After cardiac surgery, patients are at risk for both high and low blood sugar, which can lead to serious complications. Managing these fluctuations requires careful insulin dosing, but existing protocols often fall short due to the unpredictable nature of ICU care and differences among patients, say the investigators. 

To address this challenge, the research team created a reinforcement learning model, named GLUCOSE, that recommends insulin doses tailored to each patient’s needs. In tests using data from real-world ICU cases, GLUCOSE matched or even outperformed experienced clinicians in keeping blood sugar levels within a safe range—despite having access to only current patient data, while doctors used full patient histories. 

“Our study shows that artificial intelligence can be thoughtfully and responsibly developed to support, rather than replace, the clinical judgment of health care professionals,” says co-senior corresponding author Ankit Sakhuja, MBBS, MS, Associate Professor of Medicine (Data-Driven and Digital Medicine) and a member of the Institute for Critical Care Medicine at the Icahn School of Medicine at Mount Sinai. “In complex and high-pressure environments like the ICU, tools like GLUCOSE can provide real-time data-driven guidance tailored to individual patients. This kind of decision support can enhance safety, reduce the risk of complications, and ultimately allow clinicians to focus more of their attention on critical aspects of patient care.” 

The research team trained GLUCOSE using reinforcement learning, which allowed the system to learn optimal decisions through trial and error. They also used advanced methods—conservative and distributional reinforcement learning—to ensure the model made cautious, reliable recommendations. The model was then rigorously evaluated and compared to real-world clinical practices. 

While the results are promising, the researchers caution that GLUCOSE is not intended to replace doctors. It serves as a clinical decision support tool, offering suggestions that physicians can choose to follow based on their judgment and the broader clinical picture. 

The model could eventually be integrated into electronic health record systems to provide real-time insulin dosing guidance in the ICU, helping reduce complications and improve outcomes. Future steps include adapting the tool for use in other hospital settings, running clinical trials, and exploring ways to integrate it into routine care. 

One current limitation is that the model does not yet factor in nutrition data, which may affect longer-term glucose control. Still, the ability of GLUCOSE to make accurate recommendations based on limited real-time data highlights its potential to enhance safety and efficiency in postsurgical care. 

“Our goal is to develop AI systems that meaningfully augment the capabilities of health care providers and ultimately improve patient outcomes,” says co-senior corresponding author Girish N. Nadkarni, MD, MPH, Chair of the Windreich Department of Artificial Intelligence and Human Health, Director of the Hasso Plattner Institute for Digital Health, and Irene and Dr. Arthur M. Fishberg Professor of Medicine at the Icahn School of Medicine at Mount Sinai, and Chief AI Officer of the Mount Sinai Health System. “By learning from real-world clinical data and delivering personalized recommendations in real time, models like GLUCOSE represent an important advance toward integrating trustworthy data-driven tools into the clinical workflow. This study offers a glimpse of how AI can be thoughtfully embedded into care to support providers in delivering safer, more precise treatment.” 

The paper is titled “A Distributional Reinforcement Learning Model for Optimal Glucose Control After Cardiac Surgery.” 

The study’s authors, as listed in the journal, are Jacob M. Desman, Zhang-Wei Hong, Moein Sabounchi, Ashwin S. Sawant, Jaskirat Gill, Ana C. Costa, Gagan Kumar, Rajeev Sharma, Arpeta Gupta, Paul McCarthy, Veena Nandwani, Doug Powell, Alexandra Carideo, Donnie Goodwin, Sanam Ahmed, Umesh Gidwani, Matthew A. Levin, Robin Varghese, Farzan Filsoufi, Robert Freeman, Avniel Shetreat-Klein, Alexander W. Charney, Ira Hofer, Lili Chan, David Reich, Patricia Kovatch, Roopa Kohli-Seth, Monica Kraft, Pulkit Agrawal, John A. Kellum, Girish N. Nadkarni, and Ankit Sakhuja. 

The study was funded, in part, by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health grant 5K08DK131286, and by the Clinical and Translational Science Awards (CTSA) grant UL1TR004419 from the National Center for Advancing Translational Sciences. Research reported in this publication was also supported by the Office of Research Infrastructure of the National Institutes of Health under award numbers S10OD026880 and S10OD030463.  

See the journal paper for conflicts of interest: https://www.nature.com/articles/s41746-025-01709-9. 

About Mount Sinai’s Windreich Department of AI and Human Health   

Led by Girish N. Nadkarni, MD, MPH—an international authority on the safe, effective, and ethical use of AI in health care—Mount Sinai’s Windreich Department of AI and Human Health is the first of its kind at a U.S. medical school, pioneering transformative advancements at the intersection of artificial intelligence and human health.  

The Department is committed to leveraging AI in a responsible, effective, ethical, and safe manner to transform research, clinical care, education, and operations. By bringing together world-class AI expertise, cutting-edge infrastructure, and unparalleled computational power, the department is advancing breakthroughs in multi-scale, multimodal data integration while streamlining pathways for rapid testing and translation into practice.  

The Department benefits from dynamic collaborations across Mount Sinai, including with the Hasso Plattner Institute for Digital Health at Mount Sinai—a partnership between the Hasso Plattner Institute for Digital Engineering in Potsdam, Germany, and the Mount Sinai Health System—which complements its mission by advancing data-driven approaches to improve patient care and health outcomes.  

