July 18, 2017 : DCMS #354

DISASTERS AVERTED — Near Miss Case Studies

What’s the Best Teacher?

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Dr. Karl Nadolsky Part 1: Obesity is a Disease

HOMERUN SLIDES — Great Clinical Presentation Highlights

A Unifying Pathophysiologic Approach to The Complications of Diabetes in the Context of the Beta-cell Classification of Diabetes Part 3

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #82: Insulin actions in vivo: glucose metabolism Part 9 of 9

MOST POPULAR ARTICLES OF THE MONTH

#1 Type 1 Cured in Mice
#2 Metformin and Aging
#3 What is the Most Ineffective Medication?

As a birthday present to myself, I decided to have my genome done and find out about my heritage. I know that both of my parents’ families had immigrated from Minsk, in what is now Belarus, and was once part of the USSR. I was hoping to find out how they got to Belarus, and was there a connection back to other parts of the world. When I got my information back, I was somewhat disappointed as the results showed I was 99.9% Ashkenazi Jew, meaning I came from Eastern or Central Europe. I was hoping for a country or countries of origin, but they could not tell me that.

They did let me know that they have been collecting gene history from millions of people and have been able to develop some algorithms that would allow them to predict with 95% or greater accuracy if I would be likely to have diseases such as Alzheimer’s or Parkinson’s. I have not yet decided whether I am interested in knowing that or not.

This week, in our Homerun Slides, Dr. Stanley Schwartz takes a look at how these gene variants can lead to diabetes and he even shows some data indicating that evaluating genes could give us a way to select the right medication for each patient.

Dave Joffe

Editor-in-chief

Over the years I’ve found the best teacher for people who have diabetes is their numbers. Without teaching the patient targets, they don’t learn much.

This patient is just one example of many. A man, 57 years of age, visits a community diabetes education course. He tells me he has type 2 diabetes, hypertension hyperlipidemia. He said his doctor told him his numbers were fine about 9 months ago. When he came to the course, he was losing weight, was thirsty and was very tired.

In part 1 of this Exclusive Interview, Dr. Karl Nadolsky talks with Diabetes in Control Publisher Steve Freed during the AACE 2017 convention in Austin, Texas about why obesity should be classified as a disease and how it is diagnosed as such.

In this week’s Homerun Slides, genetics 101 for diabetes mellitus and the implications of the new beta-cell construct.

Oral glucose: At any point in time, the glycemic response to exogenous glucose is the balance between the rate at which glucose appears in the systemic circulation (from oral as well as endogenous sources) and the rate at which glucose is disposed of. Oral glucose appearance in the peripheral circulation depends on: (a) the rate at which the gastric contents are passed on to the small intestine; (b) the rate of intestinal glucose absorption; (c) the extent of gut glucose utilization; (d) the degree of hepatic glucose trapping; and (e) the dynamics of glucose transfer through gut, liver, and posthepatic circulation on to the right heart.

Ralph DeFronzo and his researchers at UT Health at San Antonio announced that they have cured type 1 diabetes.

Study shows age-related comorbidities decreased in males over 65 who take metformin.

As we know, the most ineffective medication is the one needed but never taken. There are many reasons our patients don’t take prescription medicines, but a biggy is the cost. If a medicine is too expensive, the patient will not fill the prescription, therefore won’t take it. For example, when ordering an SGLT-2 and/or GLP-1, each can cost hundreds or more for a month’s prescription. Some are covered for both. Some are covered for one brand, but not the other.