Wednesday , January 17 2018

From the Editor

January, 2018

  • 16 January

    Jan. 16, 2018

    So often in patients with diabetes, there are multiple co-morbidities that can lead to premature death or at the least a decreased quality of life. There is often the question as to which disease comes first and whether the combination of these diseases worsen each other. This week, our Clinical …

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January, 2018

  • 16 January

    A Way to Motivate Unmotivated Patients

    Young man, 21 years of age. type 1 diabetes since 9 years of age. Has not been to see hcp for a year. States he doesn’t like people interrogating him, but came in because he needs his insulin. States he doesn’t check his glucose because he can tell what it is. Tired of having type 1 diabetes and tired of checking numbers. A1C in office--10.2%.

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  • 16 January

    Ray Kausik Part 3, PCSK9 Effect On Lowering Cardiovascular Death

    In part 3 of this Exclusive Interview, Dr. Ray Kausik talks with Diabetes in Control Publisher Steve Freed during the ADA 2017 convention in San Diego, CA about work toward lowering the risk of cardiovascular death.

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  • 16 January

    Framework for Understanding DM Part 4

    In this week's Homerun Slides, the genetics of diabetes and the implications for beta cells.

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  • 16 January

    International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #108: Type 2 Diabetes and Cancer Part 1

    Introduction: An association between hyperglycemia, diabetes, and cancer has been recognized for many years. Epidemiologists first noted the association between diabetes and cancer in the early part of the twentieth century, while the association between hyperglycemia and cancer was reported in 1885. At that time, in Europe and North America life expectancy was improving, rates of over-nutrition and under-exercise were increasing, there was a rise in the percentage of people that were overweight, and the incidence of diabetes began to climb.

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  • 13 January

    How To Overcome The Complexities of Treatment Decisions For Your Type 2 Diabetes Patients

    Part 1 of a four part series on a framework developed by Dr. Bradley Eilerman and Len Testa for recommending medications for treating patients with type 2 diabetes.

    A thousand times today, in offices all over America, hospital patients will be diagnosed with type 2 diabetes. When that happens, a healthcare provider has to make a treatment decision of enormous complexity, often with partial information to go on, and in the span of just a few minutes.

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Test Your Knowledge

On-the-Go Treatment

A 43-year-old patient presents to your clinic for an appointment. She has mild hypertension, which is currently well controlled with a beta blocker. She was diagnosed with type 2 diabetes 6 years ago, and has been taking metformin and glipizide. She has noticed that her recent self-blood glucose monitoring numbers have been creeping up with a most recent FPG of 160 mg/dl. At today’s visit, she has an A1C of 8.0%. She tells you that until now her job has required she travel several times a month. This week, she was promoted to a managerial position that does not require travel. Which of the following approaches would be the best for her?

Correct

Correct Answer: 1. Add a basal insulin dose once a day

Educational Critique: Usually, the addition of basal insulin is considered the optimal initial insulin regimen, usually in conjunction with one or two noninsulin agents. Generally, therapeutic regimens should begin with some basal insulin before moving to more complex insulin strategies. Starting a pre-mixed insulin regimen as the initial insulin strategy can be considered in patients willing to take more than one injection a day and with higher A1C level (>9.0%). Pre-mixed regimens tend to lower A1C slightly more when compared to basal insulin alone. However, the use of pre-mixed insulin can lead to slightly more hypoglycemia and weight gain than basal insulin. When basal insulin is used, the continued use of secretagogues may provide some benefit in reducing initial glycemic control deterioration. However, with the addition of prandial insulin, while metformin is usually continued and may help prevent some weight gain, secretagogues should be stopped. In addition to continued general diabetes education (SBGM, lifestyle modifications, disease course), patients should receive education on the avoidance, recognition and treatment of hypoglycemia.  Cleveland Clinic Journal of Medicine

Incorrect

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January, 2018