CLOSE

Yearly Archives: 2016

by -
0 260
The Incorporated Village of Poquott. File photo

It is now known whose names will appear on the ballot for Village of Poquott residents when they head to the polls to elect a mayor and two board trustees on June 21.

State Supreme Court Justice W. Gerard Asher ruled Wednesday on the challenge filed by mayoral candidate Barbara Donovan and her running mates Michael Schaefer and Joan Hubbard of the validity of petitions submitted by incumbent mayor Dee Parrish and trustee hopefuls Gary Garofano, Sandy Nicoletti and John Mastauskas.

Justice Asher found in favor of Donovan and her party, according to the state Supreme Court office. Parrish, Garofano, Nicoletti and Mastauskas will not appear on the ballot.

Donovan, Schaefer and Hubbard, known as the party of “Unity and Respect,” filed the challenge to the petitions because they believed the petitions contained errors, and names and signatures submitted may have been photocopied, Donovan told Newsday in May.

Since the challenges were filed, tension has spread within the tiny community that falls within the Town of Brookhaven. On June 1, Parrish and the rest of the current board, which includes Nicoletti, called an emergency meeting to discuss what action they would take in response to the challenge filed by Donovan and her party. Donovan served as the village’s mayor for years until Parrish defeated her in the 2014 election.

At the beginning of the meeting, the board immediately moved into executive session behind closed doors, leaving community members frustrated and searching for clarity.

When they returned, the board briefly discussed their options regarding the challenge, before voting to allow for additional expenses incurred as a result of the suit against the village and Village Clerk Joe Newfield regarding the petitions to be covered. The meeting was adjourned and no public comment was allowed. Parrish and Village Attorney Joe Prokop declined to comment about the situation after the meeting.

Parrish commented on the legal battle on June 2 via email.

“It is unfortunate that a group that has based their platform on respect and unity has managed to disrespect the residents in the Village of Poquott through the filing of this suit,” she said.

Parrish sited a possible chilling effect that the suit could have on potential candidates in the future as a harmful precedent for the village to set.

Village resident John Hahm, unsatisfied with the outcome of the June 1 meeting submitted a letter to the Village Times Herald on June 2.

“Challenging petitions is not a political strategy, it is a demand for accountability when a person deliberately disregards the law,” Hahm said. “Two of the petitioners happen to be current board members who promised open and transparent government. Surely they could have produced their petitions before acknowledging that the challenges were detrimental to the spirit of an election.”

Robert Lifson, attorney for Parrish and her running mates said Wednesday in a phone interview he was “disappointed” by the ruling. He wouldn’t specify his clients’ plan of action going forward, but suggested an appeal was possible. Lifson also said it’s not beyond the realm of possibilities to win a village election without being on the ballot. He said he advised his clients to drop their defense prior to the ruling because the costs to fight the suit would be too great.

by -
0 2105
Sofia Pace of Smithtown shows off her catch of the day — an 18 inch largemouth bass caught at Willow Pond last summer. Photo from Paul Pace

By Rita J. Egan

Once the warm weather arrives, it can be a challenge when it comes to keeping children busy. Teaching them how to fish is a fun way to get them outside and have them connect with nature. Fortunately, for Long Islanders, in addition to water surrounding the region, the area is home to the Nissequogue River as well as other fish-filled waterways.

During fishing season, budding anglers can bring their poles and barbless hooks to the north side of Caleb Smith State Park Preserve in Smithtown and fish in the park’s Willow Pond, which empties into the Nissequogue.

The preserve’s environmental educator, Linda Kasten, said the park has offered children’s fishing since it opened in 1974, and little anglers can take home a fish depending on its size. A sign by Willow Pond lists the requirements that fish must be nine inches or larger, except in the case of a trout or largemouth bass, which must be more than 12 inches. Anglers who catch smaller fish are required to release them back into the river. 

Kasten said families who come to the preserve for a day of fishing are asked to sign in at the Caleb Smith House on the property and then return at the end of the session to let the staff know what fish they caught and how big.

