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Metformin Therapy During Pregnancy: Good for the goose and good for the gosling too?

Denice S. Feig
Oct 1, 2011; 34:2329-2330
Editorial (See Rowan et al., p. 2279)




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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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Glucose Management Indicator (GMI): A New Term for Estimating A1C From Continuous Glucose Monitoring

Richard M. Bergenstal
Nov 1, 2018; 41:2275-2280
Perspectives in Care




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Diabetes Technology Update: Use of Insulin Pumps and Continuous Glucose Monitoring in the Hospital

Guillermo E. Umpierrez
Aug 1, 2018; 41:1579-1589
Diabetes Care Symposium




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International Consensus on Use of Continuous Glucose Monitoring

Thomas Danne
Dec 1, 2017; 40:1631-1640
Continuous Glucose Monitoring and Risk of Hypoglycemia




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Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Tadej Battelino
Aug 1, 2019; 42:1593-1603
International Consensus Report




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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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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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CDC to offer coronavirus guidance during webinar Jan. 31

The Centers for Disease Control and Prevention will provide interim guidance to clinicians regarding the coronavirus outbreak during a webinar at 2 p.m. EST Jan. 31.




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Indian Health Service honoring National Children’s Dental Health Month

The Indian Health Service is presenting a four-part series of messages focused on their younger patients’ oral heath in honor of the February observance of National Children’s Dental Health Month.




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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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Free ADA webinar offering answers to pressing COVID-19 questions

The ADA is partnering with the Organization for Safety, Asepsis and Prevention in providing a free on-demand webinar on Friday, March 20, with content for the program based on questions the ADA has received from members looking for guidance while navigating the novel coronavirus pandemic.




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ADA begins to address coding, billing procedures during COVID-19 outbreak

The ADA is releasing a guide intended to help dental offices navigate issues related to coding and billing for virtual check-ins in the midst of the COVID-19 outbreak.




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How dentists can keep the lights on during economic downturn

The ADA is streaming a free practice management webinar March 25 designed to help dentists predict short- and long-term impacts on their business operations during tough economic times and teach them how taking the right steps now can minimize their risk during the COVID-19 outbreak and its aftermath.




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HRSA updates FAQs for health centers during COVID-19

The Health Resources and Services Administration says it is working to keep health centers and health center program partners updated on the latest information regarding COVID-19.




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ADA urges CDC to provide ‘immediate guidance’ on protecting dental patients, staff from COVID-19 during emergency treatments

The American Dental Association is urging the Centers for Disease Control and Prevention to provide immediate guidance on the best way to protect dental patients and staff from the transmission of COVID-19 during emergency and urgent care situations.




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Association offers resources on handling stress during a pandemic

Noting that we’re living through a time of uncertainty and it’s normal to feel stressed and anxious, the Center for Professional Success today posted free resources on stress management to help dentists navigate this time of uncertainty amid the COVID-19 pandemic.




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Delta Dental member companies begin offering financial assistance during pandemic

The ADA is calling on third-party payers to support dental practices in the midst of the COVID-19 pandemic.




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ADA council affirms importance of code of ethics during COVID-19 pandemic

The ADA Council on Ethics, Bylaws and Judicial Affairs’ ethics subcommittee authored an online essay as part of its Ethical Moment series in the May issue of The Journal of the American Dental Association, affirming that the ADA Principles of Ethics and Code of Professional Conduct is just as important as ever when making the difficult decisions they encounter on a daily basis.




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ADA free webinar exploring radiographs, diagnostic imaging

In a time when teledentistry is gaining more attention during the COVID-19 pandemic, the ADA will stream a free webinar in May that takes a close look at the different types of images needed for diagnosis, treatment planning and operative procedures.




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Free ADA webinar aims to help dentists plan recovery during, after pandemic

The ADA is streaming a free webinar April 14 intended to help dentists jump-start their recovery process during and after the COVID-19 pandemic.




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North Carolina interactive map launches to help public find emergency dental treatment during pandemic

A North Carolina oral health coalition, in collaboration with multiple state partners, has developed an interactive map to help guide the public to sites where emergency dental services are available throughout the Tar Heel State both during and after the COVID-19 outbreak.




