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Efficacy and Safety of Cannabidiol and Tetrahydrocannabivarin on Glycemic and Lipid Parameters in Patients With Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled, Parallel Group Pilot Study

Khalid A. Jadoon
Oct 1, 2016; 39:1777-1786
Emerging Technologies and Therapeutics




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PIONEER 1: Randomized Clinical Trial of the Efficacy and Safety of Oral Semaglutide Monotherapy in Comparison With Placebo in Patients With Type 2 Diabetes

Vanita R. Aroda
Sep 1, 2019; 42:1724-1732
Emerging Therapies: Drugs and Regimens




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Impact of Fat, Protein, and Glycemic Index on Postprandial Glucose Control in Type 1 Diabetes: Implications for Intensive Diabetes Management in the Continuous Glucose Monitoring Era

Kirstine J. Bell
Jun 1, 2015; 38:1008-1015
Type 1 Diabetes at a Crossroads




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Dietary Sugar and Body Weight: Have We Reached a Crisis in the Epidemic of Obesity and Diabetes?: Health Be Damned! Pour on the Sugar

George A. Bray
Apr 1, 2014; 37:950-956
Current Concepts of Type 2 Diabetes Prevention




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DPP-4 Inhibitors: Impact on glycemic control and cardiovascular risk factors

Dror Dicker
May 1, 2011; 34:S276-S278
Diabetes Treatments




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Long-Acting Glucagon-Like Peptide 1 Receptor Agonists: A review of their efficacy and tolerability

Alan J. Garber
May 1, 2011; 34:S279-S284
Diabetes Treatments




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Efficacy and Safety of Liraglutide 3.0 mg in Individuals With Overweight or Obesity and Type 2 Diabetes Treated With Basal Insulin: The SCALE Insulin Randomized Controlled Trial

W. Timothy Garvey
May 1, 2020; 43:1085-1093
Emerging Therapies: Drugs and Regimens




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Guideline Approach to Therapy in Patients With Newly Diagnosed Type 2 Diabetes

Itamar Raz
Aug 1, 2013; 36:S139-S144
Diabetes Pathophysiology




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Treatment of Type 2 Diabetes: From "Guidelines" to "Position Statements" and Back: Recommendations of the Israel National Diabetes Council

Ofri Mosenzon
Aug 1, 2016; 39:S146-S153
II. Diabetes Treatment Options




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Professional Practice Committee: Standards of Medical Care in Diabetes--2020


Jan 1, 2020; 43:S3-S3
Professional Practice Committee




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Vasodilatory Actions of Glucagon-Like Peptide 1 Are Preserved in Skeletal and Cardiac Muscle Microvasculature but Not in Conduit Artery in Obese Humans With Vascular Insulin Resistance

OBJECTIVE

Obesity is associated with microvascular insulin resistance, which is characterized by impaired insulin-mediated microvascular recruitment. Glucagon-like peptide 1 (GLP-1) recruits skeletal and cardiac muscle microvasculature, and this action is preserved in insulin-resistant rodents. We aimed to examine whether GLP-1 recruits microvasculature and improves the action of insulin in obese humans.

RESEARCH DESIGN AND METHODS

Fifteen obese adults received intravenous infusion of either saline or GLP-1 (1.2 pmol/kg/min) for 150 min with or without a euglycemic insulin clamp (1 mU/kg/min) superimposed over the last 120 min. Skeletal and cardiac muscle microvascular blood volume (MBV), flow velocity and blood flow, brachial artery diameter and blood flow, and pulse wave velocity (PWV) were determined.

RESULTS

Insulin failed to change MBV or flow in either skeletal or cardiac muscle, confirming the presence of microvascular insulin resistance. GLP-1 infusion alone increased MBV by ~30% and ~40% in skeletal and cardiac muscle, respectively, with no change in flow velocity, leading to a significant increase in microvascular blood flow in both skeletal and cardiac muscle. Superimposition of insulin to GLP-1 infusion did not further increase MBV or flow in either skeletal or cardiac muscle but raised the steady-state glucose infusion rate by ~20%. Insulin, GLP-1, and GLP-1 + insulin infusion did not alter brachial artery diameter and blood flow or PWV. The vasodilatory actions of GLP-1 are preserved in both skeletal and cardiac muscle microvasculature, which may contribute to improving metabolic insulin responses and cardiovascular outcomes.

