January 15, 2019 : DCMS #432

DISASTERS AVERTED — Near Miss Case Studies

What Can Happen When Patients Take Diabetes Holidays

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Todd Hobbs on Major Novo Nordisk Studies

HOMERUN SLIDES — Great Clinical Presentation Highlights

New CGM Categories and Technologies Part 3

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #160: Immunopathogenesis of Type 1 Diabetes in Western Society Part 3

MOST POPULAR ARTICLES OF THE MONTH

#1 Interview: New Drug Cocktail That Increases Human Beta Cell Proliferation at Rapid Rates
#2 HbA1c Variability and Risk of All-Cause Mortality and Cardiovascular Events
#3 Confusing Insulins Still A Common Mistake

Closed loop, Open Loop, MDI, Patch Pump. These are all methods of delivering insulin — some so complex, the combination of sensor and pump will manage highs and lows; others so simple, you barely need a meter. However, all of these methods could benefit from CGM devices.

This week in our Homerun Slides, we look at the progress to accuracy starting with the Glucowatch in 2004 and moving forward to the sensors of today.

Dave Joffe

Editor-in-chief

Man, 36 years of age, type 2 diabetes, obesity class II, fatty liver, was taking metformin 1,000mg twice daily, and lower dose of SGLT-2. A1C was elevated 9% due to steroids; had been in the 6-7% range. Came in for 3-month follow up — A1C 9.9%, glucose 359, urine positive for glucose and for ketones, gained 19 pounds since last office visit, B/P 126/78-HR 78 and regular.

The patient reports he took a “holiday” from everything during the holidays. He ate and drank anything and everything he wanted, including alcohol, and stopped his medications. He complained of  increased hunger and thirst. Very thirsty.

Todd Hobbs, MD, is Vice President and Diabetes Chief Medical Officer for Novo Nordisk in North America, where he leads the organization’s focus on the implications of diabetes for the patient, healthcare system and healthcare professionals. As the Diabetes Chief Medical Officer for Novo Nordisk in North America, he focuses on the implications of diabetes for the company and for patients, for healthcare professionals and for healthcare systems. He provides medical guidance and input to the clinical development and life cycle management strategies for diabetes and obesity-related projects, as well as input into the R&D pipeline and participate in consultant advisory boards. Prior to joining the Novo Nordisk team in 2004, he attended the University of Louisville School of Medicine and then serviced as a resident at the Anderson Area Medical Center in South Carolina.

In this week’s Homerun Slides, we conclude this series with CGM categories from the FDA’s perspective.

Insulin itself is a prototypical TRA, its synthesis being virtually restricted to pancreatic beta cells. Thymic insulin production is critical for establishing self-tolerance to beta cells; simply abolishing insulin expression in the thymus leads to the rapid onset of autoimmune diabetes even in mice lacking a diabetogenic genetic background [26]. In humans, thymic insulin expression is modulated by allelic variation and epigenetic effects at the insulin gene locus; this effect is largely mediated by a polymorphic variable nucleotide tandem repeat (VNTR) sequence.

Diabetes in Control is pleased to bring you an exclusive interview with Dr. Andrew Stewart. Dr. Stewart and his fellow researchers at the Icahn School of Medicine at Mount Sinai have discovered a novel combination of two classes of drugs that induces the highest rate of proliferation ever observed in adult human beta cells—the cells in the pancreas that produce insulin. The result is an important step toward a diabetes treatment that restores the body’s ability to produce insulin. 

Study assesses effect of variable glycemic levels on risk of vascular complication in patients without diabetes.

I have a patient who has type 2 diabetes. He was started on long-acting insulin 8 months ago. Before adding the insulin, he was taking a daily GLP-1. He had experienced diabetic ketoacidosis (DKA) while on a SGLT-2, and did not tolerate metformin due to GI side effects. Therefore, these two were no longer options. …