Someone asked me today what I thought were the biggest takeaways from the meeting. I said, I thought, Edic, Edic, Edic, Symlin, Byetta, glycemic variability, and retinopathy. More to follow on all these.
A word from the President of the ADA, Dr. Alan Cherrington: While there has been tremendous progress in the field of diabetes in terms of new drugs and technologies, there has not been much improvement in the quality of care. Dr. Cherrington reported that only 45%--less than half!—of patients with diabetes receive “recommended care” from their doctors. We doubt it is even this high. Because there are so few endocrinologists in the United States, most people with diabetes are treated by primary care physicians, who have innumerable other illnesses to treat and who all can't stay up to date on new drugs. Therefore, our focus should not just be on developing new drugs and technologies, but also on the ability of health care providers to use these drugs. Dr. Cherrington also recommended giving physicians financial incentives for achieving good outcomes in patients. Here, here...
Dr. Marion Nestle from NYU shared that food suppliers in the U.S. have a total of 3,900 kcal/day available for every person. This is up 600 kcal/day since 1980. What’s the result of having so much extra food? Pressure for companies to sell more food, which translates into pressure for people to eat more.
In this year’s ADA Banting lecture, Dr. Jeffrey Flier from Harvard Medical School discussed some of the excellent progress researchers have made in elucidating the pathogenesis of obesity, both in terms of genetics and environmental causes. Several genetic disorders relating to obesity are now known, including the MC4R mutation. We expect to be hearing a lot more about this, we imagine...
Dr. Brian M. Frier, from Scotland, gave a talk on hypoglycemia during driving. He reported that the frequency of mild hypoglycemia in diabetic patients does not change over twenty years, but rather stays constant at about two episodes per week. In contrast, the frequency severe hypoglycemia increases steadily over time, such that the longer a person has diabetes, the higher his or her risk of having an episode of severe hypoglycemia. At the same time, awareness of hypoglycemia (symptoms such as shaking and trembling) declines with time. Impaired awareness of hypoglycemia affects 25% of adults with Type 1 diabetes.
Cognitive function deteriorates at a blood glucose level less than 54mg/dl and does not recover fully until 40-90 minutes after the blood glucose level returns to normal. Applying this to daily life, Dr. Frier recommended that a person with diabetes wait at least 45 minutes to begin driving after having a hypoglycemic event.
Dr. Frier gave us some numbers to use as guidelines regarding driving and hypoglycemia. He told us that driving becomes impaired at 68 mg/dl. Also, driving has a significant metabolic demand--we burn many calories while driving! Therefore, people with diabetes should measure their blood glucose level before driving and take a snack if it is lower than 90mg/dl.
Dr. James Gavin III, while advising how to improve glycemic control in Type 2 diabetes, pointed out that each 1% increase in HbA1c level causes a 28% increase in risk of death, according to the EPIC-Norfolk study.
In highlighting the effectiveness of frequent self-monitoring of blood glucose (SMBG), Dr. Lawrence Blonde cited a study which found that people with Type 1 diabetes who performed SMBG at least three times per day had an HbA1c value 1.0% lower than people who performed SMBG less fewer times per day. In people with Type 2 diabetes, performing SMBG at least once per day was associated with an HbA1c value 0.6% lower than not performing SMBG. More people should be getting blood glucose meters, even if they are not taking insulin.
When asked if he would consider using gastric bypass surgery on non-obese people with Type 2 diabetes, Dr. Schauer from The Cleveland Clinic said that indeed he would! In fact, there is a currently a prospective study in Australia to evaluate the effects of gastric banding on patients who have BMI’s in the low 30s. Just one minor glitch: U.S. insurance carriers will not cover this operation unless the patient’s BMI is over 35.
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