Latest news with #AmericanDiabetesAssociation
Medscape
2 days ago
- Health
- Medscape
ADA Issues New MASLD Guidelines
A new consensus report from the American Diabetes Association (ADA) provides a practice-oriented framework for screening and managing metabolic dysfunction–associated steatotic liver disease (MASLD) in people with diabetes and prediabetes. Published online on May 28, 2025, in Diabetes Care, the report is a comprehensive update to the recommendations the ADA released in 2023. It is intended for clinicians treating patients with diabetes — primarily type 2 diabetes (T2D) — but also type 1 diabetes with obesity and prediabetes. Topics covered include the rationale for the recent change in terminology, epidemiology, fibrosis risk stratification, monitoring, treatment, and referral guidance, with interprofessional team management emphasized throughout. 'This will provide primary care doctors and anyone taking care of people with diabetes the tools to diagnose [MASLD] early and guide therapy…to prevent cirrhosis, and refer to the hepatologist as needed for additional therapy and monitoring,' lead author Kenneth Cusi, MD, professor of medicine at the Division of Endocrinology, Diabetes & Metabolism in the Department of Medicine at the University of Florida, Gainesville, Florida, told Medscape Medical News . The guidelines recommend that clinicians routinely screen people with T2D or prediabetes for MASLD. 'We explain that the liver should be incorporated into our management in the same way we do for chronic kidney disease, eye disease, and nerve disease as an end-organ damage that is particularly affected by diabetes,' Cusi said. In the United States, at least 70% of people with T2D have MASLD, about half of whom have the more progressive form termed metabolic dysfunction–associated steatohepatitis (MASH). About 1 in 5 with T2D have advanced liver fibrosis. The presence of MASH increases the risks for complications including cirrhosis, hepatocellular carcinoma, and overall mortality, according to the new consensus report. Liver disease has not been a focus of diabetes management until recently, Cusi noted. 'We didn't think about it. The epidemic of obesity, and with that, of diabetes, is driving this liver disease. The obesity epidemic has had a big worsening since the 1990s, so this damage in the past 20 or 30 years is just now becoming evident in the liver.' Terminology Change: Highlighting Insulin Resistance, Reducing Stigma The document reviews the current nomenclature for SLD, which was officially changed in 2023 to remove the words 'fatty' and 'alcoholic.' Now, MASLD is defined as the presence of SLD with at least one metabolic risk factor such as obesity, hypertension, prediabetes, high triglycerides, low high-density lipoprotein cholesterol, or T2D, with minimal or no alcohol consumption (< 20 g/d for women; < 30 g/d for men). The term 'MetALD' is used for those with MASLD who also have increased alcohol consumption (20-50 g/d for women; 30-60 g/day for men). Steatosis in the setting of alcohol consumption above those levels is termed 'alcohol-associated liver disease (ALD).' The term MASH is defined as steatohepatitis with at least one metabolic risk factor and minimal alcohol consumption. 'At-risk MASH' refers to steatohepatitis with clinically significant fibrosis (stage F2 or higher). Diagnosis: Staged Screening for Fibrosis The document recommends routine screening of people with T2D, prediabetes, and/or obesity with cardiovascular risk factors, with the goal of identifying those with high-risk MASH. Intervention is then aimed at preventing fibrosis progression and cirrhosis. A graphic diagnostic algorithm advises initial use of the noninvasive Fibrosis-4 (FIB-4) tool, which risk stratifies based on age, liver enzymes, and platelet count. 'The FIB-4 is composed of very simple things that are already in the electronic medical record of all patients. We also discuss the role of electronic medical records to improve implementation,' Cusi said. Those with a FIB-4 < 1.3 have a low risk for future cirrhosis and can be managed in primary or team care with optimized lifestyle and repeated FIB-4 every 1-2 years. If the FIB-4 is > 2.67, direct referral to a liver specialist is advised. If FIB-4 is between 1.3 and 2.67, a second risk-stratification test is recommended. Ideally, this would be a liver stiffness measurement (LSM), most commonly with transient elastography. If that is unavailable, an alternative is the noninvasive enhanced liver fibrosis (ELF) test. If the LSM is < 8.0 kPa or ELF is < 7.7, the fibrosis risk is low and routine management can continue with repeat testing in 1-2 years. But if higher, hepatology referral is recommended. Treatment: Lifestyle, Plus Old and New Drugs The report details lifestyle modification for MASLD, including nutrition plans; physical activity; behavioral health; and the role of diabetes self-management, education and support. The role of obesity treatment in people with MASLD, both metabolic surgery and pharmacotherapy, is also discussed at length. No current pharmacologic treatments have been approved for MASLD, but both semaglutide and tirzepatide have demonstrated benefit in treating MASH and are approved for treating T2D, obesity, and other related comorbidities. A thyroid hormone receptor beta agonist, resmetirom, was approved in early 2024 for the treatment of MASH with fibrosis stages F2 and F3, but is extremely expensive at about $50,000 a year, Cusi noted. An older, generic glucose-lowering drug, pioglitazone, has also shown benefit in reducing fibrosis and may be a lower-cost alternative. The document also includes a section on alcohol intake, which complicates the MASLD picture, Cusi noted. 'We think that this is going to help doctors to consider alcohol, which is often overlooked and under-reported. If patients have moderate fibrosis, they should completely quit alcohol.' Cusi has received research support (to his institution) from Boehringer Ingelheim, Echosens, Inventiva, Labcorp, and Perspectum, and has served as a consultant for Aligos Therapeutics, Arrowhead, AstraZeneca, 89bio, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Novo Nordisk, ProSciento, Sagimet Biosciences, Siemens USA, Zealand Pharma, and Terns Pharmaceuticals.