At the heart of this innovation is the renowned Icahn School of Medicine at Mount Sinai, which serves as a central hub for learning and collaboration. This unique integration enables dynamic partnerships across institutes, academic departments, hospitals, and outpatient centers, driving progress in disease prevention, improving treatments for complex illnesses, and elevating quality of life on a global scale.  

In 2024, the Department’s innovative NutriScan AI application, developed by the Mount Sinai Health System Clinical Data Science team in partnership with Department faculty, earned Mount Sinai Health System the prestigious Hearst Health Prize. NutriScan is designed to facilitate faster identification and treatment of malnutrition in hospitalized patients. This machine learning tool improves malnutrition diagnosis rates and resource utilization, demonstrating the impactful application of AI in health care.  

For more information on Mount Sinai’s Windreich Department of AI and Human Health, visit: ai.mssm.edu  

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According to the ADA, the diagnosed cost of diabetes in the United States is estimated to be $412.9 billion in 2022, including both direct medical costs and indirect costs like lost productivity. As the prevalence of diabetes continues to rise, costs will climb higher and higher, placing an unsustainable and unnecessary burden on our health system and economy. It points to a stark, uncomfortable realization that the biggest cost burden on the American taxpayer isn’t drugs (11 percent of the total national health spend); it is the cost of manageable disease run amuck.

While the White House and Congress rightly tout their success in lowering the cost of insulin for Americans in need, the policy victory speaks to the persistent problem—akin to closing the barn door after the horse has escaped—that more and more people are being diagnosed with or unaware of their diabetes risks. The bigger “hairy audacious goal” is to reduce the number of people with diabetes in the first place.

A Tale of Two Americas

The Type 2 diabetes epidemic is not an equal opportunity offender. It disproportionately affects racial and ethnic minorities, as well as those with lower educational attainment and socioeconomic status. This is not a coincidence; it results from systemic inequalities plaguing our health-delivery system. It speaks to the long overdue need to use PK-12 education to inform young people about healthy diets.

Black Americans, Hispanic/Latino Americans, and Native Americans bear a heavier burden of this disease because of deeply rooted social determinants of health. Access to quality healthcare, education, and economic opportunities are crucial in determining who develops Type 2 diabetes and who doesn’t.

According to the ADA: “The poorer you are in America, the less likely you are to have a grocery store within walking distance of your home. Diabetes rates are inversely related to income level, and nutrition is critical to diabetes prevention and management. Every American with diabetes and prediabetes must have access to affordable, culturally relevant food and the information they require to eat healthfully.”

At the heart of this crisis lies a fundamental issue raised for years: our relationship with food and education. The lack of basic nutritional literacy in many communities is not just unfortunate; it’s a tipping point for heart disease and diabetes. Many Americans, particularly in underserved communities, make food choices that harm their health because of strained household economics or lack of information. The food label on packaged goods is helpful to those who can translate the percentages listed into actionable decisions. Still, desperation often makes those decisions for people regardless of what the label says.

In urban and rural areas with limited access to fresh, nutritious food, food deserts are not just inconveniences but public health hazards. When the only food options available are processed, high-calorie, or convenient and tasty fast foods, we set up communities for a lifetime of health struggles.

Innovation and Public Policy: Islands of Hope

Traditional approaches are proving inadequate in the face of this growing threat. The health system needs to embrace innovative, policy- and technology-driven solutions that can reach people where they are and provide personalized support.

More than 41 million people participate in the Supplemental Nutrition Assistance Program (SNAP) and receive an average monthly benefit of $191 per person, or a little over $2 per meal. ​Roughly four out of 10 SNAP participants (42%) are children under age 18; 16% are people 60 and older, and about 12% are people with disabilities. The results are dramatic!

Children receiving SNAP benefits have better health status than youngsters who are not SNAP participants, and their households are less likely to sacrifice health care to pay for other necessary expenses. Older SNAP participants are less likely to be admitted to a nursing home or hospital than their counterparts who do not participate. It seems like common sense. Caring for the chronically ill costs taxpayers more.

Telemedicine and remote monitoring technologies offer potential avenues for diabetes management. These tools can provide real-time data to healthcare providers, allowing for more timely interventions and personalized care plans. AI-powered nutritional guidance apps have the potential to democratize access to customized meal plans, accounting for an individual’s health status, cultural preferences, and economic constraints. These tech tools can only be used as preventive and interventional extensions of the doctor’s office if third-party payers – private and public – ensure it is in the health providers’ interests. 

On the pharmaceutical side of innovation are the GLP-1 receptors – that can help millions of people struggling with obesity – among the key catalysts for the surge in pre- and Type 2 diabetes. GLP-1 receptor agonists mimic the hormone’s action, crucial in regulating blood sugar levels. But here’s the kicker: these drugs don’t just lower blood glucose; they’re a Swiss Army knife of metabolic health. However, private payers often place obstacles in the path of access. Obesity is a complex – tipping point – disease leading to diabetes, mental health challenges, heart disease, and more. Payers often will not authorize GLP-1 use for people who are overweight and have prediabetes – waiting till people (their beneficiaries) graduate to Type 2, citing cost.

The Obesity Society spokesperson Katherine H. Saunders, MD, of Weill Cornell Medicine, New York City, in an interview with Medscape, comments: “What is more expensive than Wegovy (a GLP-1 class drug)? A day in the hospital. This is a particularly important finding for health plans, employers, and any group covering the total cost of care — many of whom are concerned about the cost of Wegovy. Hopefully, this data will encourage more decision makers to recognize not only the significant health benefits associated with Wegovy but also potential cost savings.” Dr. Saunders is among the nation’s top thinkers in the field of obesity and associated conditions, and as an entrepreneur, co-founded FlyteHealth, a community of health providers who specialize in helping people manage their weight.