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ADA antibiotics guideline authors to discuss C. diff infections in dentistry during Peggy Lillis Foundation conference

Two of the authors of the American Dental Association's antibiotics guideline will discuss C. diff infections and antibiotic stewardship in dentistry April 21 as part of a free, online conference organized by the Peggy Lillis Foundation.




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May JADA discusses calcium hydroxide overfill risk during root canals

Overfill of medication or obturation materials in endodontic treatment can cause permanent neurologic injury, and there are steps clinicians can take to help prevent that, according to an article published in the May issue of The Journal of the American Dental Association.




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Dental school during a pandemic

If this were a typical day, and if these were typical times, LaShonda would be in her pediatrics competency exam, fresh off a cup of coffee, before heading to a three-hour simulation lab.




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Agencies submit final rule extending ERISA deadlines during pandemic

The U.S. Department of Labor said April 28 that it is extending the Employee Retirement Income Security Act of 1974 filing deadlines for certain notice and disclosure requirements in the wake of the COVID-19 pandemic.




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Exploring the Potential of Two-Generation Strategies in Refugee Integration

On this webinar, MPI researchers and Utah and Colorado refugee coordinators explore promising practices to better serve refugee families, including education services for refugee youth, innovative efforts to secure better jobs for adult refugees, and other services designed to aid integration over time. They also discuss the potential for implementing and supporting two-generation approaches to refugee integration at a time when the system’s funding and capacity are in peril.  




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Exploring New Legal Migration Pathways: Lessons from Pilot Projects

As European countries launch ambitious new legal migration partnerships with several origin and transit countries in Africa, this report takes stock of the long and mixed history of such projects. To make the most of their potential to encourage skills development and fill pressing labor gaps, policymakers will need to think carefully about the partners and sectors they choose, among other key considerations.




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Reduced Myocardial Perfusion Reserve in Type 2 Diabetes Is Caused by Increased Perfusion at Rest and Decreased Maximal Perfusion During Stress

OBJECTIVE

To examine differences in myocardial blood flow (MBF) at rest and during stress between patients with type 2 diabetes and controls, and to identify potential predictors of changes in MBF at rest and during stress.

RESEARCH DESIGN AND METHODS

A cross-sectional study of 193 patients with type 2 diabetes and 20 age- and sex-matched controls. Cardiovascular magnetic resonance was used in order to evaluate left ventricular structure and function, and MBF at rest and during adenosine-induced stress. MBF was derived as the mean of the flow within all segments of a midventricular slice.

RESULTS

Patients with type 2 diabetes had higher global MBF at rest (0.81 ± 0.19 mL/min/g) and lower global MBF during stress (2.4 ± 0.9 mL/min/g) than did controls (0.61 ± 0.11 at rest, 3.2 ± 0.8 mL/min/g under stress; both P < 0.01). Patients with macroalbuminuria had lower MBF during stress (1.6 ± 0.5 mL/min/g) than did patients with microalbuminuria (2.1 ± 0.7 mL/min/g; P = 0.04), who in turn had lower MBF during stress than did normoalbuminuric patients (2.7 ± 0.9 mL/min/g; P < 0.01). Patients with severe retinopathy had lower MBF during stress (1.8 ± 0.6 mL/min/g) than did patients with simplex retinopathy (2.3 ± 0.7 mL/min/g; P < 0.05) and those who did not have retinopathy (2.6 ± 1.0 mL/min/g; P < 0.05). Albuminuria and retinopathy were associated with reduced MBF during stress in a multiple regression analysis. Stress-related MBF inversely correlated with myocardial extracellular volume (P < 0.001; R2 = 0.37), a measure of diffuse myocardial fibrosis. A trend toward lower basal MBF was observed in patients treated with sodium–glucose cotransporter 2 inhibitors (P = 0.07).

CONCLUSIONS

Patients with type 2 diabetes have higher global MBF at rest and lower maximal MBF during vasodilator-induced stress than do controls. Reduced MBF during stress is associated with diabetes complications (albuminuria and retinopathy) and is inversely correlated with diffuse myocardial fibrosis.




