February 6, 2018 : DCMS #383

DISASTERS AVERTED — Near Miss Case Studies

Elevated A1C? Consider Lowering Insulin

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Ray Kausik Part 6, Good Versus Bad Cholesterol

HOMERUN SLIDES — Great Clinical Presentation Highlights

Framework for Understanding DM Part 7

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #111: Diabetes and Sleep Apnea Part 1

MOST POPULAR ARTICLES OF THE MONTH

#1 A Summary of ADA’s New 2018 Standards of Medical Care in Diabetes
#2 Know Your Insulins, Teach Your Patient
#3 SGLT-2 Inhibitors Vs DPP-4 Inhibitors Vs. GLP1’s For Type 2 Diabetes

Last week, after a 75-mile group cycling ride, about a dozen of us were enjoying coffee and conversation at our favorite shoppe. Since we might be considered a somewhat competitive bunch, there was a lot of chatter about who had the highest power, who won the final sprint, and any other “records” we could take credit for.

Somewhere in all the bragging, someone brought up their recent lab values. This got us on a discussion of cholesterol levels and who had the best. As you know, cholesterol levels are about 75% related to genes and heredity, and so we had some wide ranges of values in some really fit people. There were some riders who harped on how good their LDL to Total ratio was and others who touted their low LDL and others who shared their high HDL levels.

Each of us had our own logic as to why these values had great importance, and the logic was as diverse as the values. This week, I got to send all of them a copy of Steve Freed’s interview with Dr. Ray Kausik, on his opinions of “Good vs. Bad” cholesterol.

Dave Joffe

Editor-in-chief

This Disaster Averted is not just about one patient but about many who take insulin. Most think high A1C means one needs to increase insulin. Not always! Remember, A1C is an average. Just because someone has an A1C of <7% doesn't actually mean glucose is managed.

In part 6 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 the impact of treatments in an ongoing effort to lower cholesterol.

In this week’s Homerun Slides, the old versus the new understanding about the cause of common diabetes complications.

Obesity is a global epidemic that has far-reaching economic and public health implications. Excess body weight is associated with multiple comorbidities including type 2 diabetes (T2DM), hypertension, obstructive sleep apnea (OSA), and cardiovascular disease (CVD). Dysglycemia andOSA share common risk factors such as age and obesity; hence it is not surprising that OSA and glycemic abnormalities often coexist.

Comprehensive recommendations feature notable new recommendations for people with cardiovascular disease and diabetes.

Woman, 67 years of age, type 2 diabetes for 22 years, class II obesity. Has recently been managing her glucose levels with weight loss, using Tresiba, Trulicity, and metformin. Recent A1C 6.5%, which she’s worked hard for and been extremely proud of. She hasn’t had numbers like she has recently had for years.

How best to decide whether to use one or a combination of the new treatments and individualize the treatment for your patients.