In a new nationwide study, Mayo Clinic researchers have shed light on factors contributing to diabetes rates in rural America. Their observational study found people in rural areas were more likely to develop diabetes (higher incidence) and to already have it (greater prevalence) compared to people in urban areas. However, when risk factors that can be changed, such as inactivity and obesity, were accounted for, the gap in diabetes prevalence and incidence narrowed, and in some cases, the trend reversed. Higher levels of inactivity and obesity were the strongest predictors of higher diabetes rates.

These findings suggest that rural Americans can make a big difference in their risk for diabetes with the right resources, including targeted medical and lifestyle interventions promoting healthy behaviors. In addition, these interventions could improve diabetes prevention for all people, no matter where they live.

Sagar Dugani, M.D., Ph.D., the study's first author, says that future research will focus on the best strategies for addressing diabetes risks in rural populations.

When the researchers analyzed diabetes rates in different regions of the country, they found different associations between how rural a community was and its diabetes incidence rates. These findings suggest that tailored approaches may be needed to meet the diverse needs of rural communities and reduce diabetes-related disparities.

Adrian Vella, M.D., the study's senior author, says the study also emphasizes that taking care of diabetes involves more than just medication.

"Diabetes care also requires a suitable care environment and infrastructure," says Dr. Vella. 

Diabetes is a chronic health condition that requires lifelong care. It is also the costliest chronic condition in the U.S., expected to affect 1 in 3 Americans in their lifetime. In the U.S., 15% of the population lives in rural areas and experiences a wide range of health disparities.

The researchers say that, to their knowledge, this study is the most comprehensive report on the relationship between rurality and the incidence and prevalence of diabetes in the U.S. The study used U.S. Centers for Disease Control and Prevention (CDC) data from 2004 through 2019 to generate estimates of the incidence and prevalence of diabetes across the U.S. in 3,148 counties.  This investigation is part of a growing body of Mayo Clinic research, including this study on diabetes-related deaths, focused on understanding and finding solutions for rural health disparities.

Past studies have shown that interventions designed to promote physical exercise and improve access to healthy food helped to prevent diabetes, the researchers note.

"We plan to engage people, communities, researchers and policymakers to design comprehensive strategies for diabetes care," says Dr. Dugani.

Dr. Dugani is an academic hospitalist at Mayo Clinic and associate director of the Community-Engaged Research Program in the Mayo Clinic Center for Clinical and Translational Science.

Dr. Vella is the Earl and Annette R. McDonough Professor of Medicine in the Division of Endocrinology, Diabetes, Metabolism and Nutrition.

Review the study for a complete list of authors, disclosures and funding.

The post Diabetes isn’t destiny for rural communities appeared first on Mayo Clinic News Network.

In a new study, Mayo Clinic researchers identified substantial health disparities in rural versus urban areas in diabetes-related deaths, with other disparities based on gender.

Using nationwide data from the Centers for Disease Control and Prevention, the researchers examined rates and trends from 1999 to 2018, in diabetes-related deaths among adults based on county urbanization, gender, age group, and region. In 2017-2018 compared with 1999-2000, diabetes-related deaths increased in men living in rural areas but decreased in women living in rural areas. Furthermore, death rates increased in adults 25 to 54 years old living in rural areas, and death rates increased in the rural South but not in other regions.

"Our goal was to examine the trends below a national level in diabetes-related deaths to guide the development of rural interventions to reduce deaths," says Sagar Dugani, M.D., Ph.D., lead author of the study. "Our results highlight the importance of exploring individual and community factors for diabetes-related deaths in rural areas."

Diabetes is a chronic condition that requires lifelong care. In the U.S., the prevalence of diabetes and access to diabetes care are affected by several factors, including residency in rural areas.

According to Dr. Dugani, the prevalence of diabetes is determined, in part, by trends in death rates. However, in rural populations, information is sparse on trends in diabetes-related deaths, thereby limiting the development of rural interventions to reduce death rates.

Read the rest of the article on the Advancing the Science blog.

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Other Mayo Clinic medical research websites:

• Research at Mayo Clinic
• Discovery’s Edge
• Mayo Clinic Laboratories
• Forefront
• Center for Individualized Medicine
• Center for Regenerative Biotherapeutics
• Center for the Science of Health Care Delivery
• Mayo Clinic Cancer Center

The post Science Saturday: Mayo Clinic study indicates U.S. rural counties have higher diabetes-related deaths appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: Is it possible to reverse prediabetes by taking medication?