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Continuous Glucose Monitoring in Pregnancy: Importance of Analysing Temporal Profiles to Understand Clinical Outcomes

OBJECTIVE

To determine if temporal glucose profiles differed between 1) women who were randomized to real-time continuous glucose monitoring (RT-CGM) or self-monitored blood glucose (SMBG), 2) women who used insulin pumps or multiple daily insulin injections (MDIs), and 3) women whose infants were born large for gestational age (LGA) or not, by assessing CGM data obtained from the Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT).

RESEARCH DESIGN AND METHODS

Standard summary metrics and functional data analysis (FDA) were applied to CGM data from the CONCEPTT trial (RT-CGM, n = 100; SMBG, n = 100) taken at baseline and at 24- and 34-weeks gestation. Multivariable regression analysis determined if temporal differences in 24-h glucose profiles occurred between comparators in each of the three groups.

RESULTS

FDA revealed that women using RT-CGM had significantly lower glucose (0.4–0.8 mmol/L [7–14 mg/dL]) for 7 h/day (0800 h–1200 h and 1600 h–1900 h) compared with those with SMBG. Women using pumps had significantly higher glucose (0.4–0.9 mmol/L [7–16 mg/dL]) for 12 h/day (0300 h to 0600 h, 1300 h to 1800 h, and 2030 h to 0030 h) at 24 weeks with no difference at 34 weeks compared with MDI. Women who had an LGA infant ran a significantly higher glucose by 0.4–0.7 mmol/L (7–13 mg/dL) for 4.5 h/day at baseline; by 0.4–0.9 mmol/L (7–16 mg/dL) for 16 h/day at 24 weeks; and by 0.4–0.7 mmol/L (7–13 mg/dL) for 14 h/day at 34 weeks.

CONCLUSIONS

FDA of temporal glucose profiles gives important information about differences in glucose control and its timing, which are undetectable by standard summary metrics. Women using RT-CGM were able to achieve better daytime glucose control, reducing fetal exposure to maternal glucose.




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The Influence of Baseline Diastolic Blood Pressure on the Effects of Intensive Blood Pressure Lowering on Cardiovascular Outcomes and All-Cause Mortality in Type 2 Diabetes

OBJECTIVE

To examine whether low baseline diastolic blood pressure (DBP) modifies the effects of intensive systolic blood pressure (SBP) lowering on cardiovascular outcomes in type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS

The Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP), a two-by-two factorial randomized controlled trial, examined effects of SBP (<120 vs. <140 mmHg) and glycemic (HbA1c <6% vs. 7.0–7.9% [<42 vs. 53–63 mmol/mol]) control on cardiovascular events in T2DM (N = 4,731). We examined whether effects of SBP control on cardiovascular composite were modified by baseline DBP and glycemic control.

RESULTS

Intensive SBP lowering decreased the risk of the cardiovascular composite (hazard ratio [HR] 0.76 [95% CI 0.59–0.98]) in the standard glycemic arm but not in the intensive glycemic arm (HR 1.06 [95% CI 0.81–1.40]). Spline regression models relating the effects of the intervention on the cardiovascular composite across the range of baseline DBP did not show evidence of effect modification by low baseline DBP for the cardiovascular composite in the standard or intensive glycemic arms. The relation between the effect of the intensive SBP intervention and baseline DBP was similar between glycemic arms for the cardiovascular composite three-way interaction (P = 0.83).

CONCLUSIONS

In persons with T2DM, intensive SBP lowering decreased the risk of cardiovascular composite end point irrespective of baseline DBP in the setting of standard glycemic control. Hence, low baseline DBP should not be an impediment to intensive SBP lowering in patients with T2DM treated with guidelines recommending standard glycemic control.




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A Randomized Controlled Trial Comparing Glargine U300 and Glargine U100 for the Inpatient Management of Medicine and Surgery Patients With Type 2 Diabetes: Glargine U300 Hospital Trial

OBJECTIVE

The role of U300 glargine insulin for the inpatient management of type 2 diabetes (T2D) has not been determined. We compared the safety and efficacy of glargine U300 versus glargine U100 in noncritically ill patients with T2D.

