Valerie Espinosa, MD Achieves Certification by the American Board of Obesity Medicine

Congratulations to Texas Diabetes & Endocrinology physician partner Valerie Espinosa, MD for achieving certification by the American Board of Obesity Medicine.

The American Board of Obesity Medicine (ABOM) serves the public and the field of obesity medicine by maintaining standards for assessment and credentialing physicians.Certification as an ABOM Diplomate signifies specialized knowledge in the practice of obesity medicine and distinguishes a physician as having achieved competency in obesity care. ABOM collaborates with the National Board of Medical Examiners (NBME) to administer the annual credentialing exam.

The History of Metformin

Metformin is one of the most commonly used medications in endocrinology. It is the preferred first-line oral blood glucose-lowering medicine to manage type 2 diabetes. It is also used in the treatment of polycystic ovary syndrome. Sometimes it is used, along with other medications, to treat infertility.

The journal Diabetologia dedicated a special issue this month to Metformin, which is celebrating 60 years of clinical use.

Most people don’t know that metformin has been in use for sixty years! The effectiveness of the plant from which metformin is derived has been known since 1918. The plant Gallegos officinalis (goat’s rue, also known as French lilac or Italian fitch) was noted to have sugar-reducing properties then. Initial experiments with metformin went well, but the discovery of human insulin for the treatment of diabetes put metformin on the back-burner. Metformin was rediscovered in the 1940s. The French physician Jean Sterne was the first to pursue the glucose-lowering effect of metformin. He reported the use of metformin to treat diabetes in 1957.

Over the years, the ability of metformin to improve the way the body processes and responds to insulin was appreciated more and more through Europe. After intensive research, metformin was introduced into the USA in 1995.

Long-term benefits on heart health were identified by the UK Prospective Diabetes Study (UKPDS) in 1998. This provided yet another reason for metformin to become first-line treatment for diabetes.

Sixty years after its introduction, metformin has become the most prescribed sugar-lowering medicine worldwide with the potential for other uses.

Metformin timeline
1772 Galega officinalis used anecdotally to treat symptoms of diabetes
1929 First scientific experiments on lab animals
1957 Jean Sterne publishes on the use of metformin to treat diabetes
1958 Metformin introduced as a diabetes medication in the UK
1994 Metformin introduced in the USA
1998 UKPDS reports heart benefits of metformin in people with type 2 diabetes
2002 Metformin shown to reduce progression of prediabetes to diabetes
2011 Metformin included in the essential medications list of the World Health Organization

For further insights into the history and multiple uses of metformin – see Diabetologia (2017) 60

New Medication Option for Osteoporosis Treatment

The Food and Drug Administration (FDA) has approved Tymlos (abaloparatide) injection for the treatment of postmenopausal women with osteoporosis at high risk for fracture. High risk for fracture is defined as history of osteoporotic fracture, multiple risk factors for fracture, or patients who have failed or are intolerant to other available osteoporosis therapy. In postmenopausal women with osteoporosis, Tymlos reduces the risk of vertebral and nonvertebral fractures.

Clinical Data

The FDA’s approval of Tymlos was based on results from the ACTIVE trial and an extension of this trial. These studies demonstrated significant reductions in the risk of vertebral and nonvertebral fractures regardless of age, years since menopause, presence or absence of prior fracture and bone mineral density (BMD) at baseline. In clinical studies, Tymlos reduced the incidence of new vertebral and nonvertebral fractures, and increased bone mineral density (BMD).

The results from the ACTIVE trial were published in the Journal of the American Medical Association in August of 2016, and the results of the first six months of ACTIVExtend were published in the Mayo Clinic Proceedings in February 2017.

Specifically, in the ACTIVE trial, TYMLOS demonstrated significant reductions in the relative risk of new vertebral and nonvertebral fractures compared to placebo in the ACTIVE trial of:

  • 86% in new vertebral fractures
  • 43% in nonvertebral fractures

The absolute risk reductions were 3.6% and 2.0%, respectively.

Safety information

Abaloparatide caused a dose-dependent increase in the incidence of osteosarcoma (a malignant bone tumor) in male and female rats. The effect was observed at systemic exposures to abaloparatide ranging from 4 to 28 times the exposure in humans receiving the 80 mcg dose. It is unknown if Tymlos will cause osteosarcoma in humans.

