Update on Diabetes and Covid-19 Studies show the impact of diabetes control on Covid 19 outcomes

Two studies, one from China and one from England, offer similar messages to people with diabetes.

The first study, from Hubei Province, China, evaluated nearly 1000 patients with Covid 19 and pre-existing diabetes (published in Cell Metabolism). The patients who were better controlled upon entry to the hospital (average A1c 7.3%) had a significantly higher survival rate than those who had an average A1c of 8.1%.

The second study, from England, noted that one in four people who have died of Covid 19 also had diabetes. Weight and higher A1c correlated to a higher death rate.

Overall, the data shows that people who go to the hospital for Coronavirus and also have poorly managed diabetes, have a higher risk of dying.

What does this mean for people with diabetes?

First, there is no evidence that people with diabetes have a higher risk of contracting Coronavirus, and most people with the infection will not need hospital care at all.

Secondly, the best approach to reducing the risk of complications due to Coronavirus is to manage diabetes carefully and keep blood sugars controlled.

Prevention of Coronavirus by wearing masks and social distancing is the best approach for everyone.

If you have diabetes, be sure to monitor your blood sugars and keep all medical appointments. If your blood sugars are not well controlled, please seek medical care. Our endocrinologists and mid-level practitioners are here to help.

This update is brought to you by the doctors and mid levels at Texas Diabetes and Endocrinology, where helping you be successful in managing your diabetes is our priority.

Austin TypeOneNation Summit

Dr. Tira Chaicha-Brom, MD ECNU, of Texas Diabetes and Endocrinology, has joined a panel of experts who will be discussing Type 1 diabetes (T1D) and pregnancy at the upcoming Austin TypeOneNation Summit on Sunday, March 1, 2020.  

This educational conference is a great opportunity for those living with T1D, parents, caregivers, siblings and anyone interested in learning more about T1D. Topics include advancements in the treatment of T1D,  T1D and pregnancy and will showcase learning tracks for children and teens as well. Please join Dr. Chaicha-Brom at this important event.

Learn more and register today at bit.ly/TON2020

Diabetes

When a diagnosis of Diabetes is given it can be scary and overwhelming for most people. At Texas Diabetes and Endocrinology we are here to help you navigate a path to achieving a healthier life. We will work alongside you and your family members to gain a better understanding of both the disease as well as the treatment options.

  • In the last 20 years, the number of people diagnosed with diabetes has doubled
  • Diabetes is the 7th leading cause of death in the US
  • Diabetes is the #1 cause of kidney failure, lower-limb amputations as well as adult blindness
  • There are many types of diabetes: Type 1, Type 2, gestational diabetes and prediabetes

Risk Factors For Diabetes:

  • For Type 2 Diabetes:
    • if you have a parent or sibling with diabetes,
    • are overweight,
    • > 45 y.o,
    • history of gestational diabetes,
    • history of prediabetes,
    • and African Americans and Latinos are at a higher risk
  • For Type 1 Diabetes:
    • family history with a parent or sibling with Type 1 diabetes

What is the difference between Type 1 and Type 2 Diabetes?

Type 1 diabetes is an autoimmune disease where the pancreas is not functioning and treatment requires insulin. Type 2 diabetes is due to insufficient insulin production from beta cells in the setting of insulin resistance. The risk of type 2 diabetes is both a combination of lifestyle and genetic factors. Studies show that type 2 diabetes can be delayed or prevented with exercise and weight loss.

Treatment options:

There are many treatment options available and each person needs a plan specific to them and their needs. There are multiple options with oral medication, non-insulin injectables, as well as insulin and lifestyle modification to aid in treatment. Treatment options also include a variety of insulin pumps and we can help you in deciding the one that would be the best fit for you.

There are also numerous options available on how to monitor your blood sugars including continuous glucose monitors, traditional finger stick glucometers and even implantable monitors.

We are fortunate to have multiple treatment options for diabetes and recommend you schedule a visit so we can come up with an INDIVIDUALIZED plan for you or your loved ones.

At any given time we also have multiple research trials going on for weight loss, type 1 and type 2 diabetes. Please refer to our research page(https://texasdiabetes.com/sponsors-and-cro/currently-enrolling-trials/) for ongoing studies.

We look forward to working with you. Please do not hesitate to contact the office with any questions or concerns.

POLYCYSTIC OVARIAN SYNDROME

Do you have irregular periods? There are several reasons for missing periods, but one of the most common reasons is PCOS, polycystic ovarian syndrome.  

