Category: Diabetes

Statins & Diabetes
Posted on by Misha Diden

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.

Benefits of Continuous Glucose Monitors (CGMs)
Posted on by Misha Diden

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.

Intensive Lifestyle Intervention Improves Metabolism and Bone Strength
Posted on by Misha Diden

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

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

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.

 

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