upcoming Money Management Series that starts in mid-February. We'll be doing a special podcast in the next few weeks to talk more in-depth about the different segments of the series, what you can learn and why it's important.

Dr. Carolyn Lam:               Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. What is the association between fetal congenital heart defects and maternal risk of hypertensive disorders of pregnancy? We will be discussing new data in this area in just a moment, following these summaries.                                                 The first paper describes the effect of long-term metformin and lifestyle measures on coronary artery calcium. This is a paper from Dr. Goldberg of George Washington University Biostatistics Center and colleagues of the Diabetes Prevention Program Research Group. The Diabetes Prevention Program and its outcome study is a long-term intervention study in subjects with prediabetes, which showed reduced diabetes risk with lifestyle and metformin compared to placebo.                                                 In the current study, the authors looked at subclinical atherosclerosis, which was assessed in 2,029 participants using coronary artery calcium measurements after 14 years of average follow-up. They found that men but not women with prediabetes treated with metformin for an average duration of 14 years had lower coronary calcium scores than their placebo counterparts. No difference in coronary calcium scores was observed in the group receiving a lifestyle intervention as compared to the placebo group.                                                 These findings provide the first evidence that metformin may protect against coronary atherosclerosis in men with prediabetes, although demonstration that metformin reduces cardiovascular disease events in these subjects is still needed before firm therapeutic implications of these findings can be made. The reason for an absence of an effect in women is unclear and deserves further study.                                                 The next study provides insights on the physiology of angina from invasive catheter laboratory measurements during exercise. Dr. Asrress of Royal North Shore Hospital in Sydney, Australia, and colleagues, studied 40 patients with exertional angina and coronary artery disease who underwent cardiac catheterization via radial axis and performed incremental exercise using a supine cycle ergometer. As they developed limiting angina, sublingual GTN was administered to half the patients and all patients continued to exercise for two minutes at the same workload. Throughout exercise, distal coronary pressure and flow velocity, and central aortic pressure were recorded using sensor wires.                                                 Using this novel invasive approach, the authors showed that administration of GTN ameliorated angina by reducing myocardial oxygen demand as well as increasing supply with a key component being the reversal of exercise-induced coronary lesion vasoconstriction. This was evidenced by the fact that there was a relationship between the diastolic velocity pressure gradient with significant increase in relative stenosis severity. In keeping with exercise-induced vasoconstriction of stenosed epicardial segments and dilation of normal segments, with trends towards reversal with GTN.                                                 Thus, this study describes the development of a paradigm where patients with coronary artery disease can exercise while simultaneously having coronary and central aortic hemodynamics measured invasively, and has shown that this provides a unique opportunity to study mechanisms underlying the physiology of angina. In treating patients with exercise-induced angina, the results highlight the importance of after-load reduction and the use of agents that reduce arterial wave reflection and promote coronary artery vasodilation.                                                 The next study provides mechanistic insights into reverse cholesterol transport, where excess cholesterol is removed from macrophage-derived foam cells in atherosclerotic plaques. It suggests that melanocortin receptor-1, or MC1-R, may play a role. As background, the melanocortin system, consisting of melanocyte-stimulating hormones and their receptors, regulate a variety of physiological functions, ranging from skin pigmentation to centrally-mediated energy balance control. At the cellular level, the biological actions are mediated by G protein-coupled melanocortin receptors, such as MC1-R. MC1-R not only affects melanogenesis in the skin but also has immunomodulatory effects through its wide expression in the cells of the immune system.                                                 In the current study from Dr. Rinne of University of Turku in Finland, and colleagues, human and mouse atherosclerotic samples and primary mouse macrophages were used to study the regulatory functions of MC1-R. The impact of pharmacological MC1-R activation on atherosclerosis was further assessed in apolipoprotein E deficient mice. Their findings identified a novel role for MC1-R in macrophage cholesterol transport. Activation of MC1-R conferred protection against macrophage foam cell formation through a dual mechanism. It prevented cholesterol uptake while it concomitantly promoted reverse cholesterol transport by increasing the expression of ATP-binding cassette transporters, ABCA1 and ABCG1.                                                 Thus, the identification of MC1-R in lesional macrophages, demonstration of its role in regulating reverse cholesterol transport, combined with its established anti-inflammatory effects, suggests that MC1-R could be a novel new therapeutic target for preventing atherosclerosis.                                                 The next study suggests that obesity-related heart failure with preserved ejection fraction, or HFpEF, is a genuine form of cardiac failure and a clinically relevant phenotype that may require specific treatments. First author, Dr. Obokata, corresponding author, Dr. Borlaug, and colleagues from Mayo Clinic Rochester and Minnesota studied 99 patients with obese HFpEF with a BMI above 35, with 96 non-obese HFpEF with a BMI less than 30, and 71 non-obese controls without heart failure. All subjects underwent detailed clinical assessment, echocardiography, and invasive hemodynamic exercise testing.                                                 