For this reason, the use of Tymlos is not recommended in patients at increased risk of osteosarcoma including those with Paget’s disease of bone or unexplained elevations of alkaline phosphatase, open epiphyses, bone metastases or skeletal malignancies, hereditary disorders predisposing to osteosarcoma, or prior external beam or implant radiation therapy involving the skeleton.

Adverse Reactions: The most common adverse reactions (incidence ≥2%) are hypercalcemia, hypercalciuria, dizziness, nausea, headache, palpitations, fatigue, upper abdominal pain and vertigo.

Reminders About Osteoporosis

Osteoporosis is a silent disease, often displaying no signs or symptoms until a fracture occurs, leaving the majority of people with osteoporosis undiagnosed and untreated. Osteoporotic fractures create a significant healthcare burden. An estimated two million osteoporotic fractures occur annually in the United States, and this number is projected to grow to three million by 2025.

The National Osteoporosis Foundation (NOF) has estimated that eight million women already have osteoporosis, and another approximately 44 million may have low bone mass placing them at increased risk for osteoporosis

Screening is key to diagnose osteoporosis. Once osteoporosis is diagnosed, it is very important to undergo a thorough evaluation to look at secondary factors that can contribute to osteoporosis. Once the evaluation is complete, you and your physician can review the best treatment plan for you.

One of world’s most prestigious endocrinology conferences comes to Austin!

Texas Diabetes & Endocrinology was excited about one the world’s largest endocrinology conferences being in Austin this year. The Annual Scientific & Clinical Congress of the American Association of Clinical Endocrinologists was held in Downtown Austin between May 3rd and 7th. This is a world-renowned meeting which highlights the latest technological and medical advances in endocrinology. The program included expert speakers covering the latest developments and workshops presenting cutting-edge research to practitioners from around the world.

The most recent developments in diabetes treatment received extensive coverage at the conference. Dr. Thomas Blevins from Texas Diabetes & Endocrinology presented our clinic’s early experience with the new closed-loop insulin pump system in patients with type 1 diabetes.

In other sessions, attendees learned about recent developments in diabetes care. A special workshop reviewed data from recent studies evaluating the impact of diabetes medications on heart health.

One of the messages was that good sugar level control can have a significant impact on heart health. A study published in Diabetologia, showed that about 2.5% of patients with type 2 diabetes had known heart failure. Further detailed evaluation showed that up to 27.7% of patients had early signs or findings of heart failure. Importantly, by using medications that are known to reduce the risk of heart disease in patients with diabetes we can prevent the development and progression of these early stages of heart problems.

The special session also touched on different diabetes medications and their effects on heart function. The EMPA-REG outcome study which showed a significant reduction in heart disease and stroke-related deaths with the use of empagliflozin was reviewed. Another agent, liraglutide also reduced cardiovascular deaths, and the study that demonstrated this finding was the LEADER study.

The meeting was a major success overall, and it was a great opportunity for Texas Diabetes & Endocrinology providers to show off their city to colleagues from around the world!

Texas Diabetes & Endocrinology is awarded AlUM Ultrasound Practice Accreditation

The Ultrasound Practice Accreditation Council of the American Institute of Ultrasound in Medicine is pleased to announce that Texas Diabetes & Endocrinology has been awarded practice accreditation in the area of thyroid ultrasound.

Texas Diabetes & Endocrinology achieved this recognition by meeting rigorous voluntary guidelines set by the diagnostic ultrasound profession. All facets of the practice were assessed, including the training and qualifications of physicians and sonographers; ultrasound equipment maintenance; documentation; storage, and record-keeping practices; policies and procedures to protect patients and staff; quality assurance methods; and the thoroughness, technical quality and interpretation of the sonograms the practice performs.

About the AIUM

The American Institute of Ultrasound in Medicine is a multidisciplinary medical association of more than 9900 physicians, sonographers, and scientists dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation. Participation in the AlUM’s Ultrasound Practice Accreditation program is available to practices in the following areas of ultrasound: abdominal/general, breast, complete obstetric or trimester-specific obstetric, OB with adjunct detailed fetal anatomic ultrasound, musculoskeletal (diagnostic), musculoskeletal (ultrasound-guided interventional procedures), fetal echocardiography, gynecologic (with or without 3D), dedicated thyroid/parathyroid, urologic, ultrasound-guided regional anesthesia and head and neck. For more information, visit www.aium.org.