Symptoms of PCOS include:

  • Missing periods (usually having less than 9 periods per year)
  • Excess testosterone on blood work or on exam (excess hair growth, acne)
  • Ovarian cysts

PCOS is a diagnosis of exclusion so other diseases like thyroid or other hormone problems should be ruled out before making the diagnosis of PCOS.  The diagnosis is based on symptoms, laboratory findings, and sometimes imaging studies.

The risk of having PCOS is that it can be associated with diabetes or insulin resistance, sleep apnea, cardiovascular disease, weight issues, uterine cancer, infertility, and sleep apnea.

The cause of PCOS is unknown and treatment involves controlling the symptoms.  A healthy lifestyle with weight loss can oftentimes improve symptoms and prevent associated medical complications.  Birth control pills are typically used to help regulate periods and can sometimes decrease facial hair or acne. Metformin is another medication that is typically used to help control the blood sugar.

When a woman has regular periods, this is a good indication that her hormones are appropriate. 

You should let your healthcare provider know if you have irregular periods or excess hair growth or acne in order to do a proper evaluation.

The following references:

https://www.hormone.org/diseases-and-conditions/polycystic-ovary-syndrome

PCOSChallenge.com

Obesity

Obesity (defined as a body mass index (BMI) >30kg/m2) is a chronic disease that is increasing in prevalence in adults, adolescents, and children and is now considered to be a global epidemic. The National Health and Nutrition Examination Survey (NHANES) in 2016 showed the prevalence of obesity in the United States to be 39.6% (37.9% in men and 41.1% of women), up from 22.9% in 1994.

At Texas Diabetes and Endocrinology we investigate many aspects of this disease. We rule out any possible secondary causes (such as pituitary, thyroid, adrenal or ovarian abnormalities) as clinically indicated, discuss contributing medications, and obtain a thorough weight gain/weight loss history. Obesity is associated with a significant increase in morbidity (including diabetes mellitus, hypertension, dyslipidemia, heart disease, stroke, sleep apnea, and cancer) and we assess these and come up with a comprehensive plan to manage them.

Weight loss itself is associated with a reduction in obesity-associated morbidity and we are committed to helping our patients achieve these benefits. We counsel all patients on lifestyle and behavioral modification. We also offer medically supervised programs to assist with individual goals. Ideal Protein is one program we utilize: it provides structure and one-on-one coaching that can help achieve not only weight loss but also reduction in comorbidities and often medications. We also use FDA-approved weight loss medications as needed to help our patients achieve their goals.

Finally we conduct clinical trials at all of our locations and these often involve obesity treatments. Currently at the south office we are conducting a study on a medication (semaglutide) to evaluate weight loss and long-term cardiovascular outcomes.

 

Advanced Lipid Tests

Fish Oil (Omega 3 fatty acids has been touted as a having heart and vascular protective effects for many years.  In 2018, a number of large clinical studies including studies in people with diabetes showed that fish oil had little to no effect in reducing cardiovascular events.  This was quite disappointing to doctors and patients alike and many stopped taking fish oil.

 

  • Then in 1/19 a large study called the Reduce-It Trial was published in the New England Journal of Medicine.  It looked at the effect of an Omega 3 fatty which was a specific component of fish oil—EPA or icosapent ethyl in people with known heart disease and/or diabetes.   Let me tell you a bit about the people enrolled in the study.  The study included people who were 45 years of age or older with known heart disease OR who were 50 years of age or older and diabetes mellitus and at least 1 additional heart risk factor.
  • They had to have a fasting triglyceride of 150-499 mg/dl and their cholesterol had to be already well controlled on a statin.  The LDL cholesterol at the start of the study was really very controlled and was in the mid 70’s.
  • The study went on for 5 years.  The remarkable finding was that the icosapent ethyl reduced cardiovascular death, heart attack and stroke considerably.  This was phenomenal news to those of us who every day, treat people with heart disease and heart disease risk.

 

In summary, in the past year, we learned that regular fish oil doesn’t have the heart disease reduction effect that was claimed but that a specific derivation of fish oil, the omega 3 fatty acid icosapent ethyl (only available by prescription) reduces cardiovascular death and heart attacks and strokes in the people described above.

 

We at Texas Diabetes and Endocrinology continually strive to be current and at the forefront of using interventions to reduce heart attack and stroke risk.  We are experts in diabetes and heart risk factor management.  One of our doctors and one of our clinical nurse specialists, Ashley Davila CNS, are boarded in Lipidology.  We are also members of the National Lipid Association.   We perform noninvasive heart disease risk assessments with an easy ultrasound based arterial assessment called Carotid Intimal Medial Thickness (CIMT).  We also obtain “advanced lipid tests” in many individuals to help in their cardiovascular risk reduction/prevention.

