Focus on Diabetes: Recent Episodes
ReachMD
ReachMD takes an in-depth look at diabetes, a disease identified in nearly 1 in 10 Americans, which upsets the lives of millions more. Even more disturbing, the rates of new cases of diagnosed diabetes have risen almost twofold during the past decade. Nutrition, exercise and genetics are all factors in how the disease affects children, adults and the elderly, but that's only the beginning. How are surgical options changing the way we think about the disease? How close are we to a cure for Type 1 diabetes? Are there treatment lessons we can take from community-based initiatives abroad? Tune in to gain insights for your practice.
Guest: Kevan C. Herold, MD
Guest: Chantal Mathieu, MD, PhD
Experts in the immunopathology of type 1 diabetes discuss the epidemiology, non-genetic and genetic risk factors, and progression from preclinical to clinical stages of this disease. The discussion will emphasize the breakdown of immune tolerance that precedes type 1 diabetes and the subsequent pathogenetic role of islet autoantibodies responsible for its clinical manifestations.
Host: John E. Anderson, MD
Host: John Buse, MD, PhD
Host: Carol Wysham, MD
The wintertime presents new challenges for patients with chronic diseases, specifically diabetes. But with the spread of COVID-19, how can we help keep our patients safe all winter long? Tune in to hear our Diabetes Discourse hosts Drs. Carol Wysham, John Buse, and John Anderson discuss strategies to effectively manage patients with diabetes during these winter months.
Published December X, 2020
Host: Linda Bernstein, Pharm.D.
In this episode of The Drug Report, pharmacist Dr. Linda Bernstein highlights some diabetes medications that have achieved or are pending approval for new indications pertaining to cardiovascular disease risk reduction.
Host: Linda Bernstein, Pharm.D.
On this episode of The Drug Report, pharmacist Dr. Linda Bernstein focuses on a recent CVS Health announcement of their new plan that allows employers and health plan sponsors to work within a formulary and plan design to offer all types of diabetes medications—including insulin—at zero-dollar out of pocket for their members without raising costs for the plan sponsor or increasing premiums or deductibles for all plan members.
Host: Barnett Mennen, MD
Guest: Sarah Hallberg, MD
Carbohydrates are our main source of energy and provide important nutrients for good health. However, they are also the main culprit behind elevated blood sugar and are problematic for diabetic patients trying to control their blood sugar levels.
Host Dr. Barry Mennen sits down with Dr. Sarah Hallberg to talk about carbohydrate restriction as a key to successful weight loss programs. She prescribes that adherence to a low-carb, high-fat diet is vital to patients for controlling their diabetes, with the possibility of being able to come off medications over time.
Dr. Sarah Hallberg is the Medical Director at Virta Health and Founder of the Indiana University-Arnett Health Medical Weight Loss Program in Lafayette, Indiana.
Based on new data from two large clinical trials, the FDA concluded that the type 2 diabetes medicine canagliflozin (brand names Invokana, Invokamet, Invokamet XR) causes an increased risk of leg and foot amputations. The FDA is requiring new warnings, including their most prominent Boxed Warning, be added to the canagliflozin drug labels to describe this risk.
Amputations of the toe and middle of the foot were the most common; however, amputations involving the leg, below and above the knee, also occurred. Some patients had more than one amputation, some involving both limbs.
Report side effects involving canagliflozin and other medicines to the FDA MedWatch program at fda.gov/medwatch.
A link to the full communication detailing specific information for health care professionals and the complete Data Summary can be found at fda.gov/DrugSafetyCommunications. If you have drug questions, contact the FDA at druginfo@fda.hhs.gov.
Released 5/16/2017
Host: Brian P. McDonough, MD, FAAFP
Diabulimia, defined as the manipulation of insulin treatments by Type 1 diabetic patients in order to lose weight, is a rising problem among teens and young adults in the U.S, particularly young women. Joining Dr. Brian McDonough to discuss this dual diagnosis phenomenon of diabetes and eating disorders, ways in which they exacerbate other disease processes, the long term consequences, and management priorities for phycisians is author and registered dietitian Susan Weiner. Susan is a recipient of the AADE Diabetes Educator of the Year award and has devoted much of her writing and clinical expertise to addressing diabulimia in at-risk patients.
[Read the Article]
Despite targeted efforts to reduce obesity through diet and exercise, these rates continue to rise. A new study from Ontario, Canada found that obesity and diabetes rates were lower in more walkable neighborhoods compared to less walkable neighborhoods, where they saw an increase in these rates.
