Our very own, Dr. Hien Tran, spoke to @SilverSneakers about what it means to have pre-diabetes. “Once you have prediabetes, the chances of progressing to diabetes are quite high, and it also raises your risk of developing heart disease, stroke, and kidney disease,” says Hien Tran, M.D. “So lifestyle changes that address your prediabetes are crucial for overall health.” At Texas Diabetes, our goal is to help people gain better control over their health, so contact us if you have any questions about prediabetes.

Read the entire article here:https://www.silversneakers.com/blog/your-doc-says-you-have-prediabetes-now-what/

The pace of diabetes innovation has sped up tremendously over the past two decades. While there is still no cure, there are a plethora of new medications, therapies, tools and technologies that make living with diabetes more manageable and easier. Let’s take a look back at how far we have come.

Portable subcutaneous continuous insulin infusion (CSII) pumps  made their first appearance in the early 1970s. Research studies in early 2000s supported the change in guidelines by demonstrating that switching from multiple daily injections to CSII pump therapy could make a significant impact on the HbA1c by 0.25%-0.75% reduction after 1 year of pump therapy. It also improves fasting blood glucose, episodes of hypoglycemia, and blood glucose variability.

 Current players in the market include, Insulet OmniPod, Medtronic MiniMed, Roche, and Tandem t:slim. It was Medtronic in 2013 that changed the playing field by launching the first FDA-Approved Artificial Pancreas Device System with Hypoglycemia Threshold Suspend Automation. This was the first time patients with diabetes were able to have their fears of hypoglycemia reduced. This system automatically shut the pump off if a patient’s blood sugar was dropping too low and would resume activity once the sugar was trending back up.

In 2015 Tandem t:slim, paired with the Dexcom G4, offered a predictive low suspend feature with a touch screen.

In 2017, Medtronic launched the World’s First Hybrid Closed Loop System for Type 1 Diabetes called Minimed 670G. This new system was a step towards the “artificial pancreas”. This pump predictively adjusted insulin doses to address  both lows and highs.

Not to be left behind, Tandem released in  2020 the Tandem t:slim X2 Hybrid Closed Loop system with integration of Dexcom’s latest CGM model called G6.

These hybrid closed loop systems provide patients more flexibility, less worry, and more time in range. It is estimated that only 20-30% of type 1 diabetes patients and <1% of type 2 diabetes patients currently use insulin pumps. The often mentioned disadvantages  of using an insulin pump  include cost, body image, and some find them to be burdensome.

Glucose testing technology

Glucose testing has come a long way since using urine glucose testing in 1908, to the first blood glucose strip in 1965, and the first glucometer in the 1970s. It wasn’t until the National Institute of Health conducted a trial in the 1980s to confirm the need to monitor and control diabetes.

Coronavirus and Diabetes: Are We Really More at Risk? Dr. Edelman addresses concerns about coronavirus and diabetes at TCOYD.org.

 New! Go to CardioVisual to see educational videos about diabetes from some of your physicians at TD&E.

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.

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:

• pills
• insulin
• non-insulin injectables
• insulin pumps
• lifestyle modification with dietary changes and regular exercise
• continuous glucose monitors
• dedicated diet programs (https://texasdiabetes.com/services/next-step-weight-loss-programs/)

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.

See the segment on Fox 7 News featuring Texas Diabetes & Endocrinology founder Thomas Blevins, MD for more information on this exciting new technology!

http://www.fox7austin.com/good-day/257839964-story

 

 

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 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

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 28^th. 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

 

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.

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.

 

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…..

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

On September 25^th, the FDA approved Tresiba (insulin degludec / Novo Nordisk), making it the first new basal insulin to be approved in ten years. This is a once-daily, long acting basal insulin. The half-life is 25 hrs and it is active for up to 42 hours. One benefit of Tresiba is that the patient is not required to take it at the same time every day, although “patients are still encouraged to take it around the same time every day”. The approval was based on two clinical trial programs – BEGIN, which showed non-inferiority to comparators in A1c reduction, and DEVOTE, the cardiovascular safety program. Read the press release from Novo and additional information about Tresiba: www.tresibapro.com.

This is an exciting time in Diabetes management as there are several advancements in insulin therapy available now and coming in the near future.  These therapies will provide patients with Type 1 and Type 2 diabetes with safer and more effective treatment options moving forward.  There are three therapies that we’re discussing here.

Toujeo® (Insulin Glargine 300u/ml) is a highly concentrated type of long-acting insulin that, in clinical trials, showed less risk for causing nocturnal (overnight) hypoglycemia and no increased risk for daytime hypoglycemia versus its comparator Lantus® (Insulin Glargine 100u/ml).  Toujeo® is an FDA approved therapy for Type 1 and Type 2 diabetes that allows for a smaller volume of insulin injected.  There are several ongoing clinical trials (many being done at Texas Diabetes & Endocrinology) researching other concentrated insulin therapies, as well as some ultra-long and ultra-fast acting insulin varieties.  We expect to see more of these types of insulin coming to market in the coming years.  These advancements will alter how we manage diabetes for the better.

Another FDA approved therapy is an inhaled rapid-acting insulin called Afrezza®; this is an appealing option for those who would like to avoid administering insulin via an injection or reduce the number of insulin injections administered each day.  The insulin is approved for treatment of both Type 1 and Type 2 diabetes and is administered at mealtime.  Other varieties of insulin are being researched, many pursuing alternative modes of administration, such as: oral, buccal (placement of medication between gums & cheek), transdermal (on skin ex: patches), ocular (eye drops), and intranasal (through the nose) to name a few.  It will be very interesting to see which therapies get approved and it will hopefully provide patients with better, safer insulin treatment options.

There has also been a lot of buzz about the ongoing work toward the development of an Artificial Pancreas.  This would be a continuous glucose monitoring system, which transmits data wirelessly to an insulin pump, then the pump in turn delivers insulin automatically based on a precise algorithm.  This system would allow for more accurate glycemic control, faster response time and less fluctuation in glucose levels.  This is a remarkable technological advancement and will truly revolutionize how one manages insulin-dependent diabetes.