RESEARCH DESIGN AND METHODS

This prospective, open-label, randomized clinical trial included 176 patients with poorly controlled T2D (admission blood glucose [BG] 228 ± 82 mg/dL and HbA1c 9.5 ± 2.2%), treated with oral agents or insulin before admission. Patients were treated with a basal-bolus regimen with glargine U300 (n = 92) or glargine U100 (n = 84) and glulisine before meals. We adjusted insulin daily to a target BG of 70–180 mg/dL. The primary end point was noninferiority in the mean difference in daily BG between groups. The major safety outcome was the occurrence of hypoglycemia.

RESULTS

There were no differences between glargine U300 and U100 in mean daily BG (186 ± 40 vs. 184 ± 46 mg/dL, P = 0.62), percentage of readings within target BG of 70–180 mg/dL (50 ± 27% vs. 55 ± 29%, P = 0.3), length of stay (median [IQR] 6.0 [4.0, 8.0] vs. 4.0 [3.0, 7.0] days, P = 0.06), hospital complications (6.5% vs. 11%, P = 0.42), or insulin total daily dose (0.43 ± 0.21 vs. 0.42 ± 0.20 units/kg/day, P = 0.74). There were no differences in the proportion of patients with BG <70 mg/dL (8.7% vs. 9.5%, P > 0.99), but glargine U300 resulted in significantly lower rates of clinically significant hypoglycemia (<54 mg/dL) compared with glargine U100 (0% vs. 6.0%, P = 0.023).

CONCLUSIONS

Hospital treatment with glargine U300 resulted in similar glycemic control compared with glargine U100 and may be associated with a lower incidence of clinically significant hypoglycemia.




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Differing DREAMs: Estimating the Unauthorized Populations That Could Benefit under Different Legalization Bills

2017 saw the introduction of several bills—two of them by Senate Republicans in the weeks following the Trump administration’s announcement that it would terminate the Deferred Action for Childhood Arrivals (DACA) program—that would provide a pathway to conditional and then legal permanent residence to unauthorized immigrants brought to the United States as children, if they meet a range of educational, professional, and other criteria.




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Preparing Newcomers for the Jobs of Today and the Labor Markets of Tomorrow

This Migration Policy Institute Europe webinar examines possible scenarios for how social, economic, and technological trends could affect jobs, labor market policy, education and social policies, and migrant integration. Speakers also explored the potential of coding schools for refugees to help alleviate skills shortages and provide a pathway to work.




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Securing the Border: Defining the Current Population Living in the Shadows and Addressing Future Flows

Testimony of Marc Rosenblum before the Senate Committee on Homeland Security and Governmental Affairs for the March 26, 2015 hearing on the characteristics of unauthorized immigrants in the United States and how to address future flows.




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Will Immigration Reform Ever Succeed Again? The Legacy of IRCA &amp; Its Enduring Lessons

This provocative discussion showcases Charles Kamasaki's book, Immigration Reform: The Corpse That Will Not Die, and explores the lessons that can be learned from the Immigration Reform and Control Act of 1986, its intended and unintended consequences, and how the law’s legacy has shaped contemporary politics surrounding immigration.




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Televangelist Jim Bakker recovering from stroke

Televangelist Jim Bakker is recovering at his North Carolina home after having a stroke, his wife said Friday.




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Google brings back 'Pac-Man' game in latest Doodle

Google's homepage features arcade classic "Pac-Man" in the latest Doodle.




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Look: Brian May visits hospital after injuring buttocks while gardening

Queen guitarist Brian May is recovering after tearing his gluteus maximus during a moment of "over-enthusiastic" gardening.





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Practicing Emotional Awareness During the COVID-19 Pandemic

When COVID-19 emerged as a clear and present public health threat, most people felt the same range of emotions: somewhere along the spectrum of fear and anxiety. People are still...




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[ Politics ] Open Question : When will the democrats be arrested for being trators to SAmerica by conspiring with chine to make trump looik bad?




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[ Engineering ] Open Question : How can I determine data rate of wireless device given this information?

