February 16, 2016 : DCMS #280

DISASTERS AVERTED — Near Miss Case Studies

 Diabetes Information Best Shared By Patients and HCPs Alike

HOMERUN SLIDES — Great Clinical Presentation Highlights

Diabetes for Cardiologists Part 10

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #11: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 5 of 5

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Benefit of Various Diabetes Guidelines

MOST POPULAR ARTICLES OF THE MONTH

#1 D2 – Dementia and Diabetes
#2 International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #9: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 3 of 5
#3 AACE/ACE 2016 Update on Standards of Medical Care in Diabetes

This past week, we had our 3rd endocrinologist retire since December. We have a metropolitan population of just under 3 million people, and now we are down to 17 endocrinologists — and 6 of them only take care of children. Eleven endos for 3 million people is just hard to believe. If you do the math, that means there is one endocrinologist for every 68,000 diabetes patients in the area. If you figure that 15% of diabetes patients probably need an endocrinology consult, that means these 11 practitioners would have to see 1,000 patients. This doesn’t include the thyroid and hormone patients they also see.

The odds that a prediabetes patient would see an endo are slim to none. This can be disastrous for some of these patients, as is seen in this week’s diabetes disaster averted 

Your partner in diabetes care,
Dave Joffe
Editor-in-chief

Woman, 58 years of age, history of PCOS, prediabetes, strong family history of type 2 diabetes, cardiovascular disease and obesity. This patient lives a healthy lifestyle, including a lower carb meal plan, is very active, and keeps her weight down. Those interventions did not lower her A1C, so she educated herself and asked her NP/CDE if she should start metformin. This was about 20 years ago. Since starting metformin, A1C is in the 5.1-5.5% range. Patient regularly checks glucose, which was recently rising. A1C rose to prediabetes range again. Started on GLP-1 by NP/CDE. Patient then went to a new PCP who told her she should not be taking metformin or the GLP-1 because she does not have diabetes. Wanted to refer her to an endocrinologist….

In this week’s Homerun Slides, EMPA-REG trial results and implications.

In industrialized countries, 20–40% of T1DM patients younger than 20 years present with diabetic ketoacidosis. After adjusting for age, gender, ethnicity, diabetes type, and family history of diabetes, diabetic ketoacidosis at diagnosis was associated with lower family income, less desirable health insurance coverage, and lower parental education. Younger children present with more severe symptoms at diagnosis, because children younger than 7 years old have lost on average 80% of the islets, compared to 60% in those 7–14 years old and 40% in those older than 14 years.

In part 2 of this Exclusive Interview, Dr. Andy Rhinehart shares the benefit of keeping up with various diabetes guidelines, even from outside of the U.S.

Uncontrolled blood glucose seems to increase the risk of brain troubles.

The first large-scale studies of the prediction of T1DM relied upon the detection of cytoplasmic islet cell autoantibodies (ICA) assays based on indirect immunofluorescence. High titer cytoplasmic ICA is most often associated with the presence of multiple islet autoantibodies and therefore a high risk of progression to diabetes.

New management recommendations for the treatment of type 2 diabetes.