CONCLUSIONS

In obese humans with microvascular insulin resistance, GLP-1’s vasodilatory actions are preserved in both skeletal and cardiac muscle microvasculature, which may contribute to improving metabolic insulin responses and cardiovascular outcomes.




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A Multinational, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial to Evaluate the Efficacy of Cyclical Topical Wound Oxygen (TWO2) Therapy in the Treatment of Chronic Diabetic Foot Ulcers: The TWO2 Study

OBJECTIVE

Topical oxygen has been used for the treatment of chronic wounds for more than 50 years. Its effectiveness remains disputed due to the limited number of robust high-quality investigations. The aim of this study was to assess the efficacy of multimodality cyclical pressure Topical Wound Oxygen (TWO2) home care therapy in healing refractory diabetic foot ulcers (DFUs) that had failed to heal with standard of care (SOC) alone.

RESEARCH DESIGN AND METHODS

Patients with diabetes and chronic DFUs were randomized (double-blind) to either active TWO2 therapy or sham control therapy—both in addition to optimal SOC. The primary outcome was the percentage of ulcers in each group achieving 100% healing at 12 weeks. A group sequential design was used for the study with three predetermined analyses and hard stopping rules once 73, 146, and ultimately 220 patients completed the 12-week treatment phase.

RESULTS

At the first analysis point, the active TWO2 arm was found to be superior to the sham arm, with a closure rate of 41.7% compared with 13.5%. This difference in outcome produced an odds ratio (OR) of 4.57 (97.8% CI 1.19, 17.57), P = 0.010. After adjustment for University of Texas Classification (UTC) ulcer grade, the OR increased to 6.00 (97.8% CI 1.44, 24.93), P = 0.004. Cox proportional hazards modeling, also after adjustment for UTC grade, demonstrated >4.5 times the likelihood to heal DFUs over 12 weeks compared with the sham arm with a hazard ratio of 4.66 (97.8% CI 1.36, 15.98), P = 0.004. At 12 months postenrollment, 56% of active arm ulcers were closed compared with 27% of the sham arm ulcers (P = 0.013).

CONCLUSIONS

This sham-controlled, double-blind randomized controlled trial demonstrates that, at both 12 weeks and 12 months, adjunctive cyclical pressurized TWO2 therapy was superior in healing chronic DFUs compared with optimal SOC alone.




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ACE and Type 2 Diabetes Risk: A Mendelian Randomization Study

OBJECTIVE

To determine whether ACE inhibitors reduce the risk of type 2 diabetes using a Mendelian randomization (MR) approach.

RESEARCH DESIGN AND METHODS

A two-sample MR analysis included 17 independent genetic variants associated with ACE serum concentration in 4,147 participants from the Outcome Reduction with Initial Glargine INtervention (ORIGIN) (clinical trial reg. no. NCT00069784) trial, and their effects on type 2 diabetes risk were estimated from 18 studies of the DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) consortium. A genetic risk score (GRS) underpinning lower ACE concentration was then tested for association with type 2 diabetes prevalence in 341,872 participants, including 16,320 with type 2 diabetes, from the UK Biobank. MR estimates were compared after standardization for blood pressure change, with the estimate obtained from a randomized controlled trial (RCT) meta-analysis of ACE inhibitors versus placebo (n = 31,200).

RESULTS

Genetically lower ACE concentrations were associated with a lower risk of type 2 diabetes (odds ratio [OR] per SD 0.92 [95% CI 0.89–0.95]; P = 1.79 x 10–7). This result was replicated in the UK Biobank (OR per SD 0.97 [0.96–0.99]; P = 8.73 x 10–4). After standardization, the ACE GRS was associated with a larger decrease in type 2 diabetes risk per 2.4-mmHg lower mean arterial pressure (MAP) compared with that obtained from an RCT meta-analysis (OR per 2.4-mmHg lower MAP 0.19 [0.07–0.51] vs. 0.76 [0.60–0.97], respectively; P = 0.007 for difference).

CONCLUSIONS

These results support the causal protective effect of ACE inhibitors on type 2 diabetes risk and may guide therapeutic decision making in clinical practice.




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Time Course of Normalization of Functional {beta}-Cell Capacity in the Diabetes Remission Clinical Trial After Weight Loss in Type 2 Diabetes

OBJECTIVE

To assess functional β-cell capacity in type 2 diabetes during 2 years of remission induced by dietary weight loss.

RESEARCH DESIGN AND METHODS

A Stepped Insulin Secretion Test with Arginine was used to quantify functional β-cell capacity by hyperglycemia and arginine stimulation. Thirty-nine of 57 participants initially achieved remission (HbA1c <6.5% [<48 mmol/mol] and fasting plasma glucose <7 mmol/L on no antidiabetic drug therapy) with a 16.4 ± 7.7 kg weight loss and were followed up with supportive advice on avoidance of weight regain. At 2 years, 20 participants remained in remission in the study. A nondiabetic control (NDC) group, matched for age, sex, and weight after weight loss with the intervention group, was studied once.

RESULTS

During remission, median (interquartile range) maximal rate of insulin secretion increased from 581 (480–811) pmol/min/m2 at baseline to 736 (542–998) pmol/min/m2 at 5 months, 942 (565–1,240) pmol/min/m2 at 12 months (P = 0.028 from baseline), and 936 (635–1,435) pmol/min/m2 at 24 months (P = 0.023 from baseline; n = 20 of 39 of those initially in remission). This was comparable to the NDC group (1,016 [857–1,507] pmol/min/m2) by 12 (P = 0.064) and 24 (P = 0.244) months. Median first-phase insulin response increased from baseline to 5 months (42 [4–67] to 107 [59–163] pmol/min/m2; P < 0.0001) and then remained stable at 12 and 24 months (110 [59–201] and 125 [65–166] pmol/min/m2, respectively; P < 0.0001 vs. baseline) but lower than that of the NDC group (250 [226–429] pmol/min/m2; P < 0.0001).

CONCLUSIONS

A gradual increase in assessed functional β-cell capacity occurred after weight loss, becoming similar to that of NDC group participants by 12 months. This result was unchanged at 2 years with continuing remission of type 2 diabetes.




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Amid an Unfolding Humanitarian Crisis in Syria, the European Union Faces the Perils of Devolving Migration Management to Turkey

The high-stakes gambit taken by Turkish President Recep Tayyip Erdoğan to allow tens of thousands of asylum seekers and migrants free movement to the Greek border demonstrated the fragility of the EU-Turkey deal and the European Union's broader approach to outsource migration management to third countries. This article examines the causes for the tensions, the EU approach to external partnerships, and a hardening European attitude towards unwanted arrivals.




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As the United States Resettles Fewer Refugees, Some Countries and Religions Face Bigger Hits than Others

Even as refugee admissions have dropped sharply during the Trump administration, some countries and religions have been significantly more affected than others, as this commentary explores. In fiscal year 2019, 79 percent of refugees were Christian and 16 percent Muslim—as compared to 44 percent Christian and 46 percent Muslim in fiscal year 2016, which was the last full year of the Obama administration.




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Coronavirus Is Spreading across Borders, But It Is Not a Migration Problem

Travel bans, border closures, and other migration management tools did not prove effective at blocking COVID-19 from spreading across international borders. Yet as governments have shifted from containment to mitigation with the coronavirus now in community transmission in many countries, these restrictions are a logical part of the policy toolkit in the context of social distancing and restricting all forms of human movement, as this commentary explores.




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As COVID-19 Slows Human Mobility, Can the Global Compact for Migration Meet the Test for a Changed Era?

The coronavirus pandemic dramatically reshaped how human mobility is managed just as the Global Compact for Safe, Orderly, and Regular Migration was beginning to move from paper to implementation. As governments face pressing public-health, economic, and other concerns in responding to COVID-19, this MPI Europe commentary explores whether the first comprehensive global agreement on migration can adjust to a changed reality.




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Invertir en el Vecindario: Cambios en los Patrones de Migración Entre México y Estados Unidos y Oportunidades para una Cooperación Sostenible

Presentación del reporte que refleja el contenido de encuentros del grupo de estudio sobre la migración México-Estados Unidos convocado por El Colegio de México y el Migration Policy Institute (MPI).




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“Cubicle Activism”: Companies Face Growing Demands from Workers to Cut Ties with ICE and Others in Immigration Arena

From online petitions to organized walkouts, corporate America is facing increasing employee activism over its business involvement with agencies implementing the federal government's immigration policies. This "cubicle activism," seen at companies ranging from Amazon and Google to Bank of America and Wayfair, has garnered mixed success to date, forcing divestiture from private prison contractors but fewer results in other contexts, as this article explores.




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Will Supreme Court Ruling on DACA Finally Force Congress to Break the Ice on Immigration Reform?

The fate of the Deferred Action for Childhood Arrivals (DACA) program has ping ponged between all three branches of government. But with the Supreme Court poised to decide DACA's future in spring 2020, Congress may finally be forced to act to resolve the status of DREAMers after nearly two decades of considering various DREAM Act bills. Could this break the long stalemate Congress has had on passing substantive immigration legislation, and pave the way for other actions?




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Una nueva política migratoria para una nueva era: Una conversación con la Secretaria de Gobernación Olga Sánchez Cordero

Durante su primera visita oficial a Washington, DC, la Secretaria de Gobierno Olga Sánchez Cordero presento un discurso público sobre la nueva política migratoria de México en el Instituto de Políticas Migratorias.




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ADA supports proposed rules to update federal Anti-Kickback Statute, Stark Law

The American Dental Association supports a new safe harbor for cybersecurity technology and services and modifying the existing safe harbor for electronic health records to add protections for cybersecurity. This was in response to the Office of the Inspector General and Centers for Medicare & Medicaid Services’ proposed changes to the federal Anti-Kickback Statute and Stark Law exceptions.




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ADA asks Congress to pass Ensuring Lasting Smiles Act

The American Dental Association is asking Congress to pass the Ensuring Lasting Smiles Act — legislation that would require all private group and individual health plans to cover medically necessary services that repair or restore congenital anomalies.




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Just the Facts

In 2018, male general practitioner dentists in private practice had an average 16.2 more patient visits per week than female dentists.




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Scholarship applicants sought for 2020 Institute for Teaching and Learning

This year’s Institute for Teaching Learning program is scheduled for Aug. 23-26 in Atlanta. Now in its 14th year, with over 700 alumni, the program combines presentations, discussions, small group activities and peer-to-peer learnings to give participants new teaching skills. The onsite program is followed by a six-month distance learning experience that include online activities and interactive webinars.




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Dental practice sued for allegedly sending unsolicited text messages

A class action lawsuit alleging that a Florida dental practice sent unsolicited text messages in violation of the Telephone Consumer Protection Act was filed in the U.S. District Court for the Southern District of Florida Jan. 6.




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ADA urges subcommittee to support Ensuring Lasting Smiles Act

The American Dental Association is asking Congress to pass the Ensuring Lasting Smiles Act — legislation that would require all private group and individual health plans to cover medically necessary services that repair or restore congenital anomalies.




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Looking back: ADA annual meeting welcomes more than 200,000 attendees since 2010

The last decade brought 236,658 attendees to the American Dental Association's annual meeting. The ADA will continue to build on that momentum with the ADA FDC Annual Meeting from Oct. 15-18 in Orlando, Florida.




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Just the Facts

Dentists not busy enough




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Florida oral surgeon stays atop branding as practice expands

There is an art to conveying just who you are at every stage of your dental practice. One minute you could be a single-dentist practice with a hygienist and a receptionist, and then, the next thing you know, you could have a group practice and maybe even several locations.




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ADA unveils dental licensure interactive map

The ADA Council on Dental Education and Licensure launched in December an interactive map in an effort to assist dentists with keeping track of current initial licensure requirements by state.




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HIPAA fee limitation no longer applies to third-party access to health records

Following a ruling in federal court two days prior, the Department of Health and Human Services announced Jan. 25 that the Health Insurance Portability and Accountability Act Privacy Rule fee limitations do not apply to requests to transmit copies of records to third-parties.




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Just the Facts

Between 2008 and 2018, the share of active dentists in the U.S. age 65 and over increased by 6%.




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Abstract deadline for smokeless tobacco summit at end of February

The deadline for abstracts for the upcoming National Summit on Smokeless Tobacco Prevention is Feb. 29.




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Dental plan transparency continues to drive advocacy efforts

A new California law is requiring dental benefit companies to be more transparent about the leasing of dental networks, making California the 20th state to pass or amend such legislation.




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FDI World Dental Congress abstract deadline in late March

The deadline for submission of abstracts for the FDI World Dental Congress is March 25.




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Tampa Bay Lightning team dentist puts players’ mouths back together again

When Dr. Gil Rivera became a dentist, he had no idea his career would take him to the bloodied and bruised front lines of the NHL, but nearly 18 years later, he continues to treat the ravaged mouths of professional hockey players as the team dentist of the Tampa Bay Lightning.




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ADA Practice Transitions offering promotional trial for dentists who sign up through March 1

ADA Practice Transitions, a service offered by the ADA focused on helping dentists make the process of joining or leaving a practice successful, is offering a free three-month trial.




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FDA approves combination ibuprofen-acetaminophen drug for U.S.

The Food and Drug Administration has approved the first over-the-counter ibuprofen and acetaminophen combination drug for the U.S.




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Organized dentistry supports oral health literacy

The Organized Dentistry Coalition is applauding Congress for introducing legislation aimed at improving oral health literacy.




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ADA Accelerator Series seeks to speed up dentists’ success

The Association is launching in March a new online, on-demand program specifically designed to provide information — from parental leave to financial support — that is tailored to the early-career dentist’s unique work-life balance needs.




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New compendium summarizes best practices in oral health service delivery

Titled “Compendium of Innovations in Oral Health Service Delivery,” the 64-page digital booklet features organizations from across the country that have found success through varied measures in expanding oral care to underserved populations.




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Wisconsin faces wave of anti-fluoridation efforts

The ADA and the Wisconsin Dental Association are partnering up with other fluoridated water proponents to address February anti-fluoridation movements in three Wisconsin municipalities: Lake Delton, Berlin and Hayward.




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Private practice pays $100,000 settlement for potential HIPAA violation

Ogden, Utah — The Office for Civil Rights announced March 3 that it had reached a settlement with Dr. Steven A. Porter’s medical practice to settle a potential violation of the Health Insurance Portability and Accountability Act security rule.




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Connecticut Foundation for Dental Outreach postpones Mission of Mercy dental clinic amid coronavirus concerns

The Connecticut Foundation for Dental Outreach has postponed the Connecticut Mission of Mercy Free Dental Clinic scheduled for March 20-21 in Danbury, Connecticut, "out of abundant caution" amid the coronavirus disease outbreak.




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Just the Facts

First-year tuition




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ADA lobbies Congress’ coronavirus legislative package

As Congress works on legislation in response to the coronavirus disease outbreak, the ADA is working to ensure that those bills include provisions that are beneficial to dentists — particularly dental practice owners — and their patients.




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Senate passes coronavirus legislative package

The Senate and House have passed a coronavirus legislation package that includes three issues important to dentistry that will next head to the White House where President Donald Trump is expected to sign it into law.




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ADA lobbies Congress on CARES Act

The ADA on March 20 sent out a Legislative Issues Alert to dentists, assuring them that the Association continues to lobby on their behalf in response to the Coronavirus Aid, Relief and Economic Security Act.