Dr. Luis Casaubon Achieves American Board of Internal Medicine Recertification

Congratulations to Dr. Casaubon at our Central Austin office for completing all the required stages, and achieving recertification in Diabetes, Endocrinology and Metabolism. All our endocrinologists are board certified by the American Board of Internal Medicine. In order to maintain board certification, a specialist needs to take a comprehensive exam every ten years, and fulfill rigorous continuing education requirements. Dr. Casaubon successfully passed his recertification exam, and demonstrated completion of continuous education requirements. All our specialists maintain their specialty board certification as a way to demonstrate their commitment to staying up to date on the newest developments in their field for excellent patient care.

Groundbreaking Ceremony at New Round Rock Office

Construction at our new Texas Diabetes & Endocrinology office in Round Rock has started. The new building will allow us to serve our patients better by integrating our weight loss program, our research department, and will expand our clinic space. Our patients will also appreciate the increased parking space. The new building will be at 110 Deer Ridge Dr. We are expecting to move in to the new space this summer, and we will keep our patients posted.

Continuous Glucose Monitors (CGMs) – Gold Standard of Care for Adults with Type 1 Diabetes

The Endocrine Society recently issued a Clinical Practice Guideline recommending continuous glucose monitors (CGMs) as the gold standard of care for adults with Type 1 diabetes. Here at Texas Diabetes & Endocrinology, we provide comprehensive training and support for continuous glucose monitoring.

The guideline, titled “Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline,” was published online and also appeared in the November 2016 print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of the Endocrine Society.

Continuous glucose monitors (CGMs) are primarily used to help in the management of Type 1 diabetes, although the devices can be useful for people with type 2 diabetes, as well.

Studies have found that people with Type 1 diabetes who use CGMs are able to maintain better control of their blood sugar without increasing episodes of hypoglycemia when blood sugar drops to dangerous levels, compared to those who self-monitor blood glucose with periodic fingersticks,” said Anne L. Peters, MD, of the University of Southern California’s Keck School of Medicine in Los Angeles, CA, and chair of the task force that authored the guideline. “Scientific evidence supports the use of CGM technology in individuals with Type 1 diabetes whose blood sugar is above the targeted level as well as those whose blood glucose is well managed.”

Texas Diabetes & Endocrinology Partners with MyDiabetesHome

Texas Diabetes & Endocrinology is proud to announce our new partnership with MyDiabetesHome.  MyDiabetesHome.com is a personalized diabetes management platform providing diabetic patients with tools to track  blood sugar and manage medications. The interactive dashboard is easily accessible via computer, tablet or mobile device and allows patients to simplify their life, drastically improve doctor visits, and ultimately achieve better health. Texas Diabetes & Endocrinology will be sponsoring an upgraded membership for all patients. Check it out today!  www.mydiabeteshome.com

FDA approves first automated insulin-delivery device for type 1 diabetes

The FDA announced the approval of Medtronic’s MiniMed 670G, the first hybrid closed loop system – often referred to as an “artificial pancreas” – on September 28th. The device is designed to check sugar levels, and provide appropriate insulin doses, based on those readings. It is currently approved for use for people aged 14 years and older with type 1 diabetes.

 The FDA emphasized its dedication to making technologies available that can help improve the quality of life for those with chronic diseases — especially those that require day-to-day maintenance and ongoing attention in a press release. The press release said: “This first-of-its-kind technology can provide people with type 1 diabetes greater freedom to live their lives without having to consistently and manually monitor baseline glucose levels and administer insulin.”

The new device measures glucose every five minutes and automatically administers or withholds insulin, based on these levels. Users will still need to manually administer insulin doses for mealtime insulin.

The system includes a sensor that monitors glucose levels under the skin, an insulin pump, and an infusion patch.

Data from a clinical study including 123 participants with type 1 diabetes showed safety and effectiveness of the device for people aged 14 years and older.

