July 17, 2018 : DCMS #406

DISASTERS AVERTED — Near Miss Case Studies

Summer Travel: Don’t Forget the Feet!

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Grenye O’Malley on Prenatal Diabetes Research and the Artificial Pancreas

HOMERUN SLIDES — Great Clinical Presentation Highlights

Future Use of Technology in Outpatient Care Part 7

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #134: Pathogenesis of Type 2 Diabetes Mellitus Part 5

MOST POPULAR ARTICLES OF THE MONTH

#1 Relationship Between HbA1c and Stroke Risk
#2 How Much Monitoring is Too Much?
#3 Amazing Outcomes with Combination Therapy of GLP-1 Receptor Agonist and SGLT2 Inhibitors

Over the years, the fasting glucose has been the standard testing point for diabetes control. However, we have always been proponents of 2-hour postprandial readings to help identify diabetes sooner. This is based on the concept of first phase insulin release, and how that prevents the rise of glucose levels in the blood after a meal. As patients develop diabetes, it is thought that this rapid food-stimulated insulin release becomes impaired. This week in our Clinical Text, we look at what this “First Phase Release” is and how our patients lose the ability to control their meal time glucose excursions.

Dave Joffe

Editor-in-chief

Summer, a time for travel for so many. Over the next few weeks, we will look at ways to prevent disasters during or after travel.

When it comes to travel plans, a lot of people who have diabetes are most concerned about their medications — getting, bringing enough with them and so many issues associated with that.

I’ve found most aren’t concerned about protecting their feet.

Grenye O’Malley, MD, graduated from NYU School of Medicine. She then completed residency in Internal Medicine at the Icahn School of Medicine at Mount Sinai. During residency, she developed an interest in diabetes management and was involved in research on glucose sensor use in patients with type 1 diabetes during pregnancy.

She is now a graduating fellow at Icahn School of Medicine at Mount Sinai where she will be an Assistant Professor later this year. She is participating in multiple large clinical trials involving type 1 diabetes technologies, including a closed-loop artificial pancreas study, a first of its kind assessment of decision support algorithms for patients using multiple daily injections, and a study of continuous glucose monitoring in the elderly.

In this week’s conclusion of this series of Homerun Slides, patient care and triage reminders, and other knowledge-based computerized patient record information.

First-phase insulin secretion: In response to i.v. glucose, insulin is secreted in a biphasic pattern with an early burst of insulin release within the first 10 min followed by a progressively increasing phase of insulin secretion that persists as long as the hyperglycemic stimulus is present. This biphasic insulin response is not observed after oral glucose, because of the more gradual rise in plasma glucose concentration. Loss of first-phase insulin secretion is a characteristic and early abnormality in patients destined to develop T2DM.

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

What I love about going to conferences is the realization that what I’m doing in my practice is in line with what others I respect are doing. That is meaningful, and I always learn a new pearl. If that’s all I gain from these conferences, it’s okay, but it’s usually more than that.

I have just returned from the 2018 ADA Conference, where there was so much about new technology, particularly continuous glucose monitoring.

The different mechanisms of action of these two drugs make them an excellent combination in the treatment of patients with type 2 diabetes mellitus (T2DM).