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One-year, randomized study shows lower HbA1c, blood glucose, blood pressure and body weight without significant increase in hypoglycemia.

By Sheri R. Colberg, PhD, FACSM
A topic that comes up frequently nowadays is the use of diabetes technologies with exercise. When I surveyed close to 300 active individuals with diabetes, more than 60 percent used an insulin pump (which is well above the national average), but even more of these exercisers—over 75 percent—wear a continuous glucose monitoring (CGM) device (1). The technology fervor has grown even louder since the FDA recently granted approval in the United States to an implantable, three-month CGM sensor called Eversense (made by Senseonics). Can active people benefit from using these CGM and other devices, especially when active?

Mrs. Wilson is woman who is 71 years of age, African American and has excess weight. She has come to your clinic today for a new patient visit. She recently moved to the area to live with her daughter and is concerned about her diabetes care plan. She was diagnosed with type 2 diabetes 12 years ago at a wellness check through routine screening. In hindsight, she wonders if maybe she “went undiagnosed for a while” because she “didn’t get to the clinic very often and was having some problems with frequent urination at night” before she was screened. She currently takes metformin, glyburide, captopril, pravastatin, and aspirin, and has recently titrated to.6 U/kg/day insulin NPH as a nightly basal dose. Her current A1C goal is less than 7.5% and she has been working hard to get to that level. However, for the first time her life, she is finding herself to be nauseated and irritable in the morning, but always feels better after a little breakfast. She states she feels “pretty good for her age,” although she occasionally has “a little chest tightness when walking more than 4 or 5 blocks.” Last time she remembered to check her glucose was a few days ago. GHer postprandial glucose was “a little high” at 214 mg/dL. Her office A1C is 8.6%. Based on what you know about the patient, what is the most likely cause of her morning distress? A. Hyperglycemia B. Hypoglycemia C. Anxiety D. Cognitive decline Follow the link for the answer.

Which brand of Continuous Glucose Monitor (CGM) do you prefer -- Dexcom, Abbott FreeStyle Libre, or Eversense? Follow the link to respond.

Man, 55 years of age, type 2 diabetes, hypertension, was referred to see us. The patient reports coming to us because he does not think he is getting the right treatment. Reports having been put on insulin upon diagnosis 4 years ago--at which time he had lost 50 pounds, was very hungry, thirsty, and had urinary frequency. When visiting, he did not have his labs from diagnosis but did have labs from 3 months ago at which time A1C was 7, and C-Peptide was 2.2. He said his past endocrinologist changed him to oral meds after his glucose had come down to an average of 140.

W. Timothy Garvey, MD is the Butterworth Professor of Medicine in the Department of Nutrition Sciences at the University of Alabama at Birmingham. He obtained his MD degree from St. Louis University, completed residency training in Internal Medicine at Barnes Hospital, Washington University, and was a clinical fellow in Endocrinology and Metabolism at the University of Colorado Health Sciences Center and University of California, San Diego School of Medicine.

In this week's Homerun Slides, a look at various principles of disease management.

Beta-Cell function: Although the plasma insulin response to the development of insulin resistance typically is increased during the natural history of T2DM , this does not mean that the beta cell is functioning normally. To the contrary, studies have demonstrated that the onset of beta-cell failure occurs much earlier and is more severe than previously appreciated.

In this Exclusive Interview, Dr. Timothy Garvey talks with Diabetes in Control Publisher Steve Freed during the AACE 2018 convention in Boston, MA about the variety of available medications to help with weight loss and which — if any — might be the best to recommend.

To see this interview in full, click here. Freed: This is Steve Freed and we’re here at the 2018 AACE meeting. We have a special guest with us who we have talked to before, Dr. Timothy Garvey, and he is very interesting. I’ve got 22 paragraphs about your background but …