The authors found that, compared to non-obese HFpEF, obese HFpEF patients displayed greater volume overload, more biventricular remodeling, greater right ventricular dysfunction, worse exercise capacity, more impaired pulmonary vasodilation, and more profound hemodynamic arrangements, despite a lower NT-proBNP level. Obese HFpEF patients displayed other important contributors to high left ventricular filling pressures, including greater dependence on plasma volume expansion, increased pericardial restraint, and enhanced ventricular interaction, which was exaggerated as pulmonary pressure load increased.                                                 These data provide compelling evidence that patients with the obese HFpEF phenotype have real heart failure and display several pathophysiological mechanisms that differ from non-obese patients with HFpEF. These and other issues are discussed in an accompanying editorial by Dr. Dalane Kitzman and myself. We hope you enjoy it.                                                 The final study identifies a novel long noncoding RNA that regulates angiogenesis. As background, although we know that the mammalian genome is pervasively transcribed, a large proportion of the transcripts do not encode a protein, and are thus regarded as noncoding RNAs. Based on their length, they can be divided into small or long noncoding RNAs, long being described as more than 200 nucleotides. Although their function is not fully understood, long noncoding RNAs have been increasingly reported to mediate the expression of other genes, affect the organization of the nucleus, and modify other RNAs.                                                 In the current study by first author, Dr. Leisegang, corresponding author, Dr. Brandes, and colleagues of Goethe University in Frankfurt, Germany, epigenetically controlled long noncoding RNAs in human umbilical vein endothelial cells were searched by axon array analysis following knockdown of the histone demethylase JARID1B. The authors discovered a novel noncoding RNA named MANTIS to be strongly upregulated. MANTIS is located in the antisense strand of an intronic region of the gene for annexin A4, calcium- and phospholipid-binding protein. MANTIS is a nuclear long noncoding RNA that is enriched in endothelial cells but also expressed in other cell types. Reducing MANTIS levels led to impaired endothelial sprouting, tube formation, attenuated endothelial migration, and inhibition of the alignment of endothelial cells in response to shear stress.                                                 Brahma-like gene 1, or BRG-1, was identified as a direct interaction partner of MANTIS, implying a role of MANTIS in the formation of the switch/sucrose non-fermentable chromatin remodeling complex. MANTIS binding to BRG-1 was shown to stabilize the BRG-1 interaction, hence by inducing an open chromatin conformation, MANTIS was proposed to maintain the endothelial angiogenic potential. The implications of these findings are discussed in an accompanying editorial by Dr. Zampetaki and Mayr from Kings College London.                                                 That brings us to the end of our summaries. Now for our feature discussion.                                                 Today, we are going to be discussing the association between fetal congenital heart defects and maternal risk of hypertensive disorders of pregnancy. To discuss this, I have the first and corresponding author of our feature paper, Dr. Heather Boyd, from Statens Serum Institut in Copenhagen, and our familiar Dr. Sharon Reimold, content editor for special populations from UT Southwestern. Welcome, Heather and Sharon. Dr. Heather Boyd:            Thank you. Dr. Sharon Reimold:        Thank you. Dr. Carolyn Lam:               Heather, it's a topic that I can't say I'm very familiar with, association between fetal congenital heart defects and maternal risk of hypertensive disorders of pregnancy. Could you start by sharing why would we think there would be a link? What was the hypothesis you were testing? Dr. Heather Boyd:            A couple years ago, there was a paper published in the European Heart Journal that reported evidence of angiogenic imbalance in women with fetuses with major congenital heart defects, so women who were pregnant with babies that had heart defects, and then in fetuses that were terminated because of this kind of defect. My research group focuses a lot of attention on preeclampsia. In the last decade or so, angiogenic imbalance in preeclampsia has been a really hot topic. Women with preeclampsia, particularly women with early-onset preeclampsia, have big angiogenic imbalances. When we saw the European Heart Journal paper, we immediately thought, "What's the connection between preeclampsia and heart defects in the offspring?" Dr. Carolyn Lam:               Oh! Dr. Heather Boyd:            Exactly. That was our entry point to it, was the term "angiogenic imbalance" in that paper sort of was a flag for us. It wasn't a completely new idea, but we in Denmark have one big advantage when considering research questions that involve either rare exposures and/or rare outcomes, and that's our National Health Registry. We have the ability to assemble these huge cohorts and study conditions like heart defects with good power, so we decided just to go for it. Dr. Carolyn Lam:               That makes a lot of sense now. Please, tell us what you did and what you found. Dr. Heather Boyd:            The first thing we did was look at the association between carrying a baby with a heart defect and then whether the mom had preeclampsia later in the same pregnancy. We had information on almost 2 million pregnancies for this part of the study. We found that women carrying a baby with a heart defect were seven times as likely as women with structurally normal babies to develop early preterm preeclampsia. We defined that as preeclampsia where the baby has to be delivered before 34 weeks, so the really severe form of preeclampsia. Then, women carrying a baby with a heart defect were almost three times as likely to develop late preterm preeclampsia as well. That's where they managed to carry it until 34 weeks but it has to be delivered some time before 37 weeks.                                                 