September 4, 2018 : DCMS #413

DISASTERS AVERTED — Near Miss Case Studies

Timing Matters, But Patient Reasons May Be a Factor

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Jon Odorico on Stem Cell Derived Beta Cells

HOMERUN SLIDES — Great Clinical Presentation Highlights

Eversense CGM System Part 3

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #141: The Genetics of Type 2 Diabetes Part 3

MOST POPULAR ARTICLES OF THE MONTH

#1 Vitamin D Supplementation for Diabetes Prevention
#2 Empagliflozin’s Effect on Liver Fat
#3 What Is Glucotyping?

A couple of weeks ago, I received an email from NSI, the National Stem Cell Institute, that contained their latest newsletter. This one focused on using adipose tissue-derived stem cells to repair meniscus tears. This caught my eye because three of my fellow cyclists had avoided surgery by having this procedure done. I was interested in all the other things that stem cell therapy could be used for, and if you visit the NSI website you will find no less than 25 conditions for which there are documented treatments; but reversing diabetes was not one.

Over the years, we have heard many promising possibilities on the use of stem cells for causing beta cell regeneration. In 2006, we reported on how there would be a stem cell “cure” for type one diabetes in four years.

in 2009, our own advisory board member Dr. Aaron Vinik was working with Prochymal, an investigational therapy developed by Osiris Therapeutics, Inc. containing stem cells from healthy adult volunteer donors. When the stem cells found in Prochymal were delivered intravenously, in combination with standard care, it was thought that the compound could slow beta cell death and promote the regeneration of tissues damaged in the inflammatory process. Although this never became a viable “cure” for diabetes, the product has become very successful for acute and steroid-refractory Graft versus Host Disease.

It has been a long and hard road for the use of stem cells as a “cure” for diabetes. To catch up with the latest research, we reached out to Jon Odorico, Professor of Surgery at the University of Wisconsin, Madison School of Medicine and Public Health, at the recent ADA meeting in Orlando. Dr. Odorico gave us an update on what is going on and what researchers are doing to overcome the current challenges.

Dave Joffe

Editor-in-chief

This is about one patient but the situation is not unusual for many patients who have type 2 diabetes and take insulin. Woman, 67 years of age, type 2 diabetes, taking Tresiba 15u every day at 11am and Victoza every morning upon arising, about 8am. She wears a CGM. Glucose levels were in target range for some time. Family reported patient was having some subtle cognitive changes. We did send her for neurologic evaluation.

Jon S. Odorico, MD, FACS is Director of the Pancreas and Islet Cell Transplantation Programs and Professor in the Department of Surgery, Division of Organ Transplantation at the University of Wisconsin-Madison School of Medicine and Public Health.

In this week’s Homerun Slides, understanding the sensor procedure for the Eversense CGM.

Identification of T2DM affecting genetic variants: The methods used to map disease-causing variation have evolved rapidly in the last decades thanks to technical advances in genotyping methods. Originally, disease-causing loci were identified primarily by linkage analysis, utilizing the long stretches of linkage in affected families. By genotyping 400–500 genetic markers, disease loci can be mapped on a genome-wide level without any prior hypothesis about which genes are involved. Finding that affected family members share a certain marker that is identical by descent (i.e., identical because it was inherited from the same parent) more often than expected by chance is evidence that a disease-causing variant is in linkage with that marker. This strategy has been very successful in mapping genetic diseases like MODY that have a strong penetrance and a known mode of inheritance.

Vitamin D shows potential to lower HbA1c, FPG, insulin resistance, and 2-hour post-prandial glucose levels.

An SGLT-2 inhibitor reduces liver fat and ALT levels in people who have type 2 diabetes.

Patients who have normoglycemia still at risk for glucose spikes and diabetes.