Health- or Sick-Care – We Must Choose a Path

The economic impact of Type 2 diabetes is staggering. The time for half-measures and incremental change is long past. We need a coordinated, multisectoral response—the health sector, industry, government, and private philanthropy—working together to address the epidemic’s foundational causes.

Five suggestions include:

1. Investing in education at the primary school level and ensuring children understand healthy food choices and have access to in-school meals.
2. Addressing social determinants of health through Federal and state policies that promote economic equity and access to quality health and education
3. Leveraging well-proven approaches in remote patient monitoring to improve diabetes intervention, detection, and management
4. Strengthening the use of Federal and state programs such as SNAP and the Child and Adult Care Food Program (CACFP)
5. Fostering collaboration between health providers, community organizations, national professional health organizations and tech companies to deploy proven solutions.

The Future We Must Embrace

Current efforts to address Type 2 and prediabetes prevention are insufficient. By acknowledging the complex relationship among social, educational, economic, and environmental factors contributing to this chronic illness epidemic, the United States private and public health system must examine drug costs; however, it can develop more effective policies and campaigns for diabetes intervention and management. 

It’s time for a mindset shift in approaching this preventable condition. We must recognize that we have, to date, given lip service and window dressing to address disparities and support the needs of children growing up without sufficient knowledge about food choices or, in the case of cash-strapped families, access to a healthy meal that reinforces what they are learning in school. Half measures were never good enough and are no longer acceptable.

Every step toward managing Type 2 diabetes – or better yet, preventing it entirely – is a step toward a healthier, more equitable society. The challenge is immense, but the ability to make a difference is possible.  There are proven delivery methods for insulin, vastly improved ways to monitor blood glucose and policies that could be tweaked to meet people’s needs.  Together, we can turn the tide on this epidemic and create a future where Type 2 diabetes is no longer a looming threat but a manageable condition.

Pay now or pay later. It’s a decision payers and policymakers must make.

The post The Diabetes Epidemic: A Pressing Public Health Catastrophe appeared first on Medika Life.

More than 1.6 million New Yorkers are diagnosed with diabetes, and some 11 percent of the State’s almost 20 million residents may already have prediabetes. Diagnosis and intervention are complicated by the fact that only 20 percent of the population is aware that without a lifestyle change and medical oversight, they will “graduate” to a Type 2 diagnosis.

This crisis is hidden in plain sight, waiting to overwhelm the health system.

Diabetes and New York, Imperfect Together

Prediabetes is among the more worrisome health comorbidities. Consider that:

• Diabetes disproportionately affects racial/ethnic minority populations. Compared with white adults, the risk of having a diabetes diagnosis is 77 percent higher among African Americans, 66 percent higher among Latinos/Hispanics, and 18 percent higher among Asian Americans. New York’s diverse population positions the State as an epicenter for diabetes risks.

• Diabetes prevalence is approximately 17% higher in rural areas than in urban areas, with studies showing that adults in rural America were more likely to report a diagnosis of diabetes than their urban counterparts. Approximately 21.5 percent of New Yorkers live in rural regions, with about 4.2 million residents.

• Type 2 diabetes is a pressing public health concern in New York State, affecting individuals of all ages and backgrounds. According to the New York State Department of Health, approximately 10.3% of adults in the State have been diagnosed with diabetes, with Type 2 accounting for most cases. This prevalence translates to over 1.6 million adults living with diabetes, a figure that continues to rise.

• There are 5,228,000 people in New York, 33.5% of the adult population, who have prediabetes. Their blood glucose levels are higher than usual but not yet high enough for them to be diagnosed with diabetes.

• Some 33% of adults aged 65 or older have Type 2 or prediabetes. This age group is at higher risk than younger people of developing diabetes-related complications such as nerve damage, kidney failure, or heart disease. In New York, nearly one in six people are 65 and older, and this population is growing faster than in any other State.

Raising awareness of prediabetes is one challenge; preventing diabetes is another. Addressing the urgent needs of people unable to afford essential treatment is yet another.

Without consistent treatment, blood sugar levels in individuals with diabetes fluctuate uncontrollably, risking hyperglycemia or hypoglycemia, both life-threatening conditions. Prolonged neglect escalates health complications, including cardiovascular diseases, kidney failure, blindness, and nerve damage, significantly reducing life expectancy. The emotional toll of diabetes is also profound; diabetes burnout is real, resulting from the stress and anxiety of constant monitoring every day, all year long, which often leads to depression.

Tackling Access to Care Saves Costs and Lives

The already considerable healthcare costs of diabetes also continue to mount, causing intensifying economic strain as emergency treatment, hospitalizations and repeat hospitalizations climb due to the disease. According to the National Institutes of Health, care for people with diabetes accounts for 1 in 4 healthcare dollars in the U.S. On average, people with diabetes shoulder annual medical expenditures of $19,736, of which approximately $12,022 is specific to diabetes management.

When people require insulin, the price can be a significant obstacle, and failure to access therapy has downstream costs. According to the American Diabetes Association (ADA), people with diabetes have medical expenses that are 2.3 times higher than people who do not have diabetes, and the impact is even more significant for communities of color, which face disproportionately high diagnosis rates.