These findings were similar to those of other studies, but we were able to go a step further and look at individual heart defect subtypes. What we found there waws that these strong associations were similar across defect categories. Then we decided to see if we could shed any light on the origin of the problem, whether it was coming from the mom's side or the baby's side. To do this, we looked at women with at least two pregnancies in our study period to see whether preeclampsia in one pregnancy had any bearing on the chance of having a baby with a heart defect in another pregnancy or vice versa.                                                 This part of the study included 700,000 women. We found very similar findings. We found that women with early preterm preeclampsia in one pregnancy had eight times the risk of having a baby with a heart defect in a subsequent pregnancy. Late-term preeclampsia in one pregnancy was associated with almost three times the risk of offspring heart defects in later pregnancies. Then, we found that it worked the other way around too. Women who had a baby with a heart defect were twice as likely to have preterm preeclampsia in subsequent pregnancies.                                                 Those results were really, really exciting, because whatever mechanisms underlie the associations between preterm preeclampsia in moms and heart defects in the babies, they operate across pregnancies. Therefore, that pointed towards something maternal in origin. Dr. Carolyn Lam:               That is so fascinating. Sharon, please, share some of the thoughts, your own as well as those of the editors when we saw this paper. Dr. Sharon Reimold:        I think that there's a growing data about the links between hypertensive disorders of pregnancy and preeclampsia with subsequent abnormal maternal outcome. But this paper, I think, has implications for how we look at moms who are going to have offspring with congenital heart defects as well as those with preeclampsia. For instance, I would look at a patient now that has preeclampsia, especially in more than one pregnancy, to identify that they may be at risk to have offspring with congenital defects in the future if they have additional children. But the mom is also at risk based on other data for developing other cardiovascular risk factors and disease as she gets older. It was really the link going back and forth with the hypertensive disorders and the congenital defects that we found the most interesting. Dr. Carolyn Lam:               That struck me too, especially when you can look at multiple pregnancies and outcomes. That's amazing. You know what, Heather, could you share a little bit about what it's like working with these huge Danish databases? I think there must be a lot more than meets the eye. Dr. Heather Boyd:            It's an interesting question, because I'm a Canadian and I was trained in the US. I did my PhD in epidemiology at Emery, and then I moved to Copenhagen. When I first got here, I was absolutely floored at the possibility of doing studies with millions of women in them. It opens some amazing possibilities, like I said earlier, for certain outcomes and certain exposures. You just need to have a question where the information you want is registered. Dr. Carolyn Lam:               Yeah. But I think what I also want to put across is, having worked with big databases, and certainly not as big as that one, it's actually a lot of work. People might think, "Oh, it's just all sitting there." But, for example, how long did it take you to come to these observations and conclusions? Dr. Heather Boyd:            I have a fabulous statistician. I think she's the second author there, Saima Basit. She spends a lot of her time pulling together data from different registers. But yes, you're right. The data don't always just mesh nicely. The statisticians we have working with us are real pros at this sort of data slinging. Dr. Carolyn Lam:               Could I just pose one last question to both of you. What do you think are the remaining gaps? Dr. Sharon Reimold:        I think that this is a clinical link. Then, going back to figure more about what's going on biologically to set up this difference? Because right now there's really no intervention that's going to make a difference, it's just a risk going forward. This is sort of like medicine done backwards, that there's this association and now we need to figure out exactly why. Dr. Heather Boyd:            I can piggyback on what Sharon said a little bit, because I think one of the things we need to remember is that not all women with preeclampsia have babies with heart defects. Not by a long shot. What we need to do now is to figure out what distinguishes the women who do get this double whammy from the vast majority who don't.                                                 One of the things that Denmark does really nicely is that there are large bio banks. One of the things we want to do is go back to bank first trimester maternal blood samples and see if we can identify biomarkers that are unique to the women with both preterm preeclampsia and babies with heart defects. That's one of the things we're thinking about to address this gap. Because, as Sharon says, we've got to figure out what the mechanism is.                                                 The other thing we want to do is to see whether the association between preeclampsia and heart defects extends, for example, to other things, to cardiac functional deficits, for example, because it's probably not just severe structural defects. If there's an association, it's probably on a continuum. Are babies born to preeclamptic moms, do their cardiac outputs differ? Do their electrical parameters differ? Do they just have different hearts?                                                 We're really lucky because right now the Copenhagen Baby Heart Study is offering to scan the hearts of all infants born at one of the three major university hospitals in the Copenhagen area. We're about to have echocardiography data on 30,000 newborn hearts to help us look at this. I'm really excited about that possibility. Dr. Carolyn Lam:               I've learnt so much from this conversation. I'm sure the listeners will agree with me. Thank you both very, very much.