From left, Sofia and Angelina Pace of Smithtown with a bluegill they caught last summer at Willow Pond. Photo from Paul Pace
From left, Sofia and Angelina Pace of Smithtown with a bluegill they caught last summer at Willow Pond. Photo from Paul Pace

When a child catches a fish, the educator said, “They think it’s the coolest thing.”

The park employee said she has seen children catch pumpkinseed fish, bluegills, largemouth bass and occasionally rainbow trout. Most of the fish that the junior anglers catch at the park are the panfish variety, which are small enough to cook in a pan yet still large enough to meet the requirements of fishers not having to release them back in the water.

Depending on the age of the child, fishing could keep them busy for a couple of hours or more, according to Kasten. “When they come with friends, they’ll sit out there for hours,” she said.

Last year the educator said there was a group of five young teenagers who would come to the park practically every weekend, and they always caught fish. “They were so excited just to be with each other, let alone fishing and catching stuff,” Kasten said.

Smithtown resident Paul Pace has been bringing his two daughters, Sofia (7) and Angelina (3), to fish at the park for the last two years. It was during a visit to the preserve, which features walking trails and a nature museum in the Caleb Smith House, that the father, a fisherman himself, saw the sign and thought it would be a great idea to teach his girls the sport.

Pace said his daughters will spend a good two hours fishing. He said he loves that, “it gets them away from computer-driven things. It’s real life. They breathe in the fresh air, see some animals, plants, birds, and do some exploring.”

However, he said they don’t find a lot of time to explore the preserve because they are very lucky fishing there. “We catch a lot of fish so there’s always some action,” the father said.

Pace said one day last year, his oldest caught an 18-inch bass, and they were able to keep it and cook it. He said his daughters are developing a love for the sport and can’t wait until they are older and can fish from a boat. “They get really super excited. They love it; they’re reeling them in. Especially that big one — they both freaked out!” he said.

Besides fishing being a fun family activity, Pace also believes that it can teach children some important life lessons. “To cast the line takes a lot of practice and patience and determination. Sofia, she was casting last year … really good. There’s always something to accomplish,” Pace said. 

’[Fishing] gets [kids] away from computer-driven things. They breathe in the fresh air, see some animals, plants, birds and do some exploring.’
—Paul Pace

Each year before the season begins, the preserve offers fishing clinics so young anglers can learn some useful tips. The Friends of Caleb Smith Preserve also hosts an annual Junior Angler Catch and Release Tournament at the park. For $15 per participant, children 12 years and under can compete for prizes for the most fish caught and largest fish reeled in. This year the event takes place this Saturday, June 11, when children  ages 5 to 8 will compete in the morning and kids ages 9 to 12 will cast their poles in the afternoon.

Fishing season at Caleb Smith State Preserve Park, 581 W. Jericho Turnpike, Smithtown, runs from April 1 to Oct. 31. There is no charge for fishing; however, a parking fee of $8 is in effect, except for Empire Passport holders. Children do not need a fishing license but are required to bring their own equipment. Fishing at Willow Pond is for anglers 15 years and younger, and children under 12 must be accompanied by an adult. For more information about fishing at the preserve or the Junior Angler Catch and Release Tournament, call 631-265-1054 or visit www.nysparks.com/parks/124/.com.

by -
0 271
The Setauket Fire District breaks ground on Saturday. Photo by Kevin Redding

By Kevin Redding

Sound the alarms. On Saturday, June 4, Setauket Fire District officials broke ground on the community-approved New Era construction project, which aims to renovate and expand the current firehouse to provide safer, more efficient and “greener” emergency services. For more than a decade, the $14.9 million project had been through its fair share of planning and proposals, and after a long community effort to get it approved, a bond vote in June 2014 finally sealed the deal.

With construction finally starting, District Manager David Sterne, along with members of the Setauket Fire District and elected representatives, commemorated the slow but worthwhile journey toward the refurbished firehouse.

