July 3, 2018 : DCMS #404

DISASTERS AVERTED — Near Miss Case Studies

What’s the Real Story?

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Timothy Garvey on Weight Loss Medications

HOMERUN SLIDES — Great Clinical Presentation Highlights

Future Use of Technology in Outpatient Care Part 5

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #132: Pathogenesis of Type 2 Diabetes Mellitus Part 3

MOST POPULAR ARTICLES OF THE MONTH

#1 Can’t Afford Insulin? There Are Options!
#2 Relationship Between HbA1c and Stroke Risk
#3 Four Essentials In The New Trump Drug Pricing Reform Plan

This past week, my wife forwarded me an email for a weight loss product that had taken the internet by storm and was so good that all the Shark Tank investors had gone in on the deal for a product by two sisters that guaranteed rapid weight loss. All you had to do was take a pill. No exercise, no food changes, just take a pill and all is good. They had pictures and supposed testimonials from TV and movie stars, and even a couple of professional models. It is only natural that I would look at the product because we are always looking for ways to help our patients lose weight. I found some interesting things…some of the stars denied they had used the product and had sued the company, some of the people featured had previously announced they had LapBand or bypass surgeries to lose the weight. The links when you searched the web were linked to the company’s website.

As always, if it is too good to be true, it usually is.

There are proven, pharmaceutical ways that we can help our patients lose weight. This week our publisher, Steve Freed, shares an interview he had with Dr. Timothy Garvey during the AACE 2018 convention in Boston, MA, about the variety of available medications to help with weight loss and which — if any — might be the best to recommend.

Dave Joffe

Editor-in-chief

Man, 55 years of age, type 2 diabetes, hypertension, was referred to see us. The patient reports coming to us because he does not think he is getting the right treatment. Reports having been put on insulin upon diagnosis 4 years ago–at which time he had lost 50 pounds, was very hungry, thirsty, and had urinary frequency. When visiting, he did not have his labs from diagnosis but did have labs from 3 months ago at which time A1C was 7, and C-Peptide was 2.2. He said his past endocrinologist changed him to oral meds after his glucose had come down to an average of 140.

W. Timothy Garvey, MD is the Butterworth Professor of Medicine in the Department of Nutrition Sciences at the University of Alabama at Birmingham. He obtained his MD degree from St. Louis University, completed residency training in Internal Medicine at Barnes Hospital, Washington University, and was a clinical fellow in Endocrinology and Metabolism at the University of Colorado Health Sciences Center and University of California, San Diego School of Medicine.

In this week’s Homerun Slides, a look at various principles of disease management.

Beta-Cell function: Although the plasma insulin response to the development of insulin resistance typically is increased during the natural history of T2DM , this does not mean that the beta cell is functioning normally. To the contrary, studies have demonstrated that the onset of beta-cell failure occurs much earlier and is more severe than previously appreciated.

We all know the benefits of the newer insulins, i.e., faster action times, less peak from the long actings, etc. But the cost, more often than we know, can lead to patients decreasing insulin doses, doing without until the next payday, or doing without it altogether, as we’ve read about. (See David Kliff’s recent article.) …

New meta-analysis striving to expand on the notion that glycemic control and stroke risk are closely associated.

Administration releases “American Patient First” blueprint to lower drug prices, reduce out-of-pocket costs.