Researchers from St. Michael's Hospital in Toronto studied almost 9,000 neighborhoods in Southern Ontario looking at walkability scores, along with government health data and survey results during a twelve-year period. They examined whether neighborhoods that were more walkable experienced a slower increase in obesity and diabetes compared to less walkable neighborhoods.
[Watch more videos of The JAMA Report]
Host: Jennifer Caudle, DO
Host Jennifer Caudel, DO welcomes Jay Shubrook, DO, Director of Clinical Research and Diabetes Services at Touro University-California College of Osteopathic Medicine. Recorded on site at the American Osteopathic Association's annual medical education conference, Dr. Shubrook discusses a pilot study in which newly diagnosed type 2 diabetes patients were treated with early insulin rather than lifestyle changes and oral therapies alone. The results suggested not only good safety profiles, but also better long-term outcomes for patients.
[Read the Article]
Proliferative diabetic retinopathy (PDR) is a leading cause of vision loss in patients with diabetes, resulting in up to 24,000 cases of blindness each year in the United States. Laser therapy has been the most common treatment used to help reduce severe vision loss, but the procedure has many side effects including permanent loss of peripheral vision and swelling of the retina.
A group of researchers from across the US tested an alternative treatment using an injectable medication called ranibizumab, to see if it would be as effective as the laser therapy. They studied more than 300 patients with PDR, assigning them to either receive standard laser therapy or an injection into the eye. In total, they treated close to 400 eyes.
Outcomes, especially loss of vision, were compared at two years. Over the two year period, researchers found that patients receiving the injections of medication had fewer side effects and did somewhat better in terms of vision loss than those who received laser therapy.
[Watch more videos of The JAMA Report]
Host: John J. Russell, MD
Guest: Candis Morello, PharmD, CDE
Candis M Morello, Professor of Clinical Pharmacy at UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, joins Dr. John Russell to talk about team-based care integrations of certified diabetes educators to help empower diabetes patients and improve long-term outcomes.
Diabetes Discourse, a non-certified educational series, is brought to you by AstraZeneca, pushing the boundaries of science to create life-changing medicines for people with diabetes. Content of this diabetes education is produced and solely controlled by ReachMD. This series is intended for healthcare professionals only.
Brought to you by
Host: Brian P. McDonough, MD, FAAFP
Dr. Brian McDonough welcomes Dr. Tina Thethi, Assistant Professor of Medicine in the section of Endocrinology and Metabolism at Tulane University Health Sciences Center. Dr. Thethi provides the inside scoop on diabetes topics of particular interest to endocrinologists in practice today, from pre-diabetes management to continuous glucose monitoring to novel drug research and development.
Guest: G. Alexander Fleming, MD
Host: Bruce Bloom, DDS, JD
Researchers are looking at hundreds of ways to treat and cure type one diabetes. Most of the advances so far have come in newly diagnosed children. Is there anything on the horizon to help adults with established type one diabetes? Dr. Alexander (Zan) Fleming, chairman and chief medical officer of Exsulin, joins host Dr. Bruce Bloom to discuss the new therapies for reversing established diabetes.
Guest: Carmella Evans-Molina, MD, PhD
Host: Bruce Bloom, DDS, JD
As the epidemic of type 2 diabetes in the United States grows, researchers are investigating hundreds of ways to treat and cure diabetes. Some of these methods include exogenous insulin, while other ideas being explored require more complex changes in our understanding of cellular biology. Dr. Carmella Evans-Molina, assistant professor at the Indiana University School of Medicine, who holds a faculty appointment in the division of endocrinology, diabetes, and metabolism and the Herman B Wells Center for Pediatric Diabetes Research, joins us to discuss molecular mechanisms of diabetes, and potential methods of prevention related to these mechanisms. Dr. Bruce Bloom hosts.
Guest: Steven Wittlin, MD
Host: Lee Freedman, MD
It is often thought that patients with diabetes have more "silent" heart disease than patients without diabetes: Coronary artery disease is a leading cause of death among these patients. But is screening all asymptomatic patients with diabetes for the condition prudent, or should we exercise caution when considering cardiac screening? Dr. Steven Wittlin, associate professor of medicine and clinical director of the endocrine/metabolism division at the University of Rochester in New York, makes screening recommendations based on the recent Detection of Ischemia in Asymptomatic Diabetics (DIAD) study. Dr. Lee Freedman hosts.