According to Sterne, the primary issue with the firehouse that’s being replaced is that it was built in 1935 and doesn’t meet the needs for today’s fire services, both in size and safety.

For example, today’s modern fire trucks are bigger due to safety necessities, like closed cabs and seat belts and so the project will provide properly sized apparatus bays for new trucks, as opposed to custom ordering the trucks to fit the smaller firehouse. Along with equipment upgrades and storage space, the firehouse also plans to install a partial green roof, a high-efficiency heating system, and solar methods for energy capture.

Brookhaven Councilwoman Valerie Cartright and Supervisor Ed Romaine deliver their remarks at the Setauket Fire Department groundbreaking. Photo by Kevin Redding
Brookhaven Councilwoman Valerie Cartright and Supervisor Ed Romaine deliver their remarks at the Setauket Fire Department groundbreaking. Photo by Kevin Redding

“We have turned this into what we feel is a responsible and efficient project that will help us meet the needs for today and the next 50 to 75 years,” Sterne said. “Knowing the dedication of the men and women who volunteer their time to serve the community, to have the community come out and support this project was a reaffirmation of all the hard work that we do. We felt good in continuing to serve.”

With the sun beating down on a small gathering behind the firehouse, backhoes parked and surrounded by dirt hills, the ceremony was brief and to the point.

Among the speakers were Chairman Paul Paglia, Supervisor Ed Romaine (R), Assemblyman Steve Englebright (D-Setauket) and Councilwoman Valerie Cartright (D- Port Jefferson Station).

Speaking first, Paglia said that this building not only symbolizes a renewed commitment to the community, but also underlines the community’s decision to invest in the future of the fire department. It’s a major endeavor, he said, but one that will give the town a sense of pride for what will come of it.

Romaine expressed his immense pride for the men and women who serve the department, and men and women who guide the district.

Englebright brought his attention to the design plans.

“Your planning has just been exemplary,” he said, facing the fire district officials. “The result is a design that is compatible with the historic neighborhood. We are in the core area of the town of Brookhaven historic district in Setauket and there was every chance on a project of this scale that we could lose our sense of place. But that is not being lost. It is being preserved. I think that the community will be very grateful when they see this rise out of the sand and still look familiar, while serving their needs to protect life and property as never before.”

At the end of the ceremony, the officials and representatives posed in hard hats and dug shovels into the dirt. Even though this will be an 18 to 24 month project, the completion of over a decade’s worth of work is in sight.

“A couple of years from now,” said Sterne, “we’ll be holding those giant scissors and having a big ribbon cutting [ceremony].”

by -
0 193

We all have addictions. I don’t mean we’re all addicted to a narcotic, to alcohol or to something that can cause harm to us, to our families or to our communities.

We think of addictions as negatives, because they suggest a dependency or a need for something without which we find ourselves unbalanced, uncomfortable or unhinged.

There are plenty of positive addictions. Many of us are, for better or worse, addicted to our children. We want them to succeed, to be happy, to live better lives than we’ve had and to have every opportunity to find their niche.

When they’re born, we become addicted to the sound of their giggling and laughter, which helps us get through those sleepless nights just as effectively as a caffeinated beverage. That sound is more pleasant than the most magnificent music we’ve ever heard, than the calls of birds outside our windows in the morning, or than the school bell that signaled the end of another week and the start of a much-anticipated weekend.

Outside of the home, we can become addicted to victory, whether it’s at work, on a softball field where we are competing against a group of people from another company, or at a traffic light where we want to beat the car next to us to the on-ramp for the Long Island Expressway.

Our bodies become accustomed to these addictions. Runners receive chemical endorphins in the brain that give them a high, allowing them to run much longer than someone whose would-be endorphins are knocked unconscious by alcohol or are far too overwhelmed from sugar overload to become active. When you’re driving in extreme heat or cold and you see runners pushing themselves up a steep hill, they are feeding that addiction.