To fight the disease and its costs in reduced health and mental well-being, as well as runaway treatment and hospitalization costs, addressing the barriers to accessing insulin is paramount. For decades, data has demonstrated that tighter control of insulin blood glucose levels corresponds to fewer medical complications, keeping people out of the hospital and helping to prevent amputations.

People with Medicare Part B and D have a one-month supply of each Part D- and Part B-covered insulin, capped at $35, and do not pay a deductible. However, for the economically challenged, the cost of insulin often means that they are skipping or limiting doses. The impact on their long-term health can be disastrous.

New York State’s Governor Tackles Insulin Access

Governor Kathy Hochul has proposed eliminating insulin cost-sharing through legislation to tackle this public health challenge. The policy would cap an insured person’s cost at $100 out-of-pocket for each 30-day prescription supply.

This public policy effort is the most expansive stopgap against insulin cost-sharing in the nation, providing financial relief to New Yorkers and improving adherence to a life-saving medication that can prevent severe kidney disease that can even cascade to necessary dialysis. This proposal is estimated to save New Yorkers $14 million in 2025 alone.

By removing cost barriers, the program empowers individuals to manage their diabetes effectively. It tackles a key social determinant of health – the cost barrier to access medicine – potentially improving health outcomes. Since the insulin cap proposal was introduced in New York, other States have seen Governor Hochul’s program as a model to address their patient-care challenges.

“Access to affordable insulin is an essential need for those who require this life saving medication,” states Dr. Leon Igel, an endocrinologist and obesity medicine specialist at Weill Cornell and Chief Medical Officer for Intellihealth. Dr. Igel will be honored in May 2024 by the New York Metro Region of the American Diabetes Association for his equal commitment to patient care and research.

Insulin dependency and consistent access to diabetes care is a New York State priority.  Through public health Initiatives such as the Governor’s insulin program, progress is being made in addressing this escalating crisis. Addressing social determinants of health and ensuring that people can affordably access healthy food will also help reduce risks – these steps can address obesity, a critical preventive measure.

Relationship Between Obesity and Health Inequities

Obesity is among the primary risk factors for Type 2 diabetes, and its prevalence in New York reflects the national trend. The Centers for Disease Control and Prevention (CDC) reports that nearly 30% of adults in New York have obesity, with specific communities showing disproportionate risk. Minority populations, low-income individuals, and those residing in underserved neighborhoods are particularly vulnerable to obesity. Limited access to nutritious foods, inadequate healthcare services, and socioeconomic disparities contribute to the heightened risk faced by these groups.

Obesity also leads to prediabetes, a stepping-stone to Type 2 diabetes. Alarmingly, more than 35% of adults in New York have prediabetes, placing them at an increased risk of developing the full-blown disease if left unchecked. State health officials note that 15-30 percent of people with prediabetes without intervention will develop Type 2 diabetes within five years, leaving them vulnerable to heart disease and stroke.

The trajectory from prediabetes to Type 2 diabetes underscores the importance of early detection and comprehensive management strategies – including, if necessary – access to insulin. Moreover, addressing the underlying factors driving prediabetes, such as obesity and health inequities, is essential in stemming the tide of diabetes-related complications.

 “Treating obesity to prevent progression to Type 2 diabetes is critical” according to Dr. Katherine Saunders, an obesity medicine expert at Weill Cornell Medicine in New York City and co-founder of Intellihealth. “Once individuals develop Type 2 diabetes, it can be harder to treat their obesity and the other weight-related comorbidities they likely have as well.”

Government Action Can Save Lives

With access programs like the Governor suggests, New York State is taking bold, preemptive steps toward a future where diabetes no longer casts a dark shadow on the health and well-being of its citizens. Being insulin-dependent and having consistent access reduces a pivotal barrier to care.  As patients, care providers and insurers struggle to navigate the complexities of diabetes management, Governor Hochul’s policy efforts are paramount in shaping a healthier tomorrow for Empire State residents. This proposed legislation, if passed, may encourage other States to follow her lead.

Now, if States also recognize that preventive care – addressing access to healthy food and keeping waistlines down is a public health priority issue, our healthcare system might begin to shift from sick care to well-care.  That would be a significant cost- and life-saving advance.

The post New York Tackles Insulin Access Hurdles as Governor Hochul Takes on Therapy Costs appeared first on Medika Life.

Blood sugar levels are already routinely monitored in patients with diabetes or those at risk of developing diabetes, but the importance of maintaining stable blood sugar levels for overall health is becoming more widely recognized. Elevated blood sugar levels, even if not high enough to indicate diabetes, may be associated with an increased risk of cardiovascular disease, kidney disease, and other health problems.

As a result, tracking blood sugar levels without diabetes or pre-diabetes may become a tool for managing both disease and wellness. Or perhaps, availability of broader data sets can foster research examine blood glucose levels and trajectory to offer new insights into the pathophysiology of related diseases at earlier points in time.

Digital health has often offered monitoring solutions that reside in the consumers hands (or wrists). And this has certainly been a mixed blessing.  Some tools have provided valuable insights into health.  Yet some have become merely a source of arbitrary information that cannot be translated into clinical value.  Further, this added burden to healthcare providers may further preclude adoption.  But as innovation has taught us, the next big thing can often be close at hand.  The emergence of continuous blood glucose monitoring (CGM) has been transformative for patients.  And the new data sets have given scientists powerful insights into glucose kinetics and insulin administration.   And these insights maybe game-changing with the global concerns of obesity and metabolic syndrome.

Your watch is becoming a value tool in wellness and disease management.  And that value is only beginning to be realized and implemented.