An ongoing study is currently looking at the safety and effectiveness of the system for children aged 7 to 13 years with type 1 diabetes.

More information about the device can be found here: http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2206594

 

New Postmenopausal Osteoporosis Guidelines

The American Association of Clinical Endocrinologists (AACE) has updated its postmenopausal osteoporosis guidelines. The new guidelines cover risk factors and fall prevention measures in more detail than prior guidelines. Pharmacological treatment is recommended for patients with osteoporosis, patients with osteopenia who have had a fragility fracture of the hip or spine, and for patients with osteopenia who have a 10-year FRAX major fracture risk at or above 20%, or a 10-year FRAX hip fracture risk of 3% or above.          https://www.aace.com/files/final-appendix-sept-7.pdf

Kerem Ozer, MD inducted as a Fellow of the American College of Endocrinology

The American College of Endocrinology (ACE), the educational and research arm of the American Association of Clinical Endocrinologists (AACE), inducted Dr. Kerem Ozer, Texas Diabetes & Endocrinology physician partner, as a Fellow of the American College of Endocrinology during its recent convocation ceremony at the 2016 AACE Annual Meeting and Clinical Congress in Orlando, Florida.

Designation as a Fellow of the American College of Endocrinology (FACE) means an endocrinologist has achieved a level of training and experience consistent with the highest standards established and adopted by the clinical specialty of endocrinology.

To be accepted into the College as a Fellow, Dr. Ozer had to fulfill several rigorous academic and clinical requirements. He also had to meet service and membership expectations from the college. Alan Garber, MD, PhD, FACE, ACE president, emphasized that the FACE title also underlines international recognition of a physician’s exceptional clinical and research achievements.

About 140 endocrinologists from around the world were inducted during the ceremony. The mission of ACE is to provide and promote education, research and communication in the art and science of clinical endocrinology and to provide appropriate recognition of advances and achievements relating to clinical endocrinology.

AACE is currently the world’s largest organization representing clinical endocrinologists. With more than 6,500 members in the United States and 91 other countries, the organization has developed a robust network of professional associates.

For more information, visit www.aace.com.

Statins & Diabetes

Despite great strides in health care, heart disease remains the number one cause of death in the United States. Individuals with diabetes are three times more likely to develop heart disease, heart attack or stroke than someone without diabetes. We at TDE take this very seriously and work with our patients to reduce their cardiac risk. Of course the best approach to healthcare is prevention: maintaining an optimal weight, engaging in regular exercise and enjoying a healthy diet low in saturated fats. However, when cholesterol can’t be controlled with lifestyle changes alone, statins are an excellent option.

Why statins?
Statins such as Lipitor and Crestor have been researched extensively with studies showing a powerful reduction of LDL (bad) cholesterol (20-60%) and more importantly, a significantly reduced risk of heart attack and stroke. Statins reduce production of LDL cholesterol and triglycerides and can increase HDL (healthy) cholesterol levels. Statins have also been shown to have anti-inflammatory properties and may reverse damage from atherosclerosis in some cases. Further studies have suggested a connection between statin use and a decreased risk of developing some forms of dementia as well as improved outcomes in patients with heart failure and cardiac bypass surgery. The American Diabetes Association recommends statins for individuals with known cardiovascular disease, prior heart attack or stroke, high levels of LDL and those with diabetes between the ages of 40 and 75 years.

What is the impact of statins on blood sugar?
The news recently reported the results of a study linking the use of statins to an increased risk of diabetes. This is of course a concern as the goal of statin therapy is to reduce risk. It is true that statins can cause a mild increase in blood sugars in some individuals and bears watching. However, given the cardiac benefits, the American Diabetes Association issued the following statement, “The clear benefits of statins on cardiovascular disease likely outweigh any potential detrimental effects on glucose metabolism and diabetes risk.” A representative from the Food and Drug Administration stated, “Clearly we think that the heart benefit of statins outweighs this small increased risk.”

What about side effects?
Side effects are an important consideration whenever starting a new medication. Studies have suggested that adverse side effects occur less often with statins than with most other classes of cholesterol lowering medications. The most common side effect is muscle soreness. This can be related to the dose of the statin or vary with the type of statin being used. We also follow liver enzymes in patients taking statins as these markers can rise in some people. Most patients tolerate these medications very well and the American Association for Clinical Endocrinologists continues to recommend statins as the preferred treatment for cholesterol reduction. When starting any medication it is important to discuss the risks and benefits with your health care provider.