Speaking of feeding, we are addicted to particular foods, or food groups. If we eat cookies every night, our bodies send signals to our brains to find those chocolate chip cookies. We can also become addicted to foods that are healthy for us, like broccoli, blueberries or gluten-free kale pizza.

We can also become addicted to long days of summer sun. When the fall and winter come, we might miss the light, craving it the way we would another cup of mid-afternoon coffee when we’re feeling run down through the day.

But is addiction really the right word? Aren’t these habits and not addictions? I see addictions and habits as a spectrum, somewhat akin to the discussion about what is normal. We all tend to believe we’re normal, but as we know from our own families and from the families we marry into, the range of normal is broad. Every family has its crazy uncles, its eccentric aunts and its oddball distant cousins. Much as we might like to believe the grass is greener with other families, we know that the more we interact with extended family groups, the more likely we are to observe behaviors that fall outside the range of what we consider normal.

So, if we recognize our addictions, can we change them?

Like any addiction, change is challenging. Plenty of support groups offer help, especially with addictions to alcohol, drugs or other substances. There are also groups like Jenny Craig, which offer to provide balanced meals that help people transition to a different diet.

Even without support groups, though, people can fundamentally change some of their addictions, often when they are so concerned with the happiness of someone else — a spouse, a child, a niece or a parent — that their own needs no longer come first.

by -
0 1043

The column I intended for this week has been put aside. This is a historic moment, and as a journalist, with a front row on history, and as a woman in what many still think is a man’s job, I cannot let the moment pass without offering the recognition it surely deserves. Finally, in my lifetime, a woman has become the presidential candidate of one of the two major parties in the United States of America.

Although I have voted for candidates of both parties in different presidential elections, depending which one I thought was better, this has nothing to do with party affiliation. I would never pick party over country. The triumph of this moment does have to do with a struggle for equality in governing that is as recent as my mother’s hard-won right to vote in the 1920s. Can you imagine a time, not prehistoric but merely one family generation back, when women could not even vote? Or earn careers in medicine, law, business, literature or the arts?

This has nothing to do with whether I like Hillary Clinton or don’t like Hillary Clinton, any more than whether I am a Republican or a Democrat. This turn of events feels like we are emerging from the dark ages and into the sunshine of the 21st century. And to be honest, I am surprised at how powerfully this moment affects me.

Yes, I came of age during “women’s lib,” graduating from college at the time Betty Friedan’s book, “The Feminine Mystique,” was published. And yes, I was one of the early wives and mothers in our social circle to balance the needs of a family with those of a business, but frankly I never thought of myself as a member of “the second sex,” or as a revolutionary. I was merely doing what for me “came naturally.” But throughout my life working these dual jobs, I have felt the contradictions within society about a woman’s “role.” Indeed, my own mother was dead set against my starting a newspaper, accusing me of “abdicating my responsibilities at home.” But I thought all that was long past.

Why shouldn’t a woman lead her party in a run for the presidency? If the population feels she is qualified, why shouldn’t she lead her country as president? Now there is a lot more going on during this vindictive presidential campaign than women’s rights. In fact, I wasn’t so aware that the issue of women’s rights was playing a part. So much of the population is angry, frustrated, even frightened with how they are being governed by an obstructionist Congress and a rapidly changing economy.

Thus my surprise by my own reaction on the level of gender equality. I still remember when Geraldine Ferraro, who came to the New York Press Association as the keynote speaker when I was its president in the 1980s, declined my husband’s offer of a corsage. He had bought one for her and one for me, but she explained she “couldn’t look too feminine.”

I also recently remembered with a laugh, as I was recalling early history to my 21-year-old grandson, that I had been propositioned while eating alone in a dining room of a hotel before a convention was to begin there the next day. “Good girls don’t do that,” I was admonished, for dining solo. Lest I chalk up that encounter to a fluke, it happened again on the train trip home.

