February 12, 2019 : DCMS #436

DISASTERS AVERTED — Near Miss Case Studies

How Do You Talk with Your Patients?

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

John Buse on Observe 4D Real-World SGLT2 Study

HOMERUN SLIDES — Great Clinical Presentation Highlights

Diabetes Apps Presentation Part 3

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #164: Molecular Genetics of Type 1 Diabetes Part 1

MOST POPULAR ARTICLES OF THE MONTH

#1 Can Green Tea Increase The Risk For Type 2 Diabetes?
#2 Warn, Teach, and Revisit Metformin
#3 CGM Simplicity Can Be Complex Information for Beginners

Have you ever noticed that when an adult over 40 starts on both meal-time and long-acting insulin, they will refuse to acknowledge that they could possibly have developed type 1 diabetes? Since most of those patients will never see an endocrinologist and have an antibody test, they will never really know for sure.

This week, in our Clinical Text, we start to discuss the Molecular Genetics of Type 1. Just reading the first paragraph of this excerpt could change the way you talk to those patients. It is likely worth printing out the first paragraph and handing to your patients.

Dave Joffe

Editor-in-chief

As noted in our Editor’s Letter, David Joffe discusses the importance of how we talk with patients. And to that I’ll add…how or if we listen to our patients.

David’s letter made me think about what we say to patients when they are at risk, when they are diagnosed, and during the treatment phase. If we keep current with our knowledge of diseases — in this case, diabetes — and share what we know today but be clear that we may learn more and differently in the future, the patient may be more open to accept changes and work toward their health goals while at the same time taking into consideration what is known and currently available.

John Buse, MD, PhD, is the director of the North Carolina Translational and Clinical Sciences Institute and of the UNC Diabetes Center for Excellence, professor of Medicine and Executive Associate Dean for Clinical Research at the UNC School of Medicine. His specialty is the prevention and treatment of type 1 diabetes and type 2 diabetes, and their complications. Dr. Buse’s practice combines clinical care, research and education.

In this week’s Homerun Slides, more on the diabetes app as a tool to streamline processes and save time as well as money.

Type 1 diabetes (T1DM) is a chronic autoimmune disease in which the beta cells of the islets of Langerhans are selectively destroyed, resulting in insulin deficiency and hyperglycemia. The disease develops in genetically susceptible individuals, most likely as a result of an environmental trigger. T1DM has an uneven geographical distribution; disease prevalence is highest in populations of white European origin and lowest in those of East Asian descent. A marked gradient in disease risk also exists in Europe, with higher prevalence of T1DM in northern countries, particularly Finland, compared with areas around the Mediterranean. This pattern could be attributed to genetic differences between the populations or to the presence/absence of environmental triggers.

People consistently drinking green tea may not be getting all the benefits as hoped.

If this happens in my practice, I’m sure it likely happens with your patients too.

So many of our patients take metformin. They may be new to using metformin or have been taking it for many years. Either way it’s not unusual to have untoward GI side effects from taking it. They may have done fine taking it for years, so they don’t even think about it being their metformin.

Woman, 55 years of age visited with me 3 weeks ago. Her glucose levels were in the 200-250 mg/dL range. She was actually a new patient of ours; her A1C was 9.2%. We recommended a CGM. She purchased one and brought it to the office for me to teach her how to use it. I did so. This patient is well-educated and seemed tech-savvy. When she left the visit, she “seemed” to understand CGM, what it is, what to do, and how to insert the sensor, get readings, interpret readings, etc.