September 11, 2018 : DCMS #414

DISASTERS AVERTED — Near Miss Case Studies

When Starting a GLP-1 for Weight Loss

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Alpana Shukla on Food Order: the Effect of Eating Carbs Last

HOMERUN SLIDES — Great Clinical Presentation Highlights

Eversense CGM System Part 4

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #142: The Genetics of Type 2 Diabetes Part 4

MOST POPULAR ARTICLES OF THE MONTH

#1 Empagliflozin’s Effect on Liver Fat
#2 When and When Not to Use An SGLT-2
#3 What Is Glucotyping?

The age-old question of which came first “the chicken or the egg” takes on new meaning this week in relation to what you can eat and, more importantly, in what order. Dr. Alpana Shukla, Assistant Professor, Weill Cornell Medicine, sat down with Joy Pape, our Medical Editor, at the recent ADA meeting. She laid out her research on what order to eat food to keep glucose levels at their very best, regardless of whether you have diabetes or not. The science behind this order of eating idea is solid.

Dave Joffe

Editor-in-chief

Although GLP-1’s don’t usually cause hypoglycemia except when given with insulin or a sulfonylurea, I have found that when patients who do not have diabetes are started on a GLP-1, some can have symptoms of hypoglycemia and/or more untoward GI side effects if they start when they come in the office fasting.

Alpana Shukla MD, MRCP (UK) graduated from Grant Medical College Mumbai, India and trained in Endocrinology in the UK and Australia. She is Assistant Professor of Research in the Division of Endocrinology, Diabetes & Metabolism at Weill Cornell Medical College, and Director of Clinical Research at the Comprehensive Weight Control Center. Dr Shukla is a research mentor for the MS program at the Institute of Human Nutrition, Columbia University. Her research interests and publications include novel behavioral interventions for management of type 2 diabetes and obesity, pharmacotherapy for obesity, and metabolic surgery.

In the conclusion of this week’s Homerun Slides, the clinical performance of the Eversense CGM System.

High density mapping: GWAS do not inevitably lead to identification of a gene or genes in a given locus associated with disease.The most strongly associated SNPs are often only markers for the functional variant responsible for the observed genetic effect and most associated regions harbor several genes. Therefore, additional fine mapping of the loci in even larger sample sets is often necessary. To do this cost-efficiently a Cardio-Metabochip has been developed for metabolic/cardiovascular gene mapping. This custom-design Illumina Infinium genotyping chip contains ∼200,000 polymorphisms selected to cover association signals from a wide range of metabolic disorders (T2DM, lipid disorders, obesity, and cardiovascular disease), was designed to perform both deep replication of major disease signals and fine mapping of established loci. Meta-analysis of previous GWAS with an additional 22,669 T2DM cases and 58,119 controls genotyped using the Cardio-Metabochip has recently added another eight new loci associated with T2DM in the European population

An SGLT-2 inhibitor reduces liver fat and ALT levels in people who have type 2 diabetes.

After reviewing evidence, a tool to evaluate benefit and risk has been developed for the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors.

Patients who have normoglycemia still at risk for glucose spikes and diabetes.