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.
Construction at our new Texas Diabetes & Endocrinology office in Round Rock has started. The new building will allow us to serve our patients better by integrating our weight loss program, our research department, and will expand our clinic space. Our patients will also appreciate the increased parking space. The new building will be at 15842 Great Oaks Drive. We are expecting to move in to the new space this summer, and we will keep our patients posted.
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 28th. 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
The American Association of Clinical Endocrinologists (AACE) has updated its postmenopausal osteoporosis guidelines. The new guidelines cover risk factors and fall prevention measures in more detail than prior guidelines. Pharmacological treatment is recommended for patients with osteoporosis, patients with osteopenia who have had a fragility fracture of the hip or spine, and for patients with osteopenia who have a 10-year FRAX major fracture risk at or above 20%, or a 10-year FRAX hip fracture risk of 3% or above. https://www.aace.com/files/final-appendix-sept-7.pdf
The American College of Endocrinology (ACE), the educational and research arm of the American Association of Clinical Endocrinologists (AACE), inducted Dr. Kerem Ozer, Texas Diabetes & Endocrinology physician partner, as a Fellow of the American College of Endocrinology during its recent convocation ceremony at the 2016 AACE Annual Meeting and Clinical Congress in Orlando, Florida.
Designation as a Fellow of the American College of Endocrinology (FACE) means an endocrinologist has achieved a level of training and experience consistent with the highest standards established and adopted by the clinical specialty of endocrinology.
To be accepted into the College as a Fellow, Dr. Ozer had to fulfill several rigorous academic and clinical requirements. He also had to meet service and membership expectations from the college. Alan Garber, MD, PhD, FACE, ACE president, emphasized that the FACE title also underlines international recognition of a physician’s exceptional clinical and research achievements.
About 140 endocrinologists from around the world were inducted during the ceremony. The mission of ACE is to provide and promote education, research and communication in the art and science of clinical endocrinology and to provide appropriate recognition of advances and achievements relating to clinical endocrinology.
AACE is currently the world’s largest organization representing clinical endocrinologists. With more than 6,500 members in the United States and 91 other countries, the organization has developed a robust network of professional associates.
For more information, visit www.aace.com.
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.
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.
Effect of Adding Liraglutide vs Placebo to a High-Dose lnsulin Regimen in Patients With Type 2 Diabetes: A Randomized Clinical Trial
Liraglutide added to high-dose insulin therapy improved glycemic control, decreased body weight, and enhanced treatment satisfaction in this difficult-to-treat patient population with high-dose insulin requirements. Further studies are warranted to confirm these findings and evaluate the long-term risk and benefit of this treatment option. Read more at: http://archinte.jamanetwork.com/article.aspx?articleid=2526669
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.