802.11n device 20 MHz band 32 QAM 1/2 coding rate What's formula?




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Immigration and the U.S.-Mexico Border during the Pandemic: A Conversation with Members of Congress

In this bipartisan discussion, two border-state members of Congress—Rep. Veronica Escobar and Rep. Dan Crenshaw—discuss the response to the coronavirus outbreak, how it is affecting the interconnected border region, and what the future might hold.




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Wondering Wall Street's Mood? Look Up

Forget about buying low and selling high. If you are worried about the recent volatility in the stock market, perhaps you should let the weather be your guide.




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Reminders of Mortality Bring Out the Charitable Side

Scrooge crept towards it, trembling as he went; and following the finger, read upon the stone of the neglected grave his own name, Ebenezer Scrooge . . . "Spirit!" he cried, tight clutching at its robe, "hear me! I am not the man I was. I will not be the man I must have been . . . "




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Mass Suffering and Why We Look the Other Way

When President-elect Barack Obama, an early opponent of the Iraq war, asked Sen. Hillary Rodham Clinton -- who helped to authorize the war -- to be his secretary of state, many liberals scratched their heads.




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A Defense of Diversity Statements in Hiring

Recently, Abigail Thompson, a Vice President of the AMS and Professor at UC Davis, wrote a short opinion piece coming out against the use of diversity statements in hiring. As I read her piece, I found myself troubled by some … Continue reading




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Preparing for the Unknown: Designing Effective Predeparture Orientation for Resettling Refugees

Refugees encounter a range of challenges after resettlement—from adjusting to a new culture and language, to finding a job. Many resettlement countries invest in predeparture orientation to help refugees develop the knowledge, skills, and attitudes to face these challenges. This report explores the many forms these programs take, highlighting important design questions and key elements that effective programs share.




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Childhood and Exploring Nature

When I reread the Green Knowe books, what struck me most about them was how much time the children in the books - Tolly, Ping, Ida, Oskar, Susan,and Jacob spent exploring the outdoors. Tolly climbs the beech tree to pretend that he is a sailor boy on the mast of a ship:



He spends hours searching through shrubbery to find a lost tunnel, feeds birds, rescues carp, trims the chess men and pets the green deer:




In Treasure of Green Knowe, Tolly overlaps with Jacob and Susan, two eighteen-century children who also spend their days exploring the garden and the river.

Ping learns not only the secrets of the bamboo grove in the garden in A Stranger at Green Knowe, but also of the islands surrounding the house. In The River at Green Knowe, Ping, Ida, and Oskar spend their time exploring the River Ouse on a canoe. They wake up before dawn so that they can explore before the river is taken over by tourists, and map the islands surrounding the house. Much of their time is spent observing birds such as swans and owls, the terrain of the different islands, and the people who adapted their lives to live on them. In one episode, the three children take the canoe out after a storm and are rescued by River Patrol. Ida's aunt, when told that she will be presented with a bill for the rescue, comments only that it will be cheaper than three funerals. The writing in River is particuarly evocative since the children are not used to going outside at night, and are therefore sensitive to their physical environment.

The children themselves feel a sense of welcome and protection from the house. They know that they can go out and explore the unknown world around them, but always have the safety of the house at the end of the day. Tolly plays that the house is Noah's Ark in Children of Green Knowe, safe in the midst of the flood waters of the Ouse, which have caused the moat to overflow and turn the house into an island.

This freedom to explore is not something readily available to a twenty-first century child. Most parks are sanitized, with little shrubbery and playground equipment designed to produce the least physical damage. Children are rarely let out alone and unsupervised to play, even in yards; no child would be allowed to play alone for hours in the ramble at Central Park or the ravine at Prospect Park. While adults kayak on the Hudson, three children would not be allowed to do so without adult supervision; they would need an adult present even on the Staten Island ferry. While children in less urban areas might have some more freedom, they will still have little unstructured free time outside of school and extracurricular activities to just explore.



  • Children of Green Knowe
  • Lucy Maria Boston
  • River of Greeen Knowe
  • Treasure Green Knowe