Yahoo
24-05-2025
- Health
- Yahoo
A Low-Carb Diet for Diabetics That Doesn't Feel Restrictive? Yes!
A balanced diet is one of if not the most effective way to manage blood sugar. For people living with diabetes, it's recommended to avoid added sugars, refined grains and processed foods. One effective way to do this is to limit carbohydrate intake—but this is not to say all carbs are forbidden. Here, experts explain why a nutrient-dense, low-carb diet is a smart choice for diabetics, plus they offer easy tips for optimal glucose control. Scaling back on carbs can be a helpful step toward managing diabetes and improving your overall health. Reducing carbohydrates can help lower glucose levels both before and after meals and improve your body's response to insulin, explains Rachel Pessah-Pollack, MD, FACE, Clinical Professor at NYU Langone Health. Eating fewer carbs often promotes weight loss, which can improve insulin sensitivity and blood sugar control, says Amy Shapiro, RD, lead nutritionist at ButcherBox. A key reason for this is that when you eat a fewer amount of carbohydrates, you tend to eat more protein in its place. And sources like beef, salmon and poultry are more filling than carbs, which can reduce overall calorie intake and prevent overeating. 'Protein also helps to maintain muscle mass during weight loss, which supports a healthy metabolism and prevents muscle loss' she adds. (Learn whether a low-carb or low-fat diet is better for weight loss here.) People with diabetes are twice as likely to have heart disease or a stroke, notes Toby Smithson, RDN, CDCES, Senior Manager of Nutrition and Wellness at the American Diabetes Association. 'Following a lower-carb eating plan has shown positive outcomes related to heart health, which include lower blood pressure, an increase in high-density lipoprotein (the good cholesterol) and lower triglycerides (a fat in your blood that comes from food and excess calories),' she says. Carbohydrate needs for people with diabetes should be based on each individual's age, activity level, weight goals, medications and regular blood sugar control, says Michelle Routhenstein, RD, CDCES, Preventive Cardiology Dietitian, Certified Diabetes Educator and Owner at Entirely Nourished. It's important to note that extremely low-carb or ketogenic diets may carry risks—especially for heart health, she cautions. Research increasingly shows that very low- and no-carb diets may accelerate plaque progression in arteries, potentially increasing the risk of heart disease. 'The body requires a minimum of 130 grams of carbohydrates per day to support brain function and overall metabolic health,' says Routhenstein. 'Instead of drastically cutting carbs, the focus should be on improving insulin sensitivity by pairing carbs with protein and healthy fats and distributing intake evenly across meals and snacks to stabilize blood glucose and support metabolism.' A good reference for a low-carb eating pattern is the Diabetes Plate, offers Smithson. Per these guidelines, aim to fill half of a 9' plate with non-starchy vegetables, about 1/4 of the plate with lean protein, 1/4 of the plate with quality carbohydrates (whole grains, starchy vegetables, beans, fruit, milk or yogurt) and water or a low-calorie beverage on the side. For a more sustainable and realistic approach than completely cutting carbs, Routhenstein suggests focusing on adding nutrients from whole foods that support insulin sensitivity—like chromium, magnesium and zinc—which can help the body process glucose more efficiently. Try combining carbs with skinless poultry, low-fat cheese, eggs, nut butter, tofu, avocado or nuts, advises Smithson. Also, strive for quality carbs that are a source of fiber, such as whole grain toast, fresh fruit or beans. This may help slow down the absorption of the carb and keep blood glucose levels from rising above your target range. More diabetes How to Lower Your A1C Levels Naturally—5 Simple Ways to Improve Your Blood Sugar These 9 Easy Snacks Help Prevent Blood Sugar Spikes—a Game-Changer For Diabetics, Say Doctors Diabetic Desserts: 7 Easy Treats That Taste Indulgent—Without Spiking Your Blood SugarThis content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.
Indian Express
23-05-2025
- Health
- Indian Express
This is what happens to the body's blood sugar levels when you have coconut meat
Coconut meat — also called the flesh or kernel of mature coconuts — is popular for its taste and health benefits. But what is its impact on blood sugar levels? That's exactly what entrepreneur Karan Sarin, who tests Indian foods to measure their impact on blood sugar, demonstrated using a bowl of 50 grams of coconut meat. According to Sarin's CGM, or continuous glucose monitor reading, the spike was negligible after two hours compared to coconut water, which had a high spike. 'There is no sugar spike. There is a flatline, which is a great outcome,' Sarin stated on Instagram. As such, let's understand more from clinical dietitian Garima Goyal For ease of understanding, 100 grams of raw coconut meat contains approximately: 15g – Carbohydrates 9g – Fibre 33g – Fat (primarily saturated fat) 3g – Protein Low glycemic index Goyal said the high fibre and fat content makes it a low-glycemic food, meaning it does not cause rapid spikes in blood sugar levels. High Fibre (especially insoluble fibre): Slows down the digestion and absorption of carbohydrates, leading to a more gradual release of glucose into the bloodstream. High fat content (MCTs): Coconut is rich in medium-chain triglycerides (MCTs), which provide quick energy without needing insulin for metabolism. This minimises insulin spikes, said Goyal. Low net carbs: Out of 15g of total carbs, 9g is fibre — so net digestible carbs are pretty low (around 6g per 100g), which further helps stabilise glucose levels. For people with diabetes or insulin resistance, coconut meat can be a 'smart snack': *It helps with satiety without overloading the body with carbs. *It does not spike blood sugar if eaten in moderation. Citing a 2017 study in Nutrients journal, Goyal noted that diets rich in MCTs (like those found in coconut) may improve insulin sensitivity and support weight loss, both beneficial for type 2 diabetes. *However, portion control is crucial because it's also high in saturated fats, said Goyal. The American Diabetes Association includes unsweetened coconut (shredded or meat) in its list of diabetic-friendly snacks—if portioned correctly, mentioned Goyal. A post shared by Karan Sarin (@sweetreactions) *Those with high cholesterol or gestational diabetes may need to limit saturated fats. *Avoid sweetened coconut products, which can rapidly spike sugar. In its raw, unsweetened form, coconut meat does not significantly raise blood sugar levels, thanks to its high fibre and healthy fat content. 'It's a low-GI food and can be part of a balanced diet for diabetics, PCOS patients, or anyone watching their glucose levels—in moderation,' said Goyal. DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.
Time of India
21-05-2025
- Health
- Time of India
Why liver function tests are key for people with diabetes and obesity
Conceived as a princely minister of warmth and life, the liver is often overlooked in diabetes and obesity , whereas the organ is a prime regulator in metabolism. In recent times, a plethora of evidence has begun linking decreased liver performance with metabolic disorders. Thus stands the Liver Function Test ( LFT ) as an important investigative tool for all, ranging from diabetes to obesity or a combination of the two. The Link Between Liver, Diabetes, and Obesity The liver controls lipid metabolism and glucose metabolism. In type 2 diabetes patients, this equilibrium is lost because of insulin resistance, which generally leads to fat accumulation in the liver by a mechanism independent of alcohol, i.e., Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Likewise, obesity leads to excess fat deposition around organs, such as the liver, and sets them up for inflammation and fibrosis. Without treatment, these disorders progress to cirrhosis and ultimately, even liver cancer in certain situations. What Liver Function Tests Tell Us Proceeding with LFTs, the following enzymes and proteins are measured: ALT (SGPT)- a liver enzyme that helps detect liver damage or inflammation, especially in conditions like fatty liver , diabetes, and obesity. ALP (Alkaline Phosphatase) - reports bile duct function Bilirubin - the liver's power to clear waste Albumin and Total Protein - the capacity of the liver to synthesise proteins Elevated liver enzymes in patients with diabetes or obese individuals often indicate silent liver damage before the appearance of signs and symptoms. by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like Sente dores nas articulações? Este simples hábito pode mudar sua vida! AlwaysFit Saiba Mais Undo Why Routine Monitoring Is Important Diabetes and obesity are chronic conditions . As a rule, and when patients with diabetes have a higher than normal BMI or altered lipid profile, LFTs must be checked, Black Book Reference American Diabetes Association. Similar recommendation in Indian guidelines. With obesity rates running at 12% in India and more than 100 million