Study published in JAMA Network by Lindsay Harrison, MD

Effect of Adding Liraglutide vs Placebo to a High-Dose lnsulin Regimen in Patients With Type 2 Diabetes: A Randomized Clinical Trial

Liraglutide added to high-dose insulin therapy improved glycemic control, decreased body weight, and enhanced treatment satisfaction in this difficult-to-treat patient population with high-dose insulin requirements. Further studies are warranted to confirm these findings and evaluate the long-term risk and benefit of this treatment option.  Read more at: http://archinte.jamanetwork.com/article.aspx?articleid=2526669

Benefits of Continuous Glucose Monitors (CGMs)

Achieving your target hemoglobin A1C when you have diabetes can be difficult, and even more so if you have a fear of hypoglycemia (low blood glucose), as many do. The natural reaction is to allow blood sugar levels to remain high in order to prevent low glucose episodes. However, in the long run, we know this is more harmful than helpful. The CGMS, or continuous glucose monitoring system, can help. This tool has been around now for years. But we learn more and more about the benefit of this important tool as more research is done and as the systems themselves advance.

There are two different types of continuous glucose monitors (CGMs). The “professional” CGMs and the “personal” CGMs. Professional CGMs are provided by your healthcare provider and worn temporarily for a fixed period of time, usually about 5 days. The user is blind to the data. Data is then downloaded and analyzed by the healthcare provider and used to make medication or diet adjustments. We offer this tool here at Texas Diabetes and Endocrinology and find it to be invaluable in helping our patients safely improve control over their diabetes.

Personal CGMs are purchased by the user and worn at the user’s discretion, up to 7 days at a time. These sensors provide real time data so that adjustments can be made immediately. The user is notified by an alarm if the glucose decreases below or rises above a certain threshold, prompting a glucose finger stick and immediate treatment depending on the glucose level.

CGM systems use a very thin metallic filament (the sensor) that is inserted just below the skin to detect glucose in the subcutaneous interstitial fluid. The information from the sensor is then transmitted to a handheld receiver (smaller than most cell phones) which displays the glucose level and whether the glucose level is trending up or down.

The American Association of Clinical Endocrinologists recommends personal CGM for the following adult patients (guidelines issued in 2010):

Those with Type 1 DM and the following:

-hypoglycemia unawareness or frequent hypoglycemia judged to be excessive, potentially           disabling, or life-threatening

-Excessive glycemic variability

-Requiring HbA1C reduction without increased hypoglycemia

-during pre-conception and pregnancy

Several research trials have shown improvement in A1C in those using a CGMS in addition to self-monitoring of their glucose compared to those self-monitoring their glucose alone.

First Pediatric Research Trial – Faster Acting Meal Time Insulin

READY. SET. GO!!! Texas Diabetes & Endocrinology (TDE) announced today they are scheduling for the first, of a series of several, pediatric/teen research trials. This first study will be researching an investigational faster acting meal time insulin in children ages 10 to 17 years of age who are currently on multiple daily injections of insulin. TDE states they are in continued negotiations to be involved in at least three other pediatric/teen trials this year. These include investigational insulins, sensor studies and closed loops (artificial pancreas) studies. Call now (or apply online) to find out if your child qualifies for the current insulin study and stay tuned to hear more about future studies coming… 512.334.3505 Ext. 1

Intensive Lifestyle Intervention Improves Metabolism and Bone Strength

Older adults with obesity and type 2 diabetes saw improved glucose control, body composition, physical function, and bone quality when assigned to an intensive diet and exercise program. Preliminary results from an ongoing trial at the Baylor College of Medicine in Houston were just presented at the Endocrine Society Annual Meeting in Boston. Investigators looked at data from 17 adults aged 65 to 85 years. Ten study participants were assigned to follow an intensive diet and exercise based weight loss program, and seven participants continued their daily diet and physical activity routine. At 6 months, there was a significant improvement in average sugar levels (HbA1c), and bone density scores. The study is now looking at specifics to highlight what specific dietary and exercise measures were most beneficial.