 

We have participated in many clinical research studies evaluating a number of medications used to lower cholesterol.  We are soon enrolling a study to evaluate the effect of a medication on lowering Lp(a) also called lipoprotein little a, which is an important indicator of heart attack and stroke risk.  If you or any of your family has been told that you have an elevated Lp(a), please call our office and ask for the research department.

 

What is the pituitary?

The pituitary is a hormone-producing gland that sits just beneath the base of the brain. It is very small – only about the size of a pea. The pituitary gland has two parts. The front portion of the gland makes hormones that affect the breasts, adrenals, thyroid, ovaries and testes, as well as several other hormones. The main glands affected by the back portion of the gland are the kidneys. It plays a major role in regulating vital body functions and general wellbeing. It is referred to as the body’s ‘master gland’ because it controls the activity of most other hormone-secreting glands.

What could go wrong with my pituitary gland?
Conditions that affect the pituitary gland directly can be divided into three main categories:

• Conditions that cause the pituitary gland to produce too much of one or more hormone(s). Examples include acromegaly, Cushing’s disease and prolactinoma.

• Conditions that cause the pituitary gland to produce too little of one or more hormone(s). Examples include adult-onset growth hormone deficiency, diabetes insipidus and hypopituitarism.

• Conditions that alter the size and/or shape of the pituitary gland. Examples include empty sella syndrome.

What are the symptoms of pituitary conditions that produce too much of one or more hormones?

A prolactinoma is a tumor of the pituitary gland that produces too much of the hormone prolactin. High prolactin levels can cause women to have irregular or absent periods, infertility, or abnormal breast milk production. In men, high prolactin levels cause low testosterone which leads to fatigue, decreased muscle strength, low libido, erectile dysfunction, and infertility.

Cushing’s Disease is a hormonal disorder caused by a tumor of the pituitary gland. The tumor makes too much of a hormone called ACTH (adrenocorticotropic hormone). ACTH causes an increase in the stress hormone cortisol. Cortisol is a hormone that regulates blood pressure, blood sugar, and the immune system.

Acromegaly is caused by a tumor in the pituitary gland that makes too much growth hormone. Common symptoms of acromegaly are abnormal growth of the hands and feet, joint pain, face changes (enlarging forehead, nose, tongue, lips, widened space between teeth, and underbite), carpal tunnel syndrome, sleep apnea, diabetes, high blood pressure.

What are the symptoms of pituitary conditions that produce too little of one or more hormone(s)?

Hypopituitarism is a rare disorder in which your pituitary gland fails to produce one or more hormones, or doesn’t produce enough hormones. This can cause a variety of different symptoms depending on which hormone has been affected.

Growth hormone (GH) deficiency
In children, GH deficiency may cause growth problems and short stature. Most adults who have GH deficiency don’t have any symptoms, but for some adults it can cause fatigue, changes in body fat and muscle weakness.

Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiency
Deficiency of these hormones affect the body’s reproductive system. In women, the deficiency can cause irregular periods, hot flashes, low libido and the inability to produce milk for breast feeding. Men may also have symptoms such as erectile dysfunction, decreased facial or body hair, low libido and mood changes.

Thyroid-stimulating hormone (TSH) deficiency
This hormone controls the thyroid gland. A TSH deficiency leads to low levels of thyroid hormones (hypothyroidism). Symptoms include fatigue, weight gain, dry skin, constipation, hair loss and feeling unusually cold.

Adrenocorticotropic hormone (ACTH) deficiency
This hormone helps your adrenal glands work properly, and helps your body react to stress. Symptoms of ACTH deficiency include severe fatigue, nausea or abdominal pain, and low blood pressure, which may lead to fainting.

Anti-diuretic hormone (ADH) deficiency
This hormone helps your body balance its fluid levels. Symptoms of ADH deficiency can cause a disorder called diabetes insipidus, which can cause excessive urination and thirst.

Prolactin deficiency
Prolactin is the hormone that tells the body when to start making breast milk. Low levels of prolactin can cause women to have problems making milk for breast-feeding.

What are the symptoms of pituitary conditions that alter the size and/or shape of the pituitary gland?

Empty Sella
Most individuals with empty sella syndrome do not have any associated symptoms, but the finding raises concerns about hormone deficiencies.