cases of diabetes recorded as per the ICMR-INDIAB study 2023, the burden of liver-related comorbidities is something one can only imagine. Liver abnormalities alter drug metabolism, thereby possibly affecting diabetic treatment. In a diseased liver, drugs like metformin or statins undergo altered metabolism, which predisposes one to side effects. Fibroscan and Ultrasound Liver Advanced liver fibrosis occurs more frequently in people with type 2 diabetes, often being caught late or never at all. FibroScan and ultrasound liver imaging are two such non-invasive methods for assessing liver stiffness with high accuracy, thus providing an early diagnosis. On the Defensive Good news is that the liver is mostly reversible in early stages. When combined with lifestyle changes (weight loss, low-carb diet, physical activity, and diabetes management), LFTs may be reversible in fatty liver conditions. Also, avoiding alcohol, good hydration, and paying attention to liver health every 6–12 months, provide good points of prevention against the long-term establishment of the disease. Liver health is closely linked with diabetes and obesity, and often acts as a silent alarm system. Hence, regular liver function tests should be considered more of a preventive than just a diagnostic tool. For anyone struggling with blood sugar and weight issues, keeping an eye on their liver will be the key to keeping the metabolic system healthy throughout a long life. Authored by: Dr. Sameer Bhati, Public health expert Study shows why obese people shouldn't consume too much alcohol One step to a healthier you—join Times Health+ Yoga and feel the change
Medscape
20-05-2025
- Health
- Medscape
Obesity Association Publishes Weight Stigma, Bias Standards
New standards on weight stigma and bias in overweight and obesity were published recently the Obesity Association, a division of the American Diabetes Association (ADA). The recommendations, developed by the Obesity Association's Professional Practice Committee, make up the first of several chapters to be published as part of the organization's Standards of Care in Overweight and Obesity. The introduction and methodology sections of the standards were published as well. The ADA brought together 'an interdisciplinary panel of experts — spanning obesity medicine specialists, primary care, endocrinology, cardiology, nephrology, hepatology, surgery, pediatrics, emergency medicine, and more — to create authoritative guidance,' Nuha El Sayed, MD, the ADA's senior vice president of healthcare improvement told Medscape Medical News . The new standards 'build on a legacy of professional practice guidelines previously developed by expert organizations,' and so should not create confusion, she said. To ensure the recommendations reflect consensus across the field, collaborating organizations include the American Board of Obesity Medicine Foundation, Obesity Medicine Association, Obesity Action Coalition, The Obesity Society, and the American Society for Metabolic and Bariatric Surgery. The new standards will include updates to previous topics, while creating recommendations to guide new topics related to screening, diagnostic, and therapeutic interventions that affect the health outcomes of people living with obesity. Furthermore, she said, 'they will address the prevention, screening, diagnosis, and management of weight-related complications.' Key Recommendations Key recommendations from the new standards include: Training: Healthcare professionals and staff should receive ongoing education on weight bias and stigma beginning in early career and continuing throughout their careers. Inclusive clinical environments: Clinics should be equipped with appropriate furniture, equipment, and private accommodations that support people of all sizes. Person-centered communication: Healthcare professionals are urged to use respectful, non-judgmental language and to ask permission before discussing weight-related issues. Shared decision-making: Healthcare professionals are encouraged to align care goals with a patient's values, recognizing health outcomes beyond just weight loss. Evidence-based interventions: The guidelines support multicomponent strategies, such as role-play, self-reflection, and patient engagement, to reduce implicit and explicit bias effectively. 'Individuals with obesity should feel comfortable in healthcare settings,' El Sayed said. 'This guidance represents a call to action to eliminate the stigmatizing practices that still persist across healthcare systems.' To help raise awareness, ADA is providing continuing medical education on reducing weight bias and stigma in obesity care. The Standards of Care in Overweight and Obesity is funded by ADA general revenue. No expert panel members were employees of any pharmaceutical or medical device company during the development of the 2025 Standards of Care. Members of the PPC, subject matter experts, their employers, and their disclosed potential dualities of interest are listed in each section manuscript.