Read more here: https://endo.confex.com/endo/2016endo/webprogram/Paper25882.html

First Pediatric Research Trial Begins May 1, 2016

Time to jump in!!! On May 1st, Texas Diabetes & Endocrinology will be initiating the first, of a series of several, pediatric/teen research trials. This first study will be researching an investigational faster acting meal time insulin in children ages 10 to 17 years of age who are currently on multiple daily injections of insulin. Texas Diabetes & Endocrinology has stated they are in negotiations to be involved in at least three other pediatric/teen trials this year. These include investigational insulins, sensor studies and closed loops (artificial pancreas) studies. Call now (or apply online) to find out if your child qualifies for the study starting May 1st and stay tuned to hear more about future studies coming… 512.334.3505 Ext. 1

Lindsay Harrison, MD authors study published in the Journal of Clinical Endocrinology & Metabolism

Texas Diabetes & Endocrinology physician Lindsay Harrison, MD authored a study that was recently published in the JCEM titled Mechanisms of Action of Liraglutide in Patients with Type 2 Diabetes Treated with High Dose Insulin.

The study concluded that Treatment with liraglutide significantly improved insulin secretion even in patients with long-standing T2D requiring high-dose insulin treatment. Liraglutide also decreased liver and subcutaneous fat, but did not alter glucagon secretion. – See more at: http://press.endocrine.org/doi/abs/10.1210/jc.2015-3906#sthash.rGdwKIl1.dpuf

Texas Diabetes & Endocrinology Founder Thomas Blevins, MD Moderates Expert Assembly and Serves on Writing Committee

Expert Assembly Spearheaded by American Association of Clinical Endocrinologists Calls for Expanded Use of Continuous Glucose Monitoring Technology in the Care of People With Diabetes

WASHINGTON, D.C. – (February 23, 2016) – A consensus conference convened by the American Association of Clinical Endocrinologists (AACE) this past weekend advocated for expanded use of continuous glucose monitoring (CGM) in the management of diabetes .

The diverse cross-section of diabetes care thought leaders included scientific and medical societies, patient advocacy groups, government, insurance, and pharmaceutical and medical device manufacturers.

The key conclusions concerning CGM use in diabetes include the following:

• Robust data support benefits in many people with diabetes, particularly those with type 1 diabetes
• Technological advances have improved reliability and accuracy
• Use has reduced hypoglycemia while improving control of blood glucose, ensuring patient safety
• Data suggest benefits in other patient populations, such as patients with type 2 diabetes on intensive insulin therapy
• Studies are needed to demonstrate the value of CGM technology in other patient populations
• Access should be expanded to all patient populations with proven benefits

“This conference was a necessary and critical step to help ensure that persons with diabetes who can benefit from CGM technology gain access to the best clinical care possible,” said Dr. Vivian Fonseca, FACE and Chair of the Consensus Conference. “By incorporating the practical knowledge and insights of experts across the diabetes care spectrum, we are in a position to advance this cause considerably.”

Conference participants tackled the full spectrum of CGM-related topics during the Conference. Among the issues rigorously examined:

• Identification of patient populations who may benefit from personal and/or professional CGM use
• Standardization of CGM reporting to facilitate consistent interpretation in clinical practice
• Definition of a protocol for effective analysis of CGM data for clinical utilization
• Impact of using CGM to reduce healthcare costs associated with diabetes (e.g., severe hypoglycemic events)
• Strategies to remove barriers for successful use of CGMs by patients and healthcare providers for improved diabetes management
• Use of CGM in a rapidly evolving healthcare environment
• Use of CGM in the evolving healthcare environment, (e.g., the Patient-Centered Medical Home model, alternative payment)

A complete summary of the conference conclusions can be found online at the AACE here: https://aace.newshq.businesswire.com/press-kit/2016-continuous-glucose-monitoring-consensus-conference-summary-statement.

“It’s crucial that we embrace the technological advances in diabetes management that enhance our capacity to provide the highest level of care to people with diabetes,” added AACE President Dr. George Grunberger, FACP, FACE. “Our Conference participants’ examination of the clinical and economic issues affecting expanded use of CGM was invaluable.”