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Our taste for junk food high in fat and sugar has been cultivated, and it alters the brain’s reward circuitry, driving an addiction-like behavioural phenotype of compulsive overeating. But it doesn’t stop at obesity.

There is growing evidence to suggest that there is an association between the consumption of ultraprocessed foods and cognitive decline. In a cohort study of 10,775 individuals, higher consumption of ultraprocessed foods was associated with a higher rate of global and executive function decline after a median follow-up of 8 years.

Ultraprocessed foods often contain additives such as artificial flavors, colors, and sweeteners. They are typically high in calories, fat, and sugar. But it’s not simply these foods, but how our body processes food and our gut microbiota.

Research is pointing to the relationship between our gut and neurodegenerative disorders with recent studies denoting an association between Alzheimer’s and changes in the gut microbiome. The belief is that there is a link between how high fats and simple carbohydrates are processed in the gut resulting in changes in cognition.

The idea that what we eat is mind-altering has been explored for over a decade, but it is now coming to the fore. The exact pathways between impaired cognition and food choices are still under consideration.

The evidence related to neurologic disorders and emotional disturbances, such as depression, has established a gut-brain axis interaction (GBA) at work. Both healthy and unhealthy diets provide meaningful, previously unknown connections in our nervous system and our brain’s functioning. Who thought a life of hot dog eating could cause dementia? Scientists now see how careful food selection may ward off cognitive decline.

When you are next tempted to go for those highly processed goodies, do your brain a favor and pass them up. Practicing this type of personal food-selection discipline will be well worth it in your future functioning.

The post The Road to Dementia May Be Paved With Processed Food appeared first on Medika Life.

In contrast, the BQ.1 variant represented less than one percent of cases. To identify and track SARS-CoV-2 variants, the CDC uses genomic surveillance. This process includes the collection of SARS-CoV-2 specimens for sequencing and SARS-CoV-2 sequences generated by commercial or academic laboratories contracted by the CDC and state or local public health laboratories.

In an interview with CBS News, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and also the chief medical adviser to President Joe Biden, observes this:

“When you get variants like [BQ.1], you look at what their rate of increase is as a relative proportion of the variants, and this has a pretty troublesome doubling time.”

COVID-19 BQ.1 implications

You are probably aware of the Omicron subvariant called BA.5, the most common infection type. Nearly seven in 10 infections are secondary to BA.5. Viruses mutate, so I am not surprised that we have BQ.1 and other variants emerging.

Dr. Peter Hotez of Baylor College of Medicine Houston (USA) called BQ.1.1 on Twitter the “most likely candidate” to drive a new COVID-19 wave if that were to happen in the coming months.

Will the current treatments, including monoclonal antibodies, hold up with the new BQ.1 variant? Noting this concern, I want to share the good news:

Because the new variant is a descendant of Omicron, my upcoming booster shot may be my best first line of protection against this rising threat. I look forward to seeing if the booster works well to prevent serious illness. I don’t have high hopes that it will slow transmission much, though.

Thank you for joining me in this brief look at COVID-19 BQ.1. Stay safe.

The post BQ.1 — The New COVID-19 Variant Doctors Want You to Know About appeared first on Medika Life.

Racial bias prevents many people from attending adequate schools, entering promising careers, and accessing adequate healthcare. This bias also affects where they can find suitable housing, and that housing may contribute to health difficulties brought on by pollution or vermin infestation. The situation, undeniably, is untenable, and anyone who believes in human rights will find each of these impediments anathema.

All the above is clear, but taking the situation two steps further will reveal the hidden extent of the potential damage raining down on anyone who is a victim of this bias. And, most disturbing, this further damage to health happens in the medical realm.

Socioeconomic factors lead to health risks such as asthma, and the need for ongoing, accurate treatment for asthma is mostly with inhalers. The condition is so severe that frequent emergency treatment is sought. Compared with white people with asthma, African American people with asthma are five times more likely to visit the emergency room for symptoms.

One of the inhalers of choice for asthma is albuterol, and here, again, there is a problem with treatment. A study of over 1,400 children revealed a genetic lack of appropriate response to this drug in some patients. And problems in sampling were apparent. We and others have documented the implications and challenges posed by the lack of non-European study populations in biomedical research. Sampling bias is at the heart of one major problem in device engineering.

Once asthma treatment is sought, there still needs to be a resolution to the underlying measurement problem. While in the ER, how is the oxygen level of these patients determined? The usual initial route is to get a quick level using an oximeter slipped on a finger. It’s a rapid and supposedly accurate measure of how much oxygen the patient has in their blood; vital information.

Who questions the oximeter readings? The assumption is that the task is accurate because the device is FDA approved, made by a reputable company, and has been used for years in hospitals. But that conclusion is patently false.

The validity of the readings was made primarily on persons of European descent. How accurate would they be on anyone who did not meet that criterion? The answer would seem obvious.

Studies dating back to 2005 show pulse oximeters tend to overestimate the amount of oxygen a patient with darker skin may actually have in their blood. It’s simple physics: Melanin in skin absorbs some of the light the devices analyze to make their readings. The darker the skin, the more melanin there is, and the less light passes through.

If the readings are wrong, how does that have an impact on treatment? Again, no question that there is a bias in oxygen levels leading to changes in medical care.

The FDA issued an alert on oximeters, but did everyone dispose of their older, inaccurate devices in healthcare and the home? Other factors affect these readings, including poor circulation, skin pigmentation, skin thickness, skin temperature, current tobacco use, and use of fingernail polish.