Guest: Christopher Slatore, MD
Host: Mary Leuchars, MD
Systemic corticosteroids increase the risk of diabetes, but what about in patients who take high-dose inhaled corticosteroids? How do we best manage the risk-benefit equation in patients with chronic obstructive pulmonary disease (or COPD)? Dr. Christopher Slatore, assistant professor in the division of pulmonary and critical care medicine, Portland VA Medical Center / Oregon Health and Sciences University, in Portland, Oregon, discusses the association between inhaled corticosteroid use and serum glucose concentration. Dr. Mary Leuchars hosts.
Guest: Carolyn Paris, MD
Host: Mary Leuchars, MD
Improved living conditions and hygiene may be contributing to the rise of type 1 diabetes in children, but does the "hygiene hypothesis" fully explain the onset of type 1 diabetes in this population? What factors might explain the increased incidence of type 1 diabetes among pediatric patients in the US, Sweden and Finland, in particular? Dr. Carolyn Paris, pediatrician and emergency medicine specialist at the Center for Clinical and Translational Research at Seattle Children's Hospital, explores the indirect evidence that examines environmental influences in the development of type 1 diabetes in children. Dr. Mary Leuchars hosts.
Guest: Hugh Tildesley, MD
Host: Lee Freedman, MD
Metformin is often the first line of therapy for patients with type 2 diabetes: it is relatively inexpensive, available, and has proven efficacy. However, metformin is contraindicated for patients with renal insufficiency, a common comorbidity in diabetes. Do the benefits of metformin outweigh the risks for those with renal insufficiency, or should we use caution when considering metformin for these patients? Dr. Hugh Tildesley, clinical professor in the department of medicine, division of endocrinology at the University of British Columbia at St. Paul's Hospital in Vancouver, Canada, considers the safety of metformin in patients with diabetes. What approach should clinicians use when considering metformin for patients with type 2 diabetes who have some degree of renal impairment? Dr. Lee Freedman hosts.
Guest: Joanna Jiang, MD
Host: Bruce Japsen
The new health reform law will take steps to encourage patients to use preventive tests and screenings to head off chronic conditions, like diabetes, that extract a huge toll on the nation's medical care budget. Exactly how much does diabetes care cost the medical system, and where is the money going? Dr. Joanna Jiang, senior research scientist at the AHRQ (the Agency for Healthcare Research and Quality), tells host Bruce Japsen about the origin of hospital costs and its surprising toll on the system.
Guest: Gerald Reaven, MD
Host: Maurice Pickard, MD
Metabolic syndrome is generally considered to be a combination of conditions that increases a patient's risk of developing coronary artery disease. These conditions include elevated blood pressure, obesity, insulin resistance, elevated C-reactive proteins and high triglycerides or HDL cholesterol. If a patient has three or more of these conditions, he or she is classified as having metabolic syndrome. But what is the clinical applicability of this "syndrome," and should practicing physicians still be using the metabolic syndrome concept? Dr. Gerald Reaven, active emeritus professor of medicine at the Stanford University School of Medicine in Stanford, California, suggests that there are more reliable methods than the metabolic syndrome classification for determining a patient's risk of developing coronary artery disease. Dr. Maurice Pickard hosts.
Guest: Adam Weinstein
Host: Lisa Dandrea Lenell, PA-C, MPAS, MBA
With Web-based technologies, the click of a mouse can give doctors and advanced practice clinicians access to their diabetic patients' records follow-up information, and save them from having to search through charts or request information from other doctors. Adam Weinstein is the manager of the clinical intelligence team for Athenahealth in Watertown, Massachusetts. He joins host Lisa Dandrea Lenell to talk about setting up your practice to meet diabetic recognition goals. They look at the requirements, advantages, costs and time it takes to set up the data and tracking tools.
Guest: Patti Duprey
Host: Mimi Secor, DNP, FNP-BC, FAANP
Chronic disease is on the rise in the United States — especially diabetes. More than 57 million Americans suffer from pre-diabetic symptoms. With a shortage or primary care doctors, who will take on the role of treating these patients? Nurse Practitioner Patty Duprey, director of the Diabetes Center in North Conway, New Hampshire, joins host Mimi Secor to discuss why NPs are in the perfect position to take over care of patients with diabetes and why a team approach and teaching patients self-management skills are the keys to successful treatment.