The past may be past, but it surely isn’t forgotten. And when I looked around the table last month at the board of directors meeting of the NY Press Association and realized that there were only two other women publishers in a room of 28 board members, I realized that the past isn’t even past. But clearly there is hope.

by -
0 338
Billy Witrock competes in the 400-meter intermediate hurdles during the Eddy Games. Photo from Andrew Witrock
Billy Witrock holds up his first-place trophy. Photo from Andrew Witrock
Billy Witrock holds up his first-place trophy. Photo from Andrew Witrock

Port Jefferson senior Billy Witrock came home from the Eddy Games track and field competition in Schenectady a star.

During the meet, the athlete not only took first place in the 400-meter intermediate hurdles, but also set a new Port Jefferson record in the event, with his time of 55.27 seconds.

“I am really happy about it,” said Witrock, who runs on the cross country, winter and spring track teams.

The previous school record of 55.49 seconds was held by Danny Gross and set in 2014.

“He really did an excellent job in a difficult race,” head coach Rod Cawley said.

Aside from being a student-athlete, Witrock also serves as class president. He will be attending Tufts University.

by -
0 442
Ada Robinson mugshot from SCPD

An incident between a homeless couple in a North Shore Home Depot parking lot has left the man dead and the woman behind bars.

The Suffolk County Police Department said on Wednesday morning that detectives had arrested a woman at the scene of a fatal stabbing the night before and charged her with first-degree manslaughter.

Patrol officers from the 6th Precinct were responding to a 911 call in the parking lot of the Home Depot on Middle Country Road in Coram close to 7:30 p.m. when they found 55-year-old Ralph Anthony had been stabbed, police said. He was pronounced dead at Brookhaven Memorial Hospital Medical Center in East Patchogue.

Homicide Unit detectives arrested 60-year-old Ada Robinson at the scene.

Both the victim and the alleged attacker are homeless, according to police. The Homicide Unit’s Lt. Kevin Beyrer said in a phone interview Wednesday that the pair was “at least common-law husband and wife” — they had been a couple for a long period of time, he said, but he wasn’t sure if the two were legally married. They frequented the Coram area where the stabbing took place.

Attorney information for Robinson on the first-degree manslaughter charge was not immediately available on Wednesday morning.

She has previous charges against her of assault with a weapon, stemming from an incident with Anthony on May 9, 2015, according to the New York State court system’s online database. Her attorney on the one felony and one misdemeanor charge for that incident, Central Islip-based Robin Stanco, did not immediately return a call seeking comment on Wednesday morning.

Beyrer confirmed that Anthony was also the victim in the 2015 assault case.

Detectives are still investigating the stabbing. Anyone with information is asked to call the Homicide Squad at 631-852-6392.

This version corrects the date Ada Robinson allegedly assaulted Ralph Anthony in 2015.

by -
0 362
Rob Marianetti is raising money to help fund his daughter Kayla’s care. Photo by Elana Glowatz

A local church is hosting a fundraising event to benefit a little girl who is seriously impaired after almost drowning in a bathtub at 17 months old.

Rob Marianetti is raising money to help fund his daughter Kayla’s care. Above, Kayla before her bathtime accident. Photo from Rob Marianetti
Rob Marianetti is raising money to help fund his daughter Kayla’s care. Above, Kayla before her bathtime accident. Photo from Rob Marianetti

Although Kayla Marianetti was found floating and unresponsive, doctors revived her. However, the Port Jefferson Station toddler was left with a brain injury. She needs multiple therapy appointments each day, including hyperbaric therapy, which involves putting her in an oxygen-rich environment; physical therapy, to move her toward sitting up, standing and walking; vision therapy, as neurological issues have made her legally blind, even though her eyes themselves are fine; and speech therapy, which is used both to teach her to communicate and to eat on her own.

Her father Rob, who works for Setauket-based Hurricane Tree Experts, has seen improvement in her function but needs help to fund the girl’s expensive treatments.