A comprehensive white paper describing the necessary steps toward a concerted, collaborative effort necessary to addressing and overcome current barriers to optimal diabetes care will be published in a future issue of Endocrine Practice, AACE’s monthly, peer-reviewed medical journal.

About the American Association of Clinical Endocrinologists (AACE)
The American Association of Clinical Endocrinologists (AACE) represents more than 6,500 endocrinologists in the United States and abroad. AACE is the largest association of clinical endocrinologists in the world. The majority of AACE members are certified in endocrinology, diabetes and metabolism and concentrate on the treatment of patients with endocrine and metabolic disorders including diabetes, thyroid disorders, osteoporosis, growth hormone deficiency, cholesterol disorders, hypertension and obesity. Visit our website at www.aace.com.

About the American College of Endocrinology (ACE)
The American College of Endocrinology (ACE) is the educational and scientific arm of the American Association of Clinical Endocrinologists (AACE). ACE is the leader in advancing the care and prevention of endocrine and metabolic disorders by providing professional education and reliable public health information; recognizing excellence in education, research and service; promoting clinical research and defining the future of clinical endocrinology. For more information, please visit www.aace.com/college.

 

Texas Diabetes & Endocrinology Proudly Offers a Physician-supervised Weight Loss Program

According to a recent Johns Hopkins University study featured on Good Morning America, some weight loss centers don’t follow medical guidelines. At Texas Diabetes & Endocrinology, the doctors, physician extenders and staff are committed to helping our patients lose weight, maintain weight loss and gain better control of their health. Our programs are medically supervised for our patients with Diabetes, but are also open to people who have pre-diabetes or don’t have Diabetes at all. As your health and wellness coaches, we offer one-on-one sessions. Our goal is to educate, motivate and support you through your weight loss journey. Our programs are medically designed with two components – sensible weight loss and sustainable, stable weight maintenance. Our weight loss strategies include the use of nutrition education, diet and exercise plans as well as FDA-approved weight loss medications if necessary.

The entire GMA segment can be viewed here:  http://abcnews.go.com/GMA/video/study-weight-loss-centers-follow-guidelines-36851026

Pediatric Research Trials

Texas Diabetes & Endocrinology (TDE) is continuing forward in the effort to make available research for the children and teens of Austin, TX. The first wave will include a study for Type 1 diabetic children who are currently using daily injections of basal and mealtime insulin and have been for the last 6 months. The insulin planned for study is currently being prescribed for adults with Type 1 and Type 2 diabetes. It’s time for our children and teens to have the same available insulins as adults. TDE is planning for a February enrollment start. Ready to catch the wave? Call 512-334-3505 ext. 1 or apply on the web www.texasdiabetes.com

Pediatric Diabetes Research

Parents will be pleased to know that beginning in February, Texas Diabetes & Endocrinology (TDE) will begin clinical trials for new insulins in children and teens with Type 1 diabetes.

Dr. Tom Blevins, Medical Director of TDE Research explains, “We are excited to finally offer these trials to children and teens with Type 1 diabetes right here in Austin. The goal is to find better treatments and technology to help improve the lives of those children and teens.”

In addition, TDE plans to pursue pediatric device trials, including trials for new glucose sensors……AND……DRUM ROLL…. Closed loop systems (also known as the artificial pancreas).

To find out more about how your child/teen can participate call TDE Research at 512.334.3505 Ext. 1 or visit https://texasdiabetes.com/clinical-trials/ to apply for currently enrolling trials.

People of Austin, what do you think…. Should we pursue further Pediatric (Child/Teen) diabetes research here in Austin? Let’s get the buzz going…..

Ideal Protein Dieter of the Week!

At Texas Diabetes & Endocrinology, the doctors, physician extenders and staff are committed to helping our patients lose weight, maintain weight loss and gain better control of their health. Obesity and carrying excess weight are increasingly common, which can lead to high blood pressure, elevated cholesterol, Diabetes as well as other health conditions. People with and without Diabetes struggle to lose weight and may have to take multiple medications for medical problems related to the excess weight.