NASA had developed guidelines and devices for more accurately measuring blood oxygen, but the corporation involved in it changed its marketing direction and the device was dropped.

We know that the disturbing use of oximeters tested in Japan (with a relatively homogenous population) may lead to delays in treatment in persons with darker skin. How is this permissible? It’s not, and the NASA devices should be considered again.

The post The Medical Device That May Lead to Harm in People of Color appeared first on Medika Life.

Among those with the most significant risk are older Americans with chronic conditions. From the earliest stages of the pandemic until now, COVID hospitalizations have been six times higher and deaths 12 times higher for people with underlying medical (i.e., non-communicable diseases – NCDs) conditions such as diabetes, heart disease, or chronic lung disease. Currently, 81% of COVID deaths occur in people over age 65. The number of deaths among people over age 65 is 97 times higher than that among people ages 18-29. It’s a dangerous situation that we can overcome if we prepare before the next pandemic wave.

COVID + Diabetes = Serious Risk

For example, consider the brutal truth about one of the deadliest comorbidities in COVID at-risk communities: diabetes.

• Diabetes disproportionately affects racial/ethnic minority populations. Compared with white adults, the risk of having a diabetes diagnosis is 77% higher among African Americans, 66% higher among Latinos/Hispanics, and 18% higher among Asian Americans
• Diabetes prevalence is approximately 17% higher in rural areas than in urban areas, with studies showing that rural adults were more likely to report a diagnosis of diabetes than urban counterparts
• Some 33% of adults aged 65 or older have pre- or Type 2 diabetes. This age group is more at risk of developing diabetes-related complications like low blood sugar, kidney failure, and heart disease than younger people.

The scale of this patient challenge is immense. Approximately 84 million adults — more than 1 in 3 Americans — have prediabetes. According to the Centers for Disease Control (CDC), 90% of people with prediabetes do not know they have it; neither do they know that if left unchecked, it may lead to Type 2 diabetes.

Though its symptoms are subtle, prediabetes is insidious, and as with elevated blood pressure and high cholesterol, it can quickly become deadly. Add another pandemic into the mix, and we know where our subsequent waves of hospitalizations and deaths will come from: seniors, people of color, and rural Americans. We are not prepared, but if we recognize the risk and mobilize health professionals now, we will save lives later.

Further complicating our ability to address this threat is our disregard for prediabetes. For many people, prediabetes means, “Whew! I don’t have diabetes.” But prediabetes requires critical intervention and requires patients to change their behavior. Public health leaders must organize payers, patient groups, and providers – especially pharmacists and long-term care pharmacists – and that must happen before the next pandemic hits. We must get smarter and faster and not wait until the coffins pile up.

Primary Care Has A Change of Address

While this pressing public health threat becomes more urgent, our front-line defense, primary care, undergoes retreat in some cases and fundamentally changes to a retail pharmacy setting in others. These changes may presage increased access to care for some. Conversely, it could allow older patients to fall through the cracks in the face of the growing threat of non-communicable illnesses such as diabetes.

Historically, primary care providers diagnosed, treated, and engaged these consumers. Can walk-in services alleviate people’s ongoing care burden and be ready for the next pandemic?  Corporate and clinical leaders of the mega-chains and community retail pharmacies retail must rally these sites to be front-line communicators regarding non-communicable illnesses, especially prediabetes. Pharmacies are no longer just locations where you can grab a jab – an immunization, vaccine, or booster. Pharmacists will need greater input and support as we go forward and face emerging pandemics.

The ability to walk into a CVS MinuteClinic, Walgreen Health Corner, or Walmart Health for primary care is a win for access to manage pressing health needs. But will ongoing, long-term preventive care — featuring a plan for wellness care instead of sick care — be addressed at these sites? People “shop around” for medical convenience and not necessarily for provider relationships, another reason retail clinics need to be part of the preventive care solution.

Today, fewer and fewer people have a long-term family physician who tracks their needs and feels responsible for their longevity. The single-practitioner office is now being absorbed into larger practice groups and private practices are vanishing. Without the diagnostic oversight a trusted healthcare provider offers, we are missing an essential link between urgent and specialty care,  prevention and illness,  and prediabetes and diabetes.

Weathering the Storm

It is a perfect storm. Poorer diet, higher sugar intake, and increasingly sedentary lifestyle lead to prediabetes, which isn’t straightforward to diagnose and is often not taken seriously by patients. And, as we have seen, the essential player in defense against the condition — the primary care physician — is beginning to step off the stage.

To meet the challenges posed by diabetes/prediabetes epidemic, the lack of primary care patient support, and the persistent threats posed by COVID and other pandemics which will emerge, we need to consider the following actions:

1. Easy-Access Diagnostics Technologies – Retail pharmacies must ally with point-of-care and home-testing companies such as Babson Diagnostics and ixlayer. Consumers at risk must be empowered to take greater responsibility for their well-being. Give people with NCDs easily accessible tools to be full partners in preventive care.

• Find a Digital Connection – Netflix pings us about movies and TV shows that might attract our interest. Political parties use texts and email to rally the faithful. It’s time health insurance companies and the CDC find creative ways to enter the game using AI and digital health to establish closer relationships with consumers, helping people with diabetes to become aware of and purchase products to address their healthy lifestyle needs. Keeping people alive and well is a mutual interest of insurers and the CDC.
• Deputize Pharmacists:Pharmacists were always able to do much more than give shots, and now primary care nurses and assistants have found a home in retail pharmacies.  CDC and physician associations need to recognize that seniors and people with diabetes increasingly see pharmacy as a go-to for questions, easily accessible solutions, and vaccinations.  The American Pharmacists Association is raising the bar on public health resources.