Guest: Kenneth Moritsugu, MD, MPH
Host: Cathleen Margolin, PhD
The diabetes pandemic must be addressed around the globe with consideration for varying cultural and economic factors. How will countries around the world respond? And how can intervention programs that have proven successful be shared effectively across nations? Join host Dr. Cathleen Margolin as she discusses community based initiatives for diabetes with Dr. Kenneth Moritsugu, former Deputy Surgeon General and current chairman of the Johnson & Johnson Diabetes Institute.
Guest: Rita K. Cydulka, MD, MS
Host: Shira Johnson, MD
Diagnosing and treating high and low blood glucose levels is not always straightforward. Dr. Rita Cydulka, professor and vice-chair of the department of emergency medicine at Case Western Reserve University, discusses case management issues, including unusual presentations of abnormal blood sugars. In her interview with host Dr. Shira Johnson, Dr. Cydulka highlights the initial approach as well as clinical caveats for discharge and follow-up.
Guest: Rita K. Cydulka, MD, MS
Host: Shira Johnson, MD
Seven percent of the adult population has diabetes, and these patients often present to primary care and emergency department physicians. What do you need to know about the medications these patients may already be taking, or that they may require once they're under your care? Understanding the effects, as well as potential complications, of the most current diabetes medications and devices is crucial when treating patients who have diabetes. Dr. Rita Cydulka, professor and vice-chair of the department of emergency medicine at Case Western Reserve University, joins host Dr. Shira Johnson to highlight the new medications and devices for managing diabetes. She also describes real-life presentations of patients who may be having problems with glucose management.
Guest: Andrew Muir, MD
Host: Jennifer Shu, MD, FAAP
Cerebral edema is the most common cause of death among children with diabetes, occurring as a complication of diabetic ketoacidosis (DKA) in about one percent of children with Type 1 diabetes. Among our young patients, who carries the greatest risk for cerebral edema? How can we prevent, recognize and treat this complication of DKA? Dr. Andrew Muir, professor of pediatrics and chief of pediatric endocrinology at Emory University School of Medicine, talks about the timing of cerebral edema onset relative to diabetes, and potential theories that could explain the pathophysiology of the condition. What signs and symptoms should lead physicians to suspect cerebral edema, and should imaging play any role in diagnosis? Dr. Jennifer Shu hosts.
Guest: Jill Grimes, MD
Host: Jennifer Shu, MD, FAAP
In the state of Texas, patients can buy home exercise equipment without sales tax if they present a medical script written by their healthcare provider, at the time of purchase. Is this benefit available in your state? Host Dr. Jennifer Shu welcomes Dr. Jill Grimes, a practicing board-certified family physician in Austin, Texas, and an associate editor of the 5-Minute Clinical Consult textbook, to explore key strategies to get your patients with diabetes to do their best to keep fit. Exercise as a daily commitment is a tough proposition for many of our patients, with work, family, and other activities all competing for their time. Many patients also battle a kind of personal inertia about exercise, just as others perceive constraints imposed by chronic diseases like diabetes. How can you tailor your discussions about exercise to resonate with your patients?
Guest: Denise L. Faustman, MD
Host: Bruce Bloom, DDS, JD
The first clinical trial using generic drugs to cure type 1 diabetes has created quite a buzz in the diabetic patient and physician communities. Join host Dr.Bruce Bloom and his guest, Dr. Denise L. Faustman, associate professor of medicine at Harvard Medical School and director of the Immunobiology Laboratories at Massachusetts General Hospital, as they discuss the details of this clinical trial and what the future holds.
Guest: Denise L. Faustman, MD
Host: Bruce Bloom, DDS, JD
We spend billions each year to research possible cures for type I diabetes, but the cure may already be on the shelf. Join host Dr. Bruce Bloom and his guest, Dr. Denise L. Faustman, associated professor of medicine at Harvard Medical School and director of the Immunobiology Laboratories at Massachusetts General Hospital, as they explore the first clinical trial using generic drugs to try to cure type I diabetes.
Guest: Timothy Church, MD, PhD
Host: Bruce Japsen
Motivating your patients to exercise can be a challenge. But Dr. Timothy Church of the Pennington Biomedical Research Center in Baton Rouge, Louisiana, tells host Bruce Japsen that even 15 minutes a day can help, citing research that shows even minimal exercise can be a benefit to the obesity epidemic and other diabetes risk factors.
