May 1, 2018 : DCMS #395

DISASTERS AVERTED — Near Miss Case Studies

When Changing from Daily to Weekly GLP-1, Make Sure Patient is Clear

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

George Bakris Part 2, SGLT-2 Inhibitors and the Diabetic Kidney

HOMERUN SLIDES — Great Clinical Presentation Highlights

Hypertension Update 2018 Part 8

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #123: The Insulin Resistance Syndrome Part 4

MOST POPULAR ARTICLES OF THE MONTH

#1 New Way to Screen for Diabetes and Prediabetes
#2 A Summary of ADA’s New 2018 Standards of Medical Care in Diabetes
#3 Analysis: How Patients and HCPs Really Feel About CGMS

When I was doing Diabetes CME for clinicians and pharmacists I had a couple of slides that showed a patient hooked up to a machine as big as a small car. This device was able to control glucose levels way back in the 70’s.

The question we used to ask was, “If you could normalize a diabetes patient’s  glucose 24/7 in the hospital for 2 weeks, how long would it take their A1c to work its way back up?” Most everyone answered anywhere from 2 days to 2 months; however, the answer was 2 years.

The doctor that first researched this phenomenon was Dr. Gerald Reaven.  He was called the “Father of Insulin Resistance” by the ADA in 2014, and now all current research is said to be based on his initial work. This week in our Clinical Text, Jerry, as he insisted everyone call him, shared his knowledge of the concept of Metabolic Syndrome with the authors.

As a side note, Jerry passed away this past February at the ripe old age of 90. If you want to learn more about what this man did for the forward movement of diabetes care, take a few minutes to read  Gerald M. Reaven, MD: Demonstration of the Central Role of Insulin Resistance in Type 2 Diabetes and Cardiovascular Disease, by clicking here: https://care.diabetesjournals.org/content/diacare/37/5/1178.full.pdf

Dave Joffe

Editor-in-chief

Man, 52 years of age, with obesity and type 2 diabetes, was switched from daily liraglutide (Victoza) 1.8mg to weekly semaglutide (Ozempic) 0.25mg. I was very clear with patient about the switch being from a daily injection to a weekly and that we would be increasing the semaglutide weekly.

Dr. George Bakris talks with Diabetes in Control Publisher Steve Freed during the ADA 77th Scientific Session in San Diego about the possible kidney benefits for those using SGLT-2s.

In this week’s Homerun Slides, a closer look at the Systolic Blood Pressure Intervention Trial (SPRINT).

The foregoing observations have detailed the best established risk factors associated with insulin resistance as well some novel emerging risk factors as additionally detailed in Table 23.2, including nutritional measures such as Vitamin D. These are not comprehensive but rather a selection of emerging pathways of interest. Clearly, future research should increasingly harness genetics as well as observational data to better determine causal risk pathways. Similarly, further data are needed to better determine the extent to which insulin resistance is, or is not, linked to cardiovascular risk.

Dental exams may be earlier predictor of disease than even blood tests.

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

Both patients with diabetes and health care professionals expect wider adoption of continuous glucose management systems in the future for patients with type 2 as well as type 1, and agree that cost is a key factor in patient choices