Focus on Diabetes

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 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: 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: 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: Janine Austin Clayton, MD Guest: A. Paul Chous, MA, OD, FAAO, CDE Guest: Anne Peters, MD When it comes to protecting the vision of our patients with diabetes, the importance of taking assertive action cannot be ignored. But another key aspect that can unfortunately be easy to overlook is care collaboration. Featuring Dr. Janine Clayton, Dr. A. Paul Chous, and Dr. Anne Peters, this discussion will focus on how providers can work together to optimize patients’ eye health and minimize their risk of vision loss from diabetic retinopathy and diabetic macular edema. Vision loss caused by diabetic retinopathy can have a significant impact on a patient's quality of life. This activity emphasizes more assertive action in clinical practice for patient with diabetes. The acronym ASSERT-D is a reminder to Assess and Screen for Eye health and Refer or Treat patients with Diabetes.

Host: Janine Austin Clayton, MD Guest: A. Paul Chous, MA, OD, FAAO, CDE Guest: Anne Peters, MD When it comes to protecting the vision of our patients with diabetes, the importance of taking assertive action cannot be ignored. But another key aspect that can unfortunately be easy to overlook is care collaboration. Featuring Dr. Janine Clayton, Dr. A. Paul Chous, and Dr. Anne Peters, this discussion will focus on how providers can work together to optimize patients’ eye health and minimize their risk of vision loss from diabetic retinopathy and diabetic macular edema. Vision loss caused by diabetic retinopathy can have a significant impact on a patient's quality of life. This activity emphasizes more assertive action in clinical practice for patient with diabetes. The acronym ASSERT-D is a reminder to Assess and Screen for Eye health and Refer or Treat patients with Diabetes.

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.

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

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.

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]

[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.

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]

[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: 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.

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: 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: 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: 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: 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: 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: 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: 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.