Tuesday , November 21 2017

From the Editor

November, 2017

  • 21 November

    Nov. 21, 2017

    Last month, Bill, a cycling friend of mine, asked if I knew a good physician in the area. He was from Maine and this was the winter that he and his spouse were making their move to Florida permanent. My first choice was my own physician as he is a …

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Latest Articles

November, 2017

  • 21 November

    Do You “Make Room” for Your Patients?

    Female, 67 years of age, type 2 diabetes, class 2 diabetes, depression, hyperlipidemia, vitamin D deficiency plus more. Her A1C is 6.8% and her lipids are within goal. Her random glucose 2 hours after eating cookies was 118 today. Her glucose lowering meds are Trulicity, metformin, and Jardiance. She takes them as prescribed. Her endocrinologist recommended she meet with me. She refused until he recommended she see me the same day she was coming in to see another health care provider for her monthly infusion for another disease process to make getting here easier.

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  • 21 November

    Aaron Vinik Part 3, Reversing Heart Disease

    In part 3 of this Exclusive Interview, Dr. Aaron Vinik talks with Diabetes in Control Publisher Steve Freed during the AACE 2017 convention in Austin, Texas about the hurdle of trying to reverse arteriosclerosis.

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  • 21 November

    Diabetes 2017 Part 2

    In this week's Homerun Slides, a look at empagliflozin and the effects of SGLT-2 inhibitors.

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  • 21 November

    International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #100: Pathogenesis of nonalcoholic fatty liver disease (NAFLD) Part 2

    Cause of NAFLD: obesity and abnormalities in adipose tissue. Although both NAFLD and the MetS can occur in nonobese subjects, the prevalence of NAFLD is markedly increased in obesity as is that of the MetS. In the third National Health and Nutrition Examination Survey (NHANES), the prevalence of NAFLD averaged 7.5% and 6.7% in normal-weight men and women but was 57 and 44% in persons with a body mass index (BMI) greater than 35 kgm−2.

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  • 18 November

    New Information on SGLT-2 Inhibitors

    Research presented at the American Heart Association provided new insight into  two large diabetes drug trials, CANVAS and EMPA-REG OUTCOME.

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Test Your Knowledge

Treating Increased A1C

A 64-year-old female presents to your office for her 3-month follow-up. She has previously been diagnosed with mild diastolic heart failure, secondary to hypertension. She currently takes an ace-inhibitor and a diuretic with good control of her heart failure symptoms and hypertension. At her last visit, she had a FPG 118 mg/dl. In a subsequent conversation with her, you discussed how she has developed prediabetes and suggested lifestyle modifications. Since her last visit, she has taken up very gentle walking four times/week and has changed her diet to a more healthful one. Despite these positive changes, this visit’s labs return an A1C 7.8%; her remaining labs are within normal limits. Which one of the following antihyperglycemic medication classes would you choose to initiate treatment?

Correct

Correct Answer: B. Biguanides

Educational Critique: Metformin would be considered the first-line drug of choice for this patient. The use of metformin in patients with diabetes and heart failure used to be contraindicated (its use in patients with compromised renal function being associated with lactic acidosis). However, it can now be used in select patients with heart failure if renal function is normal, CV status is stable and ventricular dysfunction is not severe. Eurich, et al. (2005) conducted a retrospective analysis of type 2 diabetes patients treated with metformin vs. sulfonylureas and found overall decreased mortality in the metformin group. Masoudi et al (2005) examined metformin vs. thiazolidinediones and found the reduced risk of death at 1-year and lower hospital admission rates in the metformin group, while increased hospital admissions (primarily due to heart failure readmissions) was seen in the thiazolidinedione group. Thiazolidinediones increase renal sodium and water reabsorption, causing fluid retention and worsening of heart failure signs/symptoms. A recent retrospective analysis (Tzoulaki, et al., 2009) found an association between the use of sulfonylureas and increased risk of developing/worsening heart failure. Both classes of drugs should not be used in patients with diabetes and heart failure.