The theatrical fundraiser, for ages 15 and older, at the St. James R.C. Church in Setauket will be held on June 10. In addition to the performance “The Class of Life,” which starts at 7 p.m., there will be refreshments, a Chinese auction and a raffle. The father and daughter will be present. Contact Tabitha Chabalik for reservations, at 631-671-8206 or [email protected]. Tickets are $40. People can also contribute to Kayla’s recovery on her fundraising page.

Rob Marianetti has previously said his goal is to have Kayla at least be able to walk, talk, eat and see on her own.

“I’m not leaving her like this,” Marianetti said last year. “I’m going until either she gets better or I die.”

by -
0 2982
Alice Cialella during the Muddy Tire Mountain Bike Race in Wading River in 2015/Photo by Mark Wiggins

Researchers at Brookhaven National Laboratory have traveled the world, placed their scientific instruments aboard commercial ships, or gathered information from satellites, aircraft and ground-based facilities to study the atmosphere, the environment and the weather.

Chemist Arthur Sedlacek, whose work was featured last week in the Times Beacon Record, has journeyed in a plane above wildfires in the western United States to collect information about aerosolized particles, while atmospheric scientist Ernie Lewis has gathered data from commercial ships that trek back and forth from Los Angeles to Hawaii to determine how clouds change along the route through the Pacific.

Assistant ecologist Shawn Serbin, meanwhile, has studied the spectroscopic properties of forests to determine how an area responds to different temperature, precipitation and atmospheric conditions.

These are all part of the mission of the Environmental and Climate Sciences Department at BNL, explained Alice Cialella, the interim chair of the department and also the manager of the DOE ARM Climate Research Facility External Data Center.

The Environmental and Climate Sciences Department, which includes over 50 scientific, professional and technical staff, is also engaging in several new efforts, including a collaboration with Stony Brook University. Using several mobile radar systems donated by companies and the military, these two local institutions will gather a wealth of data about the local and regional climate and environment.

“The unprecedented array of radars will help us better understand pre-storm conditions before high impact weather events, provide detailed wind data for modeling energy and pollution flow through cities and better process level understanding of precipitation and cloud formation,” Cialella explained in an email.

To be sure, the initiative is so new that the weather satellites, which can be loaded on a truck and moved to different parts of a city, haven’t arrived yet. “There are many more details to work out,” she said.

This is just one of several initiatives that are all a part of the DOE-funded facility’s efforts to gain a better understanding of the local and global environment and how it might be changing over time.

Recently, Cialella’s department participated in a study to look at how air particles circulate through New York City subway stations for the Department of Homeland Security. Separately, atmospheric scientist Andrew Vogelmann is collaborating with a multi-institution study to connect ARM Climate Research Facility’s observations to climate modeling efforts.

Alice Cialella in her office at Brookhaven National Laboratory/Photo by Roger Stoutenburgh
Alice Cialella in her office at Brookhaven National Laboratory/Photo by Roger Stoutenburgh

Cialella, who has served as the interim chair of the department for six months, said this effort will “create more synergy between weather observational data sets and climate modelers.”

Martin Schoonen, the associate laboratory director for  the Environment, Biology, Nuclear Science and Nonproliferation Directorate at BNL, said he chose her as interim chair because “she has proven to be a very effective group leader, growing her group significantly over the last few years and taking on a leadership role within the DOE-Atmospheric Radiation Measurement and Climate Research Facility.”

Schoonen called her a “consensus builder” who “listens well to people and takes time to get to know all perspectives.” Cialella is “absolutely” in contention for the full-time role in the Environmental and Climate Sciences Department, Schoonen said.

Cialella said she sees opportunities to encourage scientific partnerships. “I look for a high level understanding of the science and try to identify common themes that aren’t being fully utilized or appreciated,” she said. The department is in two buildings and she tries to ensure that she assists with any potential collaborations among researchers in the same department but at different locations.

Serbin said he appreciates how Cialella has encouraged collaborations among researchers who study different elements of the environment.