ANSWER: Prediabetes means that your blood sugar level is higher than normal but not high enough to be considered diabetes. It is a warning sign that if you don't make changes, the condition may eventually progress to diabetes. But those changes typically don't include taking medication. Instead, lifestyle changes, such as improving your diet, losing weight and exercising regularly, may lower your blood sugar to a healthy level.

Diabetes happens when you have too much sugar, also called glucose, in your blood. This comes from what you eat, but during the fasting state it is released by the liver into the circulation to keep levels constant. The hormone insulin, which is made in the pancreas, is sent into your blood continuously but increases significantly after you eat. The insulin moves through your blood and works like a key, allowing the sugar from your food to enter your cells. As the sugar goes into your cells, the amount of sugar in your blood goes down. It also “puts the brakes” on the liver to prevent too much glucose release during fasting and after meals. When you have diabetes, this process doesn’t work the way it should. Sugar then accumulates in your blood.

There are several kinds of diabetes, the most common being Type 2 diabetes. It develops when your body cannot make enough insulin to keep your blood sugar at a healthy level or when your body’s cells become resistant to insulin.

Your health care provider can diagnose diabetes using several different tests. One of the most common is the fasting blood glucose test, in which a sample of your blood is taken after you have not eaten for at least eight hours. The test analyzes how much glucose is in your blood. A normal glucose level range is 70 to 100 milligrams per deciliter, or mg/dL. You have diabetes when glucose is consistently above 126 mg/dL. Prediabetes is when your fasting blood sugar is between 101 to 125 mg/dL.

Being in the prediabetes range signals that you are at high risk of developing diabetes if something doesn’t change. The exact cause is not known, but excess fat — especially abdominal fat — and inactivity seem to be important factors in the development of prediabetes. In addition, the risk for diabetes goes up as you get older, especially after age 45. You can't do anything about your age, but you can make other changes to lower your risk. Studies have found that diet and exercise are the most effective treatments for combating prediabetes and preventing its progression to diabetes.

Being sedentary can raise your diabetes risk, even if you don’t carry excess weight. Make regular exercise a priority. It doesn’t have to be a strenuous workout. A brisk walk, a bike ride, an afternoon spent gardening — anything that gets you moving helps. Aim for 30 minutes of moderate exercise each day. If you can’t fit it in all at once, try several 10-minute sessions throughout the day. If you choose an activity that you enjoy, you're more likely to stick with it. The availability of step counters — even those on smartphones — can help you keep track of your activity. You should aim for about 10,000 steps per day.

When it comes to diet, concentrate on foods lower in fat and calories and higher in fiber. Focus on eating fruits, vegetables and whole grains. If you aren’t sure what’s right for you, consider meeting with a dietitian to review your diet and help you make changes. There are numerous apps and online platforms that can help you track your food intake.

Finally, have your blood sugar checked on at least an annual basis so you know if you are making progress. Talk to your health care provider about how often you need your blood sugar tested. In many cases, blood sugar that falls in the prediabetes range can be successfully controlled without medication. — Dr. Adrian Vella, Endocrinology, Mayo Clinic, Rochester, Minnesota

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The post Mayo Clinic Q and A: Make changes to stop prediabetes from developing into diabetes appeared first on Mayo Clinic News Network.

November is National Diabetes Month, and more than 23 million people in the U.S. have been diagnosed with the disease, according to the Centers for Disease Control and Prevention. Diabetes increases your risk of conditions such as blindness, amputations, heart failure and kidney failure. Mayo Clinic experts say proper management can help diabetics stay healthy.

In this Mayo Clinic Minute, Vivien Williams talks to Dr. Adrian Vella, a Mayo Clinic endocrinologist and diabetes researcher, about the facts on Type 2 diabetes.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:00) is in the downloads at the end of the post.
Please ‘Courtesy: Mayo Clinic News Network.’ Read the script.

Type 2 diabetes is on the rise.

"The increased incidence of obesity is what has probably driven part of the increase in diabetes," says Dr. Vella.

Diabetes happens when your blood sugar is too high. It's a leading cause of blindness and amputations, and it increases your risk of heart disease and kidney failure.

"Dealing with high blood sugars early gives you a better chance of spending a longer time not requiring medications or other interventions to control your diabetes," says Dr. Vella.

Lifestyle choices, such as eating right, exercising and losing weight, can help prevent and even manage the chronic condition. But unhealthy choices can be dangerous, especially if you have a predisposition for the disease.