• Start Talking to People: There is “no one-size fits all” effective way to communicate about COVID-19. The 65+ community faces different risks than the 15-and-under crowd.  People with diabetes and heart disease face heightened risks from COVID.  People of color are often at particular risk for these illnesses, compounded by COVID. The CDC needs to address people’s specific needs and risks better. People are tired of hearing about COVID. They are less worn out from hearing about what matters to their particular interests.

CDC is the target of many critiques right now. More than 80 years ago, British Wartime Prime Minister Winston Churchill told the New Statesman: “Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things.”  For people in science, failure does not mean the end – it’s the rocket fuel of future success. The CDC will learn from the COVID chapter and return ready for the next viral confrontation.  Our lives depend on its success.

The post Taking On Prediabetes Could be America’s Best Defense Against COVID-19 appeared first on Medika Life.

There are many reasons for the failure to convince people to take sensible preventive measures. Still, a significant cause of COVID’s blow to the authorities’ credibility is that the time is over for the one-size-fits-all messages that characterized successful public health campaigns of the past. They have been notably ineffective at a time when anyone with an edgy opinion and a Twitter account is a tribal influencer. With just 240 characters, a naysayer can completely counter science when their audience unleashes a cascade of likes and retweets.

Stop Shadowboxing

The government, especially The Centers for Disease Control (CDC) and the scientific community can overcome the damage to their credibility by going small.  Focusing on specific targets and “micro-communicating,” officials and scientists can speak directly to those with the most to lose: their lives. These are the audiences with real skin in the game.

From the earliest stages of the pandemic until now, COVID hospitalizations have been six times higher and deaths 12 times higher for people with underlying medical conditions such as diabetes, heart disease, or chronic lung disease. Currently, 81% of COVID deaths occur in people over age 65. The number of deaths among people over age 65 is 97 times higher than that among people ages 18-29.

Broad messaging now flies over most people’s heads. It’s certainly doesn’t speak to patients who are BIPOC, seniors and rural Americans, patients who are struggling the most to access this nation’s health system and who are also the most at risk during viral fall-out. Their lives are on the line as we learn from communication missteps and prepare for the next pandemic.

For example, consider the brutal truth about one of the deadliest comorbidities in the COVID at-risk community: people with diabetes.

• Diabetes disproportionately affects racial/ethnic minority populations. Compared with white adults, the risk of having a diabetes diagnosis is 77% higher among African Americans, 66% higher among Latinos/Hispanics, and 18% higher among Asian Americans
• Diabetes prevalence is approximately 17% higher in rural areas than in urban areas, with studies showing that rural adults were more likely to report a diagnosis of diabetes than urban counterparts
• Some 33% of adults aged 65 or older have prediabetes or Type 2 diabetes. This age group is more at risk of developing diabetes-related complications like low blood sugar, kidney failure, and heart disease than younger people.

The CDC and other players must aggressively engage in conversations with these most vulnerable audiences. They must learn to target their messages and hone their digital marketing savvy to reach them and the patient coalitions that tap into other groups’ grassroots reach.

Part of the Problem is that Primary Care May Have Thrown in the Towel

The pressing public health threat of COVID took place just as our front-line medical defense force — primary care —was in retreat. Primary care is morphing before our eyes into a pharmacy convenience-store service plug-in. And while the ability to walk into a CVS MinuteClinic, Walgreen DR Walk-In, or Walmart Care Clinic for primary care is in many cases a win for access to care, it presents a challenge for communicators.

Today, fewer and fewer people have a long-term family physician who tracks their needs and feels responsible for their longevity. The single-practitioner office is now being absorbed into larger practice groups and private practices are vanishing. Without that relationship with a trusted healthcare provider, patients are missing out on the immediacy of personalized advice.

The CDC and other public health authorities must consider that a key communications ally has changed locations, and the forwarding address might be community-based retail pharmacies.

Communicators Need to Change their Game to Win in this Ring

A learned medical advisor — whether an in-person physician advocate or one powered by smart technology — who knows our name and what’s happening with us over time still matters. It is the best defense against diabetes and other chronic conditions and the threat posed by deadly viruses when coupled with those preexisting conditions. Even in the changing medical landscape still struggling to overcome COVID-19 and the unresolved challenges of racism that result in illness and death, there must always be a place for that relationship. Otherwise, the ticking time bomb of millions of Americans with preexisting conditions will morph into an overwhelming public health crisis when the next pandemic hits.

CDC must now think smarter and partner with major patient-centered not-for-profit groups such as the American Cancer Society, American Diabetes Association, and American Heart Association so that they can take on the primary conversation role with their communities. 

And they must forge even stronger ties with the retail community and long-term care senior pharmacy networks to fill the communications role once played by family physicians, a vital link in conveying the importance of information on public health imperatives, especially those related to combatting viral epidemics.

Down But Not Out – CDC Knows the Ropes

CDC must use the time we have now to train for the next round. Unfortunately, there will be another fight against a viral opponent soon enough, though we can’t predict when. But like any determined fighter would, our public health players must head train and spar with proven communication players to perfect how and to whom they communicate their scientific data and life-saving guidance. What’s at stake is a world title for our survival.

The post CDC Lost Round One – But the Public Health Match Continues appeared first on Medika Life.

But some clinicians are also hesitant to discuss weight with their patients. Because obesity is so stigmatized and such a sensitive topic, many providers don’t want to offend anyone, so they don’t bring up weight at all, even when the patient’s long-term health is at risk. This is not uncommon as most providers receive inadequate training on what obesity is (a complex, chronic disease), how to treat it (medical intervention is generally indicated per guidelines) and how to discuss it appropriately with patients. Now that we have more effective treatments for obesity and access to care is slowly improving, however, patients in my obesity medicine practice have actually begun to lament that their primary care and women’s health providers are staying quiet.

Many women first experience difficulty losing weight in connection with pregnancy or menopause. But because obesity is associated with more than 200 health conditions (including type 2 diabetes, coronary disease, sleep apnea, urinary incontinence, breast cancer, osteoarthritis and depression, to name just a few), providers in virtually any context can find themselves wondering whether and how to talk to patients about their weight.

If the patient presents with an acute condition or a situation that’s not weight-related, it may not be an opportune time to bring up the subject; however, if weight is pertinent to the patient’s medical concern, gently raising the issue in the context of that condition could be appropriate and even welcome. The following are tips to help make that discussion more fruitful.

1. Ask permission

Address the patient’s concerns first, and then ask permission to talk about her weight, explaining why it’s relevant.

If the patient doesn’t want to address the issue, respect her wishes and simply let her know that you’ll be there to provide support when she’s ready.

• Think about language and tone

With regard to terminology, weight experts recommend putting people first, to avoid defining them by their disease. In the same way that we would refer to “people with schizophrenia” rather than “schizophrenics,” we say “people with obesity” rather than “obese people.” We also try to avoid euphemisms (like “people of size” or “curvy women”) as well as terms that suggest victimhood (“she suffers from obesity”).

Although obesity is widely recognized as a complex chronic disease, and many people find it extremely liberating to realize that their inability to lose weight is due to biology rather than a lack of willpower, the terms “obesity” and “disease” themselves can be off-putting. I find that most patients tend to respond better to “excess weight” and “medical condition.”

The essential thing, in every interaction, is to be empathetic and respectful. Individuals with obesity are more than pounds on a scale, and they are not lazy or lacking in willpower. They are fighting a multifactorial disease. Whatever their weight, they deserve the best in compassionate, evidence-based care — just like patients with any other condition.

• Assess without making assumptions

Always assess the situation before telling patients what to do. While it’s true that obesity can cause or compound a wide variety of health issues, excess weight isn’t always the source of these problems. Providers who immediately tell their patients to lose weight, without considering all the potential causes and conducting a thorough assessment, risk overlooking other serious conditions.

It’s also possible that the patient has already lost considerable weight; insisting she do more without acknowledging this achievement may be demoralizing. Relatively small amounts of weight loss (5%-10% of body weight) can bring significant health benefits over time, even if the individual’s BMI isn’t within the normal range, so knowing the patient’s weight history is key.

Or maybe the patient has already made all the recommended lifestyle changes but her efforts are being thwarted by medications that promote weight gain. Drug-induced weight gain is common with some forms of birth control and antidepressants, for example, and this issue should be taken into account when evaluating the risks and benefits of any medication. If a woman needs hormonal treatments for breast cancer, for instance, it’s obviously most important to treat the cancer first, but when equivalent weight-neutral medications are available in any given situation, they should be considered first.

In short, it’s critical to get the full picture and listen carefully to the patient’s story to understand what factors have contributed to her weight gain and what barriers might be preventing weight loss. Specific factors and barriers are associated with each weight-related health condition, and these factors depend on the woman’s stage of life, comorbidities and other variables. An effective individualized treatment plan requires a thorough assessment.

• Provide support

If the patient agrees that she’s ready to make changes, simply telling her to eat less and exercise more is unlikely to be helpful. Obesity is a medical condition that needs to be addressed with a comprehensive medical approach, with ongoing support and regular follow-up.

Lifestyle changes are the cornerstone of any weight-management program, so focus first on collaboratively setting realistic goals for healthy eating and physical activity. If you don’t have the time or expertise to provide the necessary guidance, you can connect your patients with outside resources such as dietitians, behavioral therapists, health coaches, and community or telehealth programs.

When lifestyle interventions have been optimized or aren’t working, consider referring patients to an obesity medicine specialist to discuss adding anti-obesity medications to the mix. These agents can help overcome metabolic adaptation (our bodies’ anti-starvation responses to weight loss that push weight back up) and allow patients to lose significant weight.

• Offer hope

Most women with obesity have tried to lose weight many times, only to gain it back. This pattern often leads not only to feelings of shame and personal failure, but also to a sense of futility. To give these women hope, it’s important to emphasize, first, that their inability to lose weight is not their fault — the body has evolved many complex hormonal, metabolic, and neurobehavioral mechanisms to actively fight weight loss — and second, that excess weight is a treatable condition.

Every day we’re learning more about this complex disease, and although only 2% of eligible patients are currently receiving medical weight management according to guidelines, telemedicine and data-driven tools are expanding access to evidence-based obesity treatment, new anti-obesity medications offer increasingly effective pharmacotherapy options, and insurance coverage of obesity treatment is improving. Now is not the time to give up!

If we as women’s healthcare providers can help our patients overcome the discomfort of bringing up a difficult topic, we can help more women with obesity achieve better health and well-being.

The post Hesitant to Discuss Weight with Your Patients? appeared first on Medika Life.