Dulaglutide in Type 2 Diabetes: Do GLP-1 agonists delay progression of diabetic nephropathy?

By Connor Emdin
June 27, 2018

Forty percent of patients with type 2 diabetes go on to develop chronic kidney disease (CKD).1 These patients are at markedly elevated risk of death from cardiovascular disease.2 They also suffer from reduced quality of life, particularly when CKD progresses to end-stage renal disease and dialysis.3 Despite the substantial morbidity and mortality associated with diabetic kidney disease, therapies are limited. In the National Kidney Foundation Clinical Practice Guidelines for Diabetes and CKD from 2012, only angiotensin converting-enzyme-inhibitors (ACE-inhibitors) and angiotensin-receptor blockers were recommended for protection of renal function in patients with CKD and diabetes with albuminuria.4 Continue reading “Dulaglutide in Type 2 Diabetes: Do GLP-1 agonists delay progression of diabetic nephropathy?”

Does Menu Labeling Lead to Healthier Food Choices?

By Lea Borgi, MD
May 16, 2018

Americans consume about a third of their calories outside the home,1 but estimating the calorie count of a restaurant’s meal can be extremely difficult. In a cross-sectional study of 1,877 adults and 330 school age children, two thirds of participants underestimated the calories of fast food meals.2 The larger the ingested meal, the larger the discrepancy between the estimated and the actual calorie content of that meal. In another study, participants consistently underestimated both the fat and calorie content of a range of menu items, where the actual content was up to 2 times greater than expected by consumers.3 Continue reading “Does Menu Labeling Lead to Healthier Food Choices?”

Food and Chemicals: An Unwanted Phthalate Partnership

By Lea Borgi, MD
April 24, 2018

Restaurant meals have more calories, salt, and fat than meals consumed at home.1 Additionally, eating out has been associated with an increased risk of obesity and hypertension.2

The Study

A recently published study found that there is even more reason for concern when it comes to food prepared away from home.3 Indeed, in an analysis of participants in the National Health and Nutrition Examination (NHANES), dining out was associated with a higher exposure to phthalate, an endocrine disrupting chemical (EDC).3 Phthalates, also called plasticizers, are found in several products, including food packaging and personal care products.4 By measuring urinary phthalate metabolites, authors were able to estimate individuals’ cumulative phthalate exposure. Continue reading “Food and Chemicals: An Unwanted Phthalate Partnership”

Type 1 Diabetes: Not Just a Disease of the Young

By Connor Emdin
January 30, 2018

Type 1 diabetes (T1D) is commonly thought of as a disease of children and young adults, with a peak age of diagnosis around 14 years.1 However, adults with T1D may be misdiagnosed as having type 2 diabetes (T2D) due to the much greater prevalence of T2D in older ages.2 Such misdiagnosis of T1D as T2D may have important clinical consequences. Individuals with undiagnosed T1D may be less likely to receive insulin therapy and may present with diabetic ketoacidosis, a life-threatening emergency characterized by elevated blood glucose and ketone levels.3 Continue reading “Type 1 Diabetes: Not Just a Disease of the Young”

Chocolate Intake and Risk of Atrial Fibrillation

By Martina M. McGrath, MD
June 7, 2017

Cocoa beans were highly prized by the Aztecs, used in religious ceremonies, traded for goods, and believed to have medicinal purposes.1 While cocoa beans are a rich source of anti-inflammatory flavonols and antioxidants, it is reported that modern manufacturing processes destroy most of these potentially beneficial substances.2 Furthermore, modern chocolate typically contains large quantities of sugar, meaning this popular indulgence is an unlikely health food supplement. Despite this, epidemiological studies have associated moderate chocolate consumption with reduced risk of myocardial infarction and several cardiovascular end points.3,4 Continue reading “Chocolate Intake and Risk of Atrial Fibrillation”

Bariatric Surgery or Intensive Medical Therapy for Diabetes?

By Charbel C. Khoury, MD
May 11, 2017

Obesity has grown at epidemic rates over the past few decades. According to the most recent data from the Behavioral Risk Factor Surveillance System, adult obesity prevalence now exceeds 35% in four US states, 30% in 25 states and is above 20% in all states.1 Numerous studies have established excess weight as a risk factor for type 2 diabetes, thus adding to the morbidity and mortality of obese patients. While dieting, behavioral approaches, and tight glucose control can limit the long-term complications of diabetes, sustaining adherence is often difficult for most patients. Continue reading “Bariatric Surgery or Intensive Medical Therapy for Diabetes?”

Intensive Intervention in Type 2 Diabetes Leads to Long-Term Gains

Steno Type 2 Trial: Striking long-term benefits of multiple risk factor intervention in type 2 DM.

By Martina M. McGrath, MD
April 14, 2017

Risk factor management in patients with diabetes is challenging, and despite best medical efforts, few achieve the targets set out by society guidelines1. Two recently published papers reporting long-term follow up of Steno-2 are a timely reminder as to what can be achieved with a structured, well-resourced approach to caring for these patients. Continue reading “Intensive Intervention in Type 2 Diabetes Leads to Long-Term Gains”

Interpreting Hemoglobin A1c in African Americans with Sickle Cell Trait

By Charbel C. Khoury, MD
March 16, 2017

Hemoglobin A1c (HbA1c) testing is mainstay in screening, diagnosis, and management of diabetes mellitus.1 Since it measures the glycation of hemoglobin occurring over the entire lifespan of a red blood cell, the HbA1c is a very practical measure for clinicians and can be used to surmise the mean blood glucose over the previous 8 to 12 weeks.2 Nonetheless, several patient-specific factors such as iron/vitamin B12/folate deficiency anemias, chronic kidney disease, cirrhosis, and erythropoietin treatment have been known to affect the reliability of this assay, due to variations in red cell turnover.2  Moreover, HbA1c levels may vary with race. In fact, numerous studies have suggested that African Americans may have higher HbA1c levels than non-Hispanic whites with the same fasting and post-glucose load glucose levels.3 Continue reading “Interpreting Hemoglobin A1c in African Americans with Sickle Cell Trait”

Metformin: Meta-Analysis of Benefits in Comorbid Patients

Broadening access: Meta-analysis suggests benefits of metformin therapy in patients with comorbid kidney or heart disease.

By Martina M. McGrath, MD
February 9, 2017

Metformin is a safe, effective and well-tolerated agent, which is recommended as the first line oral hypoglycemic in treatment of newly diagnosed Type II diabetes. Its central role is underpinned by research showing reductions in long-term cardiovascular mortality in patients treated with metformin, as compared to sulphonylureas or placebo. Continue reading “Metformin: Meta-Analysis of Benefits in Comorbid Patients”

The Artificial Pancreas: A Breakthrough in Diabetes Management

Ajay K. Singh, MBBS, FRCP, MBA
January 3, 2017

The discovery of insulin was one of the biggest discoveries in medicine. In January 1922 (thought to be January 11), Dr. Frederick G. Banting and his student assistant, Mr. Charles Best, chose 14-year-old Leonard Thompson as the first person with diabetes to receive insulin. In doing so, they saved Leonard’s life and thus began an era where diabetes mellitus, a hitherto fatal disease, could be treated successfully. Continue reading “The Artificial Pancreas: A Breakthrough in Diabetes Management”