Office of the National Coordinator for Health IT and Accenture Federal Services to demonstrate how patient-generated health data (PGHD) can best be delivered to clinicians and researchers to improve patient care and outcomes.

The federal pilot, which began in September 2016 and continues through August 2017, is a collaboration with Sutter Health, a 24-hospital health system in Northern California with over 11 million outpatient visits per year.

The pilot will focus on providing remote care and interventions using digital health devices to better manage and engage a population suffering from Type 2 Diabetes.


Genetics of Adipose Fat

The thrifty gene hypothesis (also called the famine hypothesis) states that in some populations the body would be more efficient at retaining fat in times of plenty, thereby endowing greater resistance to starvation in times of food scarcity. This hypothesis, originally advanced in the context of glucose metabolism and insulin resistance, has been discredited by physical anthropologists, physiologists, and the original proponent of the idea himself with respect to that context, although according to its developer it remains “as viable as when [it was] first advanced” in other contexts.[42][43]

In 1995, Jeffrey Friedman, in his residency at the Rockefeller University, together with Rudolph Leibel, Douglas Coleman et al. discovered the protein leptin that the genetically obese mouse lacked.[44][45][46] Leptin is produced in the white adipose tissue and signals to the hypothalamus. When leptin levels drop, the body interprets this as a loss of energy, and hunger increases. Mice lacking this protein eat until they are four times their normal size.

Leptin, however, plays a different role in diet-induced obesity in rodents and humans. Because adipocytes produce leptin, leptin levels are elevated in the obese. However, hunger remains, and – when leptin levels drop due to weight loss – hunger increases. The drop of leptin is better viewed as a starvation signal than the rise of leptin as a satiety signal.[47] However, elevated leptin in obesity is known as leptin resistance. The changes that occur in the hypothalamus to result in leptin resistance in obesity are currently the focus of obesity research.[48]

Gene defects in the leptin gene (ob) are rare in human obesity.[49] As of July, 2010, only 14 individuals from five families have been identified worldwide who carry a mutated ob gene (one of which was the first ever identified cause of genetic obesity in humans)—two families of Pakistani origin living in the UK, one family living in Turkey, one in Egypt, and one in Austria[50][51][52][53][54]—and two other families have been found that carry a mutated ob receptor.[55][56] Others have been identified as genetically partially deficient in leptin, and, in these individuals, leptin levels on the low end of the normal range can predict obesity.[57]

Several mutations of genes involving the melanocortins (used in brain signaling associated with appetite) and their receptorshave also been identified as causing obesity in a larger portion of the population than leptin mutations.[58]

In 2007, researchers isolated the adipose gene, which those researchers hypothesize serves to keep animals lean during times of plenty. In that study, increased adipose gene activity was associated with slimmer animals.[59] Although its discoverers dubbed this gene the adipose gene, it is not a gene responsible for creating adipose tissue.

Pre-adipocytes are undifferentiated fibroblasts that can be stimulated to form adipocytes. Recent studies shed light into potential molecular mechanisms in the fate determination of pre-adipocytes although the exact lineage of adipocyte is still unclear.

Ectopic Fat

Ectopic fat is defined by the deposition of triglycerides within cells of non-adipose tissue that normally contain only small amounts of fat. Over the past decade, magnetic resonance spectroscopy has been used extensively for noninvasive quantification of intramyocellular, intrahepatocellular, and more recently myocardial and pancreatic lipids. In liver and muscle, triglyceride content usually correlates with whole-body and tissue-specific insulin sensitivity. However, fat mass and oxidative capacity influence this relationship, indicating that ectopic lipid content is not the only factor that explains insulin resistance. Ectopic lipids may rather serve as biomarkers of the balance between metabolic supply and demand in different states of insulin sensitivity. Consequently, ectopic lipid concentrations, particularly in the liver, decrease with lifestyle- or drug-induced improvement of insulin sensitivity.

  • These foods supply important nutrients that are often low in diabetics and pre-diabetics, and linked to conditions like stroke, heart disease, hypertension, gastrointestinal ailments and obesity
  • About half of all American adults are either pre-diabetic or diabetic. Even one-third of normal-weight adults may also be pre-diabetic without knowing it
  • Diabetes is rooted in insulin resistance and malfunctioning leptin signaling, caused by chronically elevated insulin and leptin levels. This is why treating type 2 diabetes with insulin does not resolve the problem
  • Dietary recommendations for diabetics include a diet high in healthy fats, moderate protein and low in net carbs.


Most cases of diabetes mellitus type 2 involved many genes contributing small amount to the overall condition.[1] As of 2011 more than 36 genes have been found that contribute to the risk of type 2 diabetes.[2] All of these genes together still only account for 10% of the total genetic component of the disease.[2]

There are a number of rare cases of diabetes that arise due to an abnormality in a single gene (known as monogenic forms of diabetes).[1] These include maturity onset diabetes of the young (MODY), Donohue syndrome, and Rabson-Mendenhall syndrome, among others.[1] Maturity onset diabetes of the young constitute 1–5% of all cases of diabetes in young people.[3]


Genetic cause and mechanism of type 2 diabetes is largely unknown. However, single nucleotide polymorphism (SNP) is one of many mechanisms that leads to increased risk for type 2 diabetes. To locate genes and loci that are responsible for the risk of type 2 diabetes, genome wide association studies (GWAS) was utilized to compare the genomes of diabetic patient group and the non-diabetic control group.[4] The diabetic patients’ genome sequences differ from the controls’ genome in specific loci along and around numerous genes, and these differences in the nucleotide sequences alter phenotypic traits that exhibit increased susceptibility to the diabetes. GWAS has revealed 65 different loci (where single nucleotide sequences differ from the patient and control group’s genomes), and genes associated with type 2 diabetes, including TCF7L2, PPARG, FTO,KCNJ11,NOTCH2, WFS1, IGF2BP2, SLC30A8, JAZF1, HHEX, DGKB, CDKN2A, CDKN2B, KCNQ1, HNF1A, HNF1B MC4R,GIPR, HNF4A, MTNR1B, PARG6, ZBED3, SLC30A8, CDKAL1, GLIS3, GCKR, among others.[4][5][6][7]KCNJ11 (potassium inwardly rectifying channel, subfamily J, member 11), encodes the islet ATP-sensitive potassium channel Kir6.2, and TCF7L2(transcription factor 7–like 2) regulates proglucagon gene expression and thus the production of glucagon-like peptide-1.[8] In addition, there is also a mutation to the Islet Amyloid Polypeptide gene that results in an earlier onset, more severe, form of diabetes.[9][10] However, this is not a comprehensive list of genes that affects the proneness to the diabetes.

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9 Super foods

  • From Dr Mercola:
  • The following are nine “superfoods” for diabetics7 that you’d be wise to add to your diet on a regular basis.


    1.Fatty Fish Low in Mercury

    One of the most important foods for diabetes is seafood, as it provides the essential animal-based omega-3 fat docosahexaenoic acid (DHA) from a food source.

    DHA is vitally important as it is the only fat we know of that allows your body to take advantage of the photoelectric effect, the one that Einstein received his Noble Prize for. It converts the photons from the sun into DC electric current (electrons), which help fuel your mitochondria.

    Optimal levels of DHA are one of the most important nutritional interventions that you can choose to make. If you haven’t already checked your omega-3 index test to confirm your levels are adequate, I would strongly encourage you to do so.

    That said, as levels of pollution have increased, you have to be very choosy about which types of seafood you eat. Most major waterways in the world are contaminated with mercury, heavy metals and chemicals like dioxins, PCBs and other agricultural chemicals. If you’re not careful, the toxic effects from the pollutants in the fish will outweigh the benefits of the omega-3 fats. Here are some important factors to consider:

    Choose fatty fish from cold-water locations, as not all seafood is a good source of omega-3. Good choices include wild-caught Alaskan sockeye salmon, sardines, anchovies, herring and fish roe.

    Avoid farm-raised fish, as they can actually be more hazardous than wild in terms of their toxic content. For example, researchers warn that farmed salmon may be one of the most toxic foods in the world, thanks to toxins found in the feed. Levels of omega-3 fats may also be reduced by as much as 50 percent in farmed salmon, compared to wild salmon, due to the grains they’re fed.

    To evaluate your mercury exposure from various seafood sources, check out the online mercury calculator at The Environmental Working Group (EWG) also has a seafood calculator9 that can help you identify fish that are high in omega-3 and low in pollutants.


    Avocado (which is actually a fruit, not a vegetable) is a great source of healthy fat, fiber and about 20 different vitamins and minerals, including magnesium. As noted by Medical News Today:

    “Eating foods that contain healthy fats may help increase fullness. Eating fat slows the digestion of carbohydrates, which helps to keep blood sugar levels more stable. Avocado is high in fiber too, with half a fruit containing 6 to 7 grams … Eating high-fiber foods can … improve weight loss, and make insulin more efficient. Spread avocado on toast in the morning instead of butter. Use avocado instead of mayonnaise in chicken or egg salad.”

    3.Seeds (Sunflower, Black Sesame, Black Cumin, Pumpkin and Chia)

    Magnesium is a very important nutrient that many are deficient in. Lack of magnesium may raise your risk of insulin resistance, as it plays an important role in carbohydrate and glucose metabolism. Besides that, your body needs magnesium for more than 300 other biological and chemical processes, so make sure you’re getting enough. As noted by Medical News Today:10

    “For every 100 [milligram per day] mg/day increase in magnesium intake (up to a point), the risk of developing type 2 diabetes decreases by approximately 15 percent.11 Most magnesium intake in these studies was from dietary sources, not supplements.

    Clinical studies have shown improvement in insulin sensitivity with magnesium intake between 300 and 365 mg/day.Researchers were also able to show that low magnesium levels resulted in impaired insulin secretion and lower insulin sensitivity.”

    Some of the most magnesium-rich foods are seeds. Additionally, although most of us are overloaded on unhealthy industrially processed omega 6 oils, we clearly need some, and unprocessed seeds are a terrific source:

    Sunflower: One-quarter cup of sunflower seeds gives you 128 mg of magnesium.

    Black sesame: One ounce of sesame seeds contains about 101 mg of magnesium.

    Black cumin: Black cumin has a long history of medicinal use. Packed with antioxidants and immune-boosting components, black cumin has even been shown to have potent anti-cancer activity.12 Studies have also shown black cumin can help prevent both type 1 and type 2 diabetes. In one study, black cumin (nigella sativa) improved glucose tolerance as efficiently as metformin.13

    Pumpkin: Two tablespoons of pumpkin seeds will provide you with 74 mg of magnesium (about 25 percent of your recommended daily intake). Pumpkin seed butter can be made at home; simply blend whole, raw pumpkin seeds in a food processor until smooth.

    Chia: Besides magnesium, chia seeds are also a good source of healthy fats, fiber and antioxidants. Just 1 ounce of chia seeds provides 10 grams of fiber. Add them to smoothies and salads

    Other foods high in magnesium14 include nuts (especially almonds and cashews) and dark leafy greens (especially boiled spinach, which provides 78 mg of magnesium per cup). Avocados also contain magnesium.

    4.Fiber and Digestive-Resistant Carbs

    Diabetics also need to mind their fiber intake. Research15 shows that people with high intakes of dietary fiber not only have a significantly lower risk of obesity and diabetes, but also a lower risk of coronary heart disease, stroke, hypertension and gastrointestinal ailments.

    Importantly, higher fiber intake has been shown to improve glycemia, leptin and insulin sensitivity in non-diabetic and diabetic individuals alike. The best sources of fiber in your diet come from whole foods and include the following. Aim for about 50 grams of fiber per 1,000 calories consumed.

    Chia seeds Berries Almonds
    Cauliflower Root vegetables and tubers, such as onions and sweet potatoes Green beans
    Peas Vegetables, such as broccoli, cauliflower and Brussels sprouts Organic psyllium seed husk
     Artichokes  Freshly ground flaxseed meal. Never use pre-ground as it is oxidized and damaged Black beans

    Digestive-resistant starches also help maintain a steady blood sugar level. This refers to low-viscous dietary fibers that resist digestion in the small intestine and slowly ferment in your large intestine.16 Here, resistant starches act as prebiotics, feeding healthy bacteria. Since they’re indigestible, resistant starches do not result in blood sugar spikes. In fact, research suggests resistant starches help improve insulin regulation, reducing your risk of insulin resistance.17,18,19,20

    Foods high in digestive-resistant starch include certain underripe fruits, specifically banana, papaya and mango, as well as white beans, lentils, seeds and products like potato starch, tapioca starch and brown rice flour. Interestingly, cooking a normally digestible starch such as potato or pasta and then cooling it in the refrigerator will alter the chemistry of the food, transforming more of it into resistant-type starch.21


    Research shows higher nut consumption is associated with lower body weight, which is helpful for maintaining normal blood sugar levels.22 Walnuts, in particular, are a healthy choice for diabetics as they’re high in fiber and healthy fats.

    In one recent study,23 participants at increased risk of developing diabetes who added 2 ounces of walnuts to their daily diet for six months showed improvements in blood vessel wall (epithelial) function, and lower levels of low-density lipoprotein (LDL) cholesterol.

    Walnuts are great for snacking when you might otherwise be tempted to reach for chips or crackers. You can easily make your own trail mix, combining walnuts, pumpkin seeds and raw cacao nibs, for example. They’re also a great addition to salads.


    Besides magnesium, spinach is also a superb source of potassium, low levels of which have been linked to an increased risk of diabetes and diabetes complications. Cooked spinach provides 839 mg of potassium per cup. For comparison, 1 cup of banana — well-known as a potassium-rich food — contains 539 mg of potassium. One way to dramatically increase your spinach intake is to juice it. You can also add it to salad along with other mixed greens.


    Fisetin, a substance found in strawberries, has been shown to prevent kidney and brain complications in diabetic mice.24Human studies have also demonstrated that people who eat plenty of berries, such as strawberries and blueberries, have a lower risk of both diabetes, heart attacks and dementia — outcomes thought to be related to the anthocyanins (a class of flavonoids) found in red, blue and purple-colored berries.25

    Studies have also linked the high vitamin C content of strawberries to a lower risk of type 2 diabetes. One cup of fresh strawberries provides 160 percent of your daily need of vitamin C. They’re a delicious addition to salad (spinach, walnut and strawberries make a tasty combination). You can also blend fresh or frozen strawberries into your smoothies. According to one such study:26

    “Though diabetes is not traditionally considered a risk factor for vitamin C deficiency, patients with diabetes should all receive dietary advice about healthy eating and vitamin C dietary sources, including fresh fruits and vegetables. The recommended dietary intake of vitamin C is 45 mg per day for adults.

    There are some data suggesting that people with diabetes may have increased cellular uptake and turnover of vitamin C that would necessitate increased intake, and they also have an increased risk of deficiency.”


    Research suggests ginger may help reduce fasting blood sugar in diabetics.27 Part of this effect relates to its anti-inflammatory capacity. Indeed, anti-inflammatory diets in general are helpful for the prevention of diabetes. Ginger is often used in cooking. For example, you can add fresh, grated ginger to sauces, marinades and dressing. Alternatively, drink a cup or two of ginger tea each day. Simply steep a slice of fresh ginger in boiling water for a few minutes.


    Cinnamon is another common cooking spice that has garnered attention for its anti-diabetes benefits. Besides sprinkling it onsweet potatoes or carrots, you can add it to tea for a flavorful kick in lieu of sugar, which is best avoided anyway. As noted in Medical News Today:28

    “Participants in one study29 who took a high dose of cinnamon reduced their average blood sugar levels from 8.9 percent to 8.0 percent. Participants who took a low dose of cinnamon reduced their average blood sugar levels from 8.9 to 8.2 percent. Participants who did not take cinnamon saw no change.”

    Connie’s notes: Avoid over-ripe fruits, fruit juices (not freshly squeeze), eat in moderation with high-fiber whole foods, avoid charred meat, trans fat, and add lemon in your drinking water.