The Ideal Protein protocol offers structured weight loss while supporting muscle mass and understanding of how food affects and is utilized by the body, including what causes fat storage, utilization of stored fat for energy (usually has been by day 4 of the program), improved energy, appetite control and reduced cravings (usually on day 4 or 5). It is proven losing weight can improve blood sugar, cholesterol levels and reduce blood pressure. While following the Ideal Protein protocol, your pancreas will get a well-deserved break by limiting simple and complex carbs until your weight loss goal is achieved. To learn more about the Ideal Protein protocol visit our website https://texasdiabetes.com/services/weight-loss-programs/.

Doug lost a total of 172 lbs. and is now on phase 2!!  He looks amazing!

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is an important cause of menstrual irregularity and androgen excess (elevations in testosterone) in women. It is one of the most common endocrine disorders affecting up to 8% of women overall.  Symptoms often include irregular menstrual cycles, facial hair, thinning hair on the scalp, acne and infertility.   Affected women also tend to carry risk factors for cardiovascular disease including obesity, diabetes or pre-diabetes and high cholesterol.  Approximately 40-85% of women with PCOS are overweight or obese and carry a higher risk of developing type 2 diabetes mellitus. PCOS is also associated with depression and anxiety, fatty liver and obstructive sleep apnea.Most women with PCOS grow many small cysts on their ovaries–these cysts are not necessarily harmful but are associated with hormonal imbalances that cause the manifestations noted above.

Making a diagnosis of PCOS involves taking a thorough medical history as well as performing a comprehensive physical exam.  If indicated, your doctor may also perform ovarian ultrasound (although this latter test may not be necessary to make the diagnosis), and blood testing to diagnose PCOS.  Once diagnosed, treatment for this disorder should be initiated promptly.   The first recommendation is usually weight loss through healthful dietary changes and daily exercise.  If you are overweight, even a small amount of weight loss will help the manifestations of PCOS.  There are also some medications that can be used to improve metabolic profiles as well as increase fertility by regulating menstrual cycles.  Birth control pills and Metformin are examples of common medications used to treat PCOS.  Hormonal therapies are also used to treat infertility associated with PCOS.

Having PCOS can significantly negatively impact quality of life and as such, should be promptly diagnosed and treated.  Early treatment can help control the symptoms of PCOS and may help prevent long term health problems.

Thyroid Nodules Are Common

Depending on the reference about 7% of incidentally noted thyroid nodules are found to be from thyroid cancer. The increase in imaging procedures (MRI, CT scans, neck ultrasounds) are finding many “incidental” thyroid nodules that we might not have otherwise detected on the physical exam. The vast majority of thyroid nodules are benign, however, the risk for cancer is real. With the increased detection of thyroid nodules, it is especially important to better identify the true cancer risk of these nodules. This can help us to avoid unnecessary surgery for nodules that are likely benign but cannot be clearly designated as such on the basic pathology report, as well as help to identify nodules that are especially high risk that may warrant a different surgical approach. Here at Texas, Diabetes and Endocrinology, we can offer this genetic analysis of your thyroid cells with samples obtained during the standard thyroid biopsy. We continue to always look forward in your treatment as the science and research of thyroid nodules and thyroid cancer becomes ever more focused on genetic analysis.

American Thyroid Association Releases New Guidelines

The American Thyroid Association released their new Guidelines for managing thyroid nodules and differentiated thyroid cancer. The long-awaited guidelines incorporate new findings from a wide range of studies into 101 recommendations. Main areas that have seen major updates include role of molecular markers in diagnosis, imaging frequency for follow-up, indications for I-131 treatment, risk assessment / prognosis, and treatment of advanced disease. The guidelines are here: http://online.liebertpub.com/doi/pdfplus/10.1089/thy.2015.0020

New Tools Calculate Absolute Risk for Blindness, Amputation in Adults with Diabetes

According to research in The BMJ, two new algorithms can accurately calculate the absolute risk during a 10-year period for developing blindness or needing limb amputation, two potentially serious complications for men and women living with type 1 or type 2 diabetes. The risk calculator takes into account multiple factors including age, type and duration of diabetes, smoking status, HbA1c, BMI, BP, hypertension, and known CVD. Here is the link to an online version of the calculator: http://qdiabetes.org/amputation-blindness/index.php