Hired at first for her software engineering skills and her master’s degree in physical geography, one of her initial jobs was to create maps for the ARM sites using Geographic Information Systems software.

In her work as the manager of the data center, which represents about half her time, Cialella and Laurie Gregory supervise a team of eight. They identify new sources of data that are external to the ARM Climate Research Facility and that augment the ARM facility, such as weather forecast model data. The group has been creating ARM databases and Web data applications for ARM for over 20 years.

While she hasn’t worked on a computer program in a number of years, Cialella’s work allows her to engage in “more broad-thinking and strategic planning.” Over time, the focus of the ARM Climate Research Facility has shifted from gathering information through observations to using that information to inform global climate models. “In the last couple of years, the move has been to provide the data for the modeling component of the program much more directly,” she said.

A resident of Poquott, Cialella lives with her husband John Robinson, who is a professor in integrative neuroscience in the Department of Psychology at Stony Brook. Using mouse models, Robinson hopes to understand the function and dysfunction of the human central nervous system.

The couple has a daughter Zoe, who is a senior at Ward Melville High School and is planning to attend the University of Vermont in the fall.

Cialella said she enjoys anything that gets her moving. She runs, bikes, swims and does triathlons in the summer. Exercise is a great “stress reliever,” she said. She also enjoys being a part of a book group. She recently read “Tinkers” by Paul Harding.

Cialella grew up in Maryland, the fourth of five children. Her late father, Carmen, was a physicist at Aberdeen Proving Grounds.

As for her work, Cialella said she continues to plan for the future. “You always want to be thinking at least three to five years out and what the next area of research might be,” she said. “The next area may well be high-resolution atmospheric modeling for urban and regional studies.”

by -
0 254

When we refer to diabetes, we think of its complications. It may lead to microvascular maladies that affect vision (retinopathy), the kidneys (nephropathy) and the limbs (peripheral neuropathy), as well as macrovascular diseases such as heart disease and heart attacks. These are important reasons to prevent and treat it.

However, diabetes, in and of itself, is complicated. For example, in the ACCORD trial, we treated diabetes patients aggressively with medication trying to get their HbA1C (three-month sugars) to below 6.0 percent rather than the standard 7.0 percent because we thought lower would mean fewer complications. According to the results, the patients who were treated more aggressively had a higher risk of mortality (1).

We know that in type 2 diabetes, the first line of therapy beyond lifestyle modifications is metformin. But when that is not enough, we also know that insulin is the most powerful treatment for decreasing glucose, or sugar, levels. But are insulin therapies the best drugs to use? Well, it turns out that they may have more risk of death compared to another drug class, sulfonylureas (e.g., Glucotrol, Amaryl). However, sulfonylureas, along with another drug class, thiazolidinediones (e.g., Avandia, Actos), may increase the risk of fractures. Sulfonylureas and insulin each have also been associated with increased risk of hypoglycemia (low sugar).

Diabetes is also associated with depression. The prevailing thought has been that having diabetes may contribute to depression. However, the association may be related to another common factor, inflammation.

If that isn’t enough to make your head spin, the Centers for Disease Control and Prevention reports that one-quarter of patients don’t even know they have diabetes (2). And for people over the age of 20, 33 percent have prediabetes, defined as sugar levels between normal and diabetes, with fasting sugar of 100-125 mg/dl or HbA1C of 5.7-6.4 percent. However, there is good news as it relates to lifestyle modification.

Let’s look at the evidence.

Medications: insulin versus sulfonylurea

Two of the most common medications for the treatment of diabetes, referred to as second-line therapies since they would be used after metformin, are insulin and sulfonylureas. In an observational comparative effectiveness trial with patients already on metformin, results showed that when insulin was added compared to when sulfonylureas were added, there was a 44 percent increased risk of all-cause mortality and a 30 percent increased risk of cardiovascular outcomes including heart attack, stroke or all-cause death (3).