"One of my more famous colleagues actually said that heredity loads the gun, while environment pulls the trigger," says Dr. Vella.

The good news is treatment with lifestyle changes, medication or insulin can help manage diabetes and prevent complications.

The post Mayo Clinic Minute: Get the facts on Type 2 diabetes appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Charles Rosen, director of the Mayo Clinic Transplant Center, will discuss the importance of organ donation and operating a transplant center with three sites. Also on the program, Dr. Adrian Vella, an endocrinologist at Mayo Clinic, will discuss A1C guidelines for diabetes. And Dr. Michael Joyner, a Mayo Clinic anesthesiologist, will share the many benefits of exercise.

Here's your Mayo Clinic Radio podcast.

The post Organ donation and transplant / diabetes guidelines / benefits of exercise: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

April is National Donate Life Month, a time to encourage people to become organ, eye or tissue donors. This is also a time to celebrate donors and transplant recipients.

On the next Mayo Clinic Radio program, Dr. Charles Rosen, director of the Mayo Clinic Transplant Center, will discuss the importance of organ donation and operating a transplant center with three sites. Also on the program, Dr. Adrian Vella, an endocrinologist at Mayo Clinic, will discuss A1C guidelines for diabetes. And Dr. Michael Joyner, a Mayo Clinic anesthesiologist, will share the many benefits of exercise.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: National Donate Life Month appeared first on Mayo Clinic News Network.

April is National Donate Life Month, a time to encourage people to become organ, eye or tissue donors. This is also a time to celebrate donors and transplant recipients.

On the next Mayo Clinic Radio program, Dr. Charles Rosen, director of the Mayo Clinic Transplant Center, will discuss the importance of organ donation and operating a transplant center with three sites. Also on the program, Dr. Adrian Vella, an endocrinologist at Mayo Clinic, will discuss A1C guidelines for diabetes. And Dr. Michael Joyner, a Mayo Clinic anesthesiologist, will share the many benefits of exercise.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Organ donation and transplant / diabetes guidelines / benefits of exercise appeared first on Mayo Clinic News Network.

The American College of Physicians has come out with new guidelines for treating Type 2 diabetes. The group advises clinicians to prescribe metformin to patients with Type 2 diabetes as first-line therapy. Then adding to the metformin — a sulfonylurea, a thiazolidinedione, an SGLT-2 inhibitor, or a DPP-4 inhibitor, when a second oral therapy is considered. Mayo Clinic endocrinologist Dr. Adrian Vella says the guidelines "break no new ground  in terms of therapeutic hierarchy and are confined to oral pharmacotherapy. While an excellent compilation of available safety and efficacy data, there is little novelty in treatment recommendations."

Dr. Vella says, "The review is not necessarily comprehensive, as three oral drug classes are omitted, although there is not much data to support their use as primary therapy (i.e., dopamine agonists, bile-acid binding resins and acarbose). Furthermore, by confining the recommendations to oral medications, another class of injectable medication – glucagon-like peptide-1 receptor agonists - is omitted completely. These medications are associated with some weight loss and recently (like SGLT-2 inhibitors) have been associated with cardiovascular benefit. Lifestyle modification up front is not emphasized. And I think the guideline might overplay the potential benefits of metformin as a first-line drug, which may not be ideal for all patients."

He adds, "The role of dietary modification and exercise, especially early in the disease, should not be overlooked."

Diabetes is the seventh leading cause of death in the U.S. and can lead to a host of serious health complications, including heart disease, blindness, kidney failure, and lower-extremity amputations.

Related posts:

• Mayo Clinic Minute: Type 2 diabetes – What you need to know (Nov. 14, 2016)

The post Mayo Clinic expert responds to new Type 2 diabetes guidelines appeared first on Mayo Clinic News Network.

In this Mayo Clinic Minute, reporter Vivien Williams talks to endocrinologist and diabetes researcher Dr. Adrian Vella about what you need to know about Type 2 diabetes.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (0:59) is in the downloads. Read the script.

The post Mayo Clinic Minute: Type 2 diabetes – What you need to know appeared first on Mayo Clinic News Network.

Type 2 diabetes

In this Mayo Clinic Minute, reporter Vivien Williams talks to endocrinologist and diabetes researcher Dr. Adrian Vella about what you need to know about Type 2 diabetes.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:08) is in the downloads. Read the script.

The post Mayo Clinic Minute: The Facts on Type 2 Diabetes appeared first on Mayo Clinic News Network.