November 27, 2018 : DCMS #425

DISASTERS AVERTED — Near Miss Case Studies

Prevent Disasters By Using CGM

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Judith Wylie-Rosett on Non-Nutritive Sweeteners

HOMERUN SLIDES — Great Clinical Presentation Highlights

CGM Review of Clinical Outcomes Studies Part 5

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #153: Monogenic Disorders of the Beta Cell Part 3

MOST POPULAR ARTICLES OF THE MONTH

#1 Possible Breakthrough In Treating Type 2 Diabetes and Prediabetes
#2 Updated Patient-Centered Hyperglycemia Guidelines for 2018
#3 New (2018) ADA Position Statement for Type 1 Diabetes

Last week, I got a new update of software for my Stages power meter. The Stages is a device that is milled into the left crank arm (what the pedal is screwed into) of my bike. This device measures the power (as wattage) that I create when I am on my road bike. I know that you are wondering why a non-professional rider would need such a high-tech device. The reason is that I want to maximize what I can accomplish and learn how best to use the ability I have.

This idea is also the reason that more and more patients who have diabetes are using CGM devices. We all know they are perfect for patients who have type 1 diabetes and those with more complex treatment strategies, such as those who require multiple injections, but now we are seeing a lot more patients overall maximizing their own care with CGM.

Check out this week’s Homerun Slides to understand firsthand the clinical and personal benefits of using continuous glucose monitors.

Dave Joffe

Editor-in-chief

Man, 69 years of age, of Italian descent, “a numbers guy,” has type 2 diabetes, A1C 8.9%, taking a GLP-1 daily, and metformin 1,000mg twice daily. Blood pressure was managed, in target range of ~110-120/70-80, HR 76-82, weight-BMI 25.3. Had been on an SGLT-2, but developed DKA, so he can no longer take SGLT-2’s nor did he want to. Checked fasting glucose some mornings a week but not every day because he did not like to stick his finger. He really didn’t want to deal with his diabetes. Due to his recent illness, he was willing to try something new and different, especially since I told him it’s about numbers and he would not have to regularly stick his fingers.

Judith Wylie-Rosett, EdD, RD, is a professor at the Albert Einstein Medical Center and co-director of the New York Regional Center for Diabetes Translation Research in Bronx, NY.

Dr. Wylie-Rosett’s research focuses on nutrition’s role in preventing and controlling chronic diseases—particularly diseases such as type 2 diabetes and heart disease in which obesity is an important risk factor.  She is associate editor of the journal Diabetes Care and author of The Complete Weight Loss Workbook. Dr. Wylie-Rosett has helped the American Diabetes Association and American Heart Association develop nutrition-related recommendations and position statements.

In this week’s Homerun Slides, the conclusion of comparing Flash CGM with Dexcom rtCGM.

Glucokinase MODY: Glucokinase catalyzes the phosphorylation of glucose to glucose-6-phosphate. Its unique kinetic properties result in the rate of glucose phosphorylation being proportional to the physiologic glucose concentration. This means that the beta cell and hepatocyte can respond appropriately to fluctuations in the degree of glycemia. In the pancreatic beta cell, glucokinase acts as “the glucose sensor” ensuring insulin release is appropriate to the blood glucose concentration.

Free potential treatment lowers blood sugars, helps with weight loss, drops blood pressure and cholesterol, and may add at least 10 years of quality of life.

Holistic approach revised, but there is still more to be done to individualize treatment.

Recommendations place special emphasis on youth newly diagnosed with diabetes.