Incorrect

More Articles

November, 2017

  • 18 November

    Next CGMS “Flash” FreeStyle Libre FDA Approved, Available Shortly

    CGM will be available at lower price, without fingerstick calibration, and can be worn for 10 days with 12-hour warmup.

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  • 18 November

    Metformin Improves Vascular Health in Children With Type 1 Diabetes

    HbA1c, daily insulin dose requirement also found to benefit from treatment.

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  • 18 November

    Magnesium To Prevent Type 2 Diabetes

    Diet may play a major role in magnesium and its association to type 2 diabetes.

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  • 18 November

    Alzheimer’s Gene Linked to Diabetes

    Researchers found that the Alzheimer’s gene ApoE4 could be linked to type 3 diabetes. The Apolipoprotein E (APOE) gene is one of the strongest genetic risk factors for Alzheimer’s disease. Diabetes and impaired insulin signaling in the brain are linked to the development of Alzheimer’s disease. This study shows how …

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  • 18 November

    Treating Comorbidities

    In treating your patients with diabetes who have hypertension, elevated blood sugars, and elevated LDL’s, do you treat 1 or 2 of the comorbidities or all 3 at the same time? Follow the link to share your response.

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  • 18 November

    Mark Huising Current Interview

    Dr. Mark O. Huising completed his formal education in the Netherlands, where he spent his PhD studying the evolution of immune and endocrine systems in early vertebrates.

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  • 18 November

    Mark Huising Transcript

    Mark Huising discusses his ADA symposium on “Neglected Delta Cell: The Difference Delta Cells Make in Glucose Control," and the nature and importance of delta cells in diabetes research.

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  • 18 November

    Mark Huising Full Interview

    In this Exclusive Interview, Dr. Mark Huising talks with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California about his work in delta cells, their impact on the body as well as diabetes, and the importance of imparting an understanding about these cells to the diabetes community, patients and medical professionals alike.

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  • 17 November

    Mark Huising Part 1, The Difference Delta Cells Make in Glucose Control

    In part 1 of this Exclusive Interview, Dr. Mark Huising talks with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California about the function of delta cells and what precipitated his work in this field.

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  • 17 November

    Mark Huising Part 2, Delta Cells Effects on Type 2 Diabetes

    In part 2 of this Exclusive Interview, Dr. Mark Huising talks with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California about the impact of type 2 on delta cells and measuring the activity of these cells.

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  • 17 November

    Mark Huising Part 3, Diabetes Medication Effects on Delta Cells

    In part 3 of this Exclusive Interview, Dr. Mark Huising talks with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California about the impact of diabetes medications on delta cell activity.

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  • 17 November

    Mark Huising Part 4, Delta Cell Research Effect on Diabetes

    In part 4 of this Exclusive Interview, Dr. Mark Huising explains the benefit of his research for those with diabetes, medical professionals, and medical students as well, in a conversation with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California.

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  • 17 November

    Mark Huising Part 5, Final Thoughts

    In part 5, the conclusion of this Exclusive Interview, Dr. Mark Huising talks with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California about what he's learned from colleagues and the importance of collaboration.

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  • 14 November

    Scare Them or Inspire Them?

    Today, my patient, a woman, 42 years of age, brought her daughter who is 18 years of age with her for her visit. Mother has PCOS, class III obesity and type 2 diabetes. She told me she brought her because of the strong family history of diabetes on both sides of his family. She wanted her to understand what someone who has diabetes goes through.

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  • 14 November

    Aaron Vinik Part 2, Heart Failure and Diabetes

    In part 2 of this Exclusive Interview, Dr. Aaron Vinik talks with Diabetes in Control Publisher Steve Freed during the AACE 2017 convention in Austin, Texas about the work and results of the EMPA-REG and LIRA studies, among others, and the medication that truly is the game changer in the world of diabetes treatment.

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