Guest: R. Paul Robertson, MD
Host: Mary Leuchars, MD
Can patients with type I diabetes achieve insulin independence with islet cell transplantation? Host Dr. Mary Leuchars explores this question with Dr. R. Paul Robertson, president and scientific director of the Pacific Northwest Diabetes Research Institute and professor of pharmacology and medicine at the University of Washington. Their discussion focuses on the clinical relevancy of pancreatic islet cell transplantation, and what we can hope to achieve for diabetics undergoing this procedure.
Guest: H. Peter Chase, MD
Host: Mary Leuchars, MD
For teenage diabetic populations, maintaining good glycemic control is often a low priority. Clinicians and families need to be aware of special considerations in this age group to ensure better control and reduce risk for postpubertal complication. How do physicians optimize management protocols for patients entering a stage of rapid hormonal flux? Can school support systems and peer groups play integral roles? Answering these questions with host Dr. Mary Leuchars is Dr. H. Peter Chase, professor of pediatrics at the University of Colorado Health Sciences Center and past executive and clinical director of the Barbara Davis Center for Childhood Diabetes in Denver, Colorado.
Guest: H. Peter Chase, MD
Host: Mary Leuchars, MD
Over 40 children a day are diagnosed with type I diabetes in the United States. What are the clinical management issues pediatric practitioners face today? Joining host Dr. Mary Leuchars is Dr. H. Peter Chase, professor of pediatrics at the University of Colorado Health Sciences Center and past-executive and clinical director of the Barbara Davis Center for Childhood Diabetes in Denver, Colorado. Their subject is type I diabetes in children, from U.S. population trends to keys in clinical recognition, counseling methods for patients and families, and recommendations for follow-up glucose management.
Host: Bruce Bloom, DDS, JD
Guest: Mary Elizabeth Hartnett, MD
Almost a third of all type I and type II diabetics develop macular edema. Join host Dr. Bruce Bloom and his guest, ophthalmologist, researcher and vitreo-retinal surgeon Dr. Mary Elizabeth Hartnett, professor of opthamology at the University of North Carolina at Chapel Hill School of Medicine, as they discuss the etiology and treatment of diabetic macular edema.
Guest: John Dixon, MBBS, PhD
Host: Mark Nolan Hill, MD
Gastric bypass surgery has received significant attention as an up-and-coming treatment for type 2 diabetes. At the same time, we are also seeing the emergence of encouraging results from laparoscopic gastric banding surgery for patients with diabetes. Dr. John Dixon, associate professor of medicine and head of obesity research at Monash University Medical School in Melbourne, Australia, compares the efficacy of gastric banding surgery with gastric bypass as a treatment for diabetes. Further, some medical experts have been very critical of any form of surgery as a means to reverse lifestyle tendencies that often contribute to the onset of diabetes, including one's propensity to eat too much or an aversion to exercise. Dr. Dixon responds to this notion in this conversation with Dr. Mark Nolan Hill.
Guest: John Dixon, MBBS, PhD
Host: Mark Nolan Hill, MD
There is mounting evidence that surgery can be a key weapon against diabetes, improving glycemic control or sending the disease into remission entirely. As the scourge of diabetes continues across our country and abroad, safety and efficacy of surgery are two legitimate concerns. How does gastric banding surgery stack up against more traditional therapies for diabetes? What is the key mechanism behind gastric banding: does it reduce the patient's appetite or make the patient ill if they eat too much? Dr. John Dixon, associate professor of medicine and head of obesity research at Monash University Medical School in Melbourne, Australia, details his research team's work to assess the viability of gastric banding surgery. Dr. Mark Nolan Hill hosts.
Guest: Jeannee Diaz, RD
Host: Leslie P. Lundt, MD
We all know that exercise is crucial in the successful management of diabetes. But how do you actually get patients to do it? Certified diabetes educator Jeanne Diaz, certified diabetes educator and personal trainer, provides practical tips as she discusses diabetes fitness with host Dr. Leslie Lundt.
Guest: Kristen Knutson, PhD
Host: Leslie P. Lundt, MD
Glucose regulation is a complicated process governed by many different metabolic factors. Increasingly, we are realizing that even sleep has an important role to play. Host Dr. Leslie Lundt welcomes Dr. Kristen Knutson, whose research at the department of health studies at the University of Chicago focuses on the association between sleep and health, to discuss her work linking sleep duration and diabetes.