Does this mean we should not use insulin? No. There were limitations to this study. Though it was more sophisticated with its comparative effectiveness design, it was still retrospective, which is not as strong as some other study types and may involve bias. The only conclusion that can be made is that insulin, when used with metformin, had an association with, but not a link to, significantly negative side effects versus sulfonylureas. These patients were followed for a median of 14 months. We need prospective studies, especially randomized controlled studies. However, the results are intriguing. It makes you think twice before reaching for insulin as a second-line therapy.

Medications: sulfonylureas and thiazolidinediones

Does this mean that we know what to use for second-line therapy? Not necessarily. In a 2014 study, both sulfonylureas and thiazolidinediones showed a significantly increased risk of fractures. There was a 9 percent increase in fracture risk with sulfonylureas and a 40 percent increased risk with thiazolidinediones when each was compared to metformin (4). The good news is that other drug classes were tested and did not show statistically significant elevated risk occurrences. This was also a retrospective observational study so the same study limitations apply, most importantly, bias and confounding factors.

Depression

To complicate matters further, diabetes and depressive symptoms are associated with each other, but not in the way you might think. According to one study, these two maladies may not be a classic chicken-and-egg argument but rather a common denominator; inflammation may be the culprit that is at least partially responsible for both diseases’ processes (5).

The researchers found that six biomarkers of inflammation were increased in patients with both diabetes and depressive symptoms. These inflammatory markers include C-reactive protein, tumor necrosis factor alpha, triglycerides, white blood cells, interleukin 1 (IL-1B and IL-1RA) and monocyte chemotactic protein-1. Ultimately, if they are both caused by inflammation to varying degrees, then theoretically if we reduced inflammation it may give us beneficial results for both diseases.

This is important, since those with both diseases may have a two times greater likelihood of death, according to the authors. They also note that lifestyle modifications, including diet and exercise, are the best way to reduce inflammation. The study involved 1,227 newly diagnosed diabetes patients.

Heart attack

Both men and women with diabetes are at increased risk of heart attacks. However, in a meta-analysis (group of 64 studies) involving over 800,000 patients, the results surprisingly show that women with diabetes are at a significantly greater risk of having a heart attack than men (6). In fact, these women were at a 44 percent increased risk of having fatal and nonfatal cardiovascular events compared to their male counterparts. The reason for this, according to the authors, was that women may already be in poorer health before the onset of diabetes. What to do?

Exercise: games

We tell patients to exercise, but many of us know just how difficult it can be to motivate ourselves to do this. Video games may provide the needed spark. In a randomized controlled trial, the gold standard of studies, those who used Wii Fit Plus saw improvements in their diabetes parameters compared to those who were given usual care (7). Results included significant decreases in their HbA1C, fasting blood sugars and weight. These results were seen in just three months.

There were also improvements in daily physical activity, quality of life and depressive symptoms that are so commonly associated with diabetes. Family members were also likely to get involved in the Wii with the patient, creating a natural support network. Interestingly, after 12 weeks, those in the control group were then given the Wii Fit Plus and followed for an additional 12 weeks. They saw similar benefits. The authors called this “exergaming.”

Ultimately, we should do a really good job with lifestyle modifications and, if that is not enough, add metformin because we know that both have much greater upsides and very few downsides compared to many other diabetes treatments. Exercise can even be fun, as shown by the exergaming study. However, if insulin or other medications are needed, while there are treatment guidelines, it really comes down to a case-by-case decision to be made by the patient and doctor.

References:

(1) N Engl J Med. 2008;358:2545-2559. (2) cdc.gov/diabetes. (3) JAMA. 2014;311:2288-2296. (4) ADA 2014 Scientific Sessions;165-OR. (5) Diabetes Care Online. 2014 May 19. (6) Diabetologia Online. 2014 May. (7) BMC Endocr Disord. 2013;13:5.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Prev1...111112113...205Next Page 112 of 205
TBR News Media is your local news and entertainment website.
We provide you with the latest breaking news and information for your community.
Contact us: [email protected]

Most Viewed

©