What is the treatment?

The treatment for pituitary problems are vast. Sometimes only monitoring the patient is needed. Other times a simple medication can resolve problems; however, in some cases surgery is required.

Why you should contact TD&E?

Pituitary disorders are often complex, and successful diagnosis and treatment can be a challenge. The physicians at TD&E offer an integrated, comprehensive approach to all pituitary problems. To ensure the best chances for successful treatment, you should be cared for by experts who specialize in pituitary diseases.

Resources

1. http://pituitarysociety.org/patient-education/pituitary-disorders
2. http://www.yourhormones.info/glands/pituitary-gland/
3. https://www.hormone.org/diseases-and-conditions/pituitary-tumors
4. https://www.mayoclinic.org/diseases-conditions/hypopituitarism/symptoms-causes/syc-20351645

Low testosterone (hypogonadism) in men

What is testosterone?

Testosterone is the most important androgen (male hormone) that men make. It helps regulate muscle mass and strength, it can effect sex drive and sexual function, and it helps maintain bone strength.

What is “low T”?

Low testosterone is when the body does not produce sufficient testosterone. With age, it is normal for levels of testosterone to get a bit lower. When the levels of testosterone get too low, men can have symptoms.

What are the symptoms?

The symptoms may change from person to person.
If someone has had low testosterone for a relatively short period of time, he may experience: fatigue, low libido (little or no interest in sex), or he may feel sad or depressed
If low T goes unnoticed for a long time, some people experience loss of bone and / or muscle mass, loss of facial or body hair, increase in breast size (gynecomastia)

What are the causes?

  • Normal aging
  • Diseases affecting the testicles (which produce testosterone in men)
  • Certain treatments for cancer, including radiation, chemotherapy or certain types of hormone therapy
  • Disorders that affect the pituitary gland, a gland at the base of the brain that regulates all other hormones in the body

Other medical problems: liver and kidney disease, obesity, diabetes, AIDS, and some relatively rare hereditary conditions

Why should you see us for this?

There are many things that can cause these symptoms. Your provider can try to find out what might be causing them. A blood test can show whether you have low T, but you might not need that test if something else is causing your symptoms. Also finding the cause of low T is important, since treatment may change depending on the cause.

What is the treatment?

Low testosterone can be treated with testosterone replacement, which comes in patches, gels, injections, and other options. It is very important to pick the treatment that will work best for you and to monitor your testosterone levels to optimize the results. The providers at Texas Diabetes & Endocrinology are experts in low testosterone management and can help you achieve personalized results!


Why you should contact TD&E

  • It is very important to evaluate and understand the specific cause of low T before starting treatment for it. Treatment depends on the cause, and sometimes starting treatment before detailed evaluation can make it harder to understand the underlying cause
  • Getting your testosterone levels to optimal has health benefits including improved muscle mass, increased bone density, better energy levels, and improved sexual function.
  • The providers at Texas Diabetes & Endocrinology are experts in low testosterone management and can help you achieve personalized results!

 


What you need to know about Osteoporosis

Osteoporosis is a growing public health concern. It is characterized by low bone mass and decreased bone strength which results in an increased risk for fracture. This disease can affect both men and women. Current estimates are that 5.1% of men and 24.5% of women age 65 years and older have osteoporosis of the hip or spine.

Osteoporosis can be diagnosed with a BMD (bone mineral density) assessment.

Most experts recommend a BMD assessment in all postmenopausal women 65 years and older.

Many experts also recommend a BMD assessment in women younger than 65 who are at increased risk for osteoporosis.

Some experts recommend a BMD assessment for men over the age of 70.

Osteoporosis is a silent disease. As such, there are no clinical manifestations until the affected individual suffers a fracture. This is why early diagnosis is important -we have therapies that can slow or even reverse the progression of osteoporosis so that fracture risk is reduced. One of our goals at Texas Diabetes and Endocrinology is to deliver interventional therapies that will maintain quality of life for an aging population. If you have osteoporosis, we can perform a thorough evaluation and offer an individualized treatment plan.

Here are things you can do on your own to preserve bone mass:

  • Limit alcohol consumption to <2 drinks daily
  • Avoid smoking
  • Take a daily walk for at least 30-45 minutes
  • Consume foods containing vitamin D (dairy and fish from the ocean) and/or take a supplement
  • Consume foods containing calcium (dairy, green leafy vegetables) and/or take a supplement.

Links for more information:
nia.nih.gov/health/osteoporosis
nof.org/patients
rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteoporosis