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.

 

Hashimoto’s…What the heck is that?

Looking online about a medical diagnosis can be overwhelming. A quick Google search about your thyroid condition might lead you down a rabbit hole where things get pretty grim, pretty fast. So what is this mystery diagnosis of Hashimoto’s? Simply put, it’s the name of the condition where your immune system turns against you and attacks your thyroid. It is the most common cause for someone to need to take a thyroid supplement – hypothyroidism.
Your immune system normally does a fantastic job of keeping your body safe from foreign “attacks” like bacterias and viruses. In some individuals, their immune system is tricked into attacking their own body. As a result, the target organ can be destroyed to the point that it no longer works properly. There are a number of conditions that follow this pattern but seem different because different organs are attacked. For instance, if the immune system targets your joints, you get rheumatoid arthritis, your pancreas – type 1 diabetes. All of these “autoimmune diseases” are interrelated and often times hereditary. This is why various members of the same family can present with a variety of autoimmune diseases. Experts do not know why or how the immune system gets activated but the gradual and eventual destruction of the thyroid can lead to devastating consequences for the patient.
The thyroid gland sits in the lower, front part of your neck and its purpose is to make thyroid hormone. This hormone serves to control the metabolic rate of almost all of the organs in your body. It controls processes as diverse as the rate at which the heart beats, the stomach digests food, the brain processes memories and learning, to the condition of your skin, hair and nails. When the thyroid is partially or completely destroyed, the lack of thyroid hormone will make an individual feel tired, constipated, forgetful, have dry skin or brittle nails. Each individual will present in their own unique way. The symptoms can be subtle or get worse gradually. This makes the diagnosis difficult to come by at times.
Your doctor at Texas Diabetes and Endocrinology can run a series of blood tests to see the status of your thyroid levels. At times, we can determine if your immune system is making antibodies that are attacking your thyroid. Lastly, an ultrasound of your thyroid can sometimes be useful to see if your thyroid is healthy or if there is a problem.
Sometimes, Hashimoto’s can flare up and seemingly get worse. When this occurs, patients can experience the fatigue and other symptoms that first alerted them to the condition. Your doctor might need to increase or adjust your medication so that you can return to feeling back to normal again.

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.