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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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Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers

William J. Jeffcoate
Apr 1, 2018; 41:645-652
Perspectives in Care




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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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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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International Experience Suggests Safe Third-Country Agreement Would Not Solve the U.S.-Mexico Border Crisis

While safe third-country agreements appear to hold the potential of deterring new asylum claims, experience suggests this may be a false promise. As the Trump administration explores the possibility of such agreements with Mexico and Guatemala, this commentary examines the evidence of safe third-country arrangements in Europe, finding them difficult to enforce and playing little role in deterring new claims.




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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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Humanitarian Protection in an Era of Pandemic

MPI and MPI Europe experts discuss the effects of the coronavirus pandemic on asylum systems in Europe and North America, as well as in developing regions, where 85 percent of refugees live. During this freeform conversation, our analysts also assess the implications for the principle of asylum and the future for a post-World War II humanitarian protection system that is under threat.




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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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Snapshots of American Dentistry

Average educational indebtedness of graduating students from U.S. dental schools has increased an average of 3.5% annually between 2000 and 2018 after adjusting for inflation.




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Send Give Kids A Smile photos

ADA News welcomes digital submissions from GKAS program participants.




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ADA provides suggestions to help protect dentists from employee theft

Nearly 49% of responding dental practices have experienced employee theft, and nearly 46% of those have experienced theft or embezzlement more than once, according to a survey conducted by the ADA Council on Dental Practice.




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Snapshots of American Dentistry

International dental school graduates in U.S. dental schools




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Missouri Dental Association notches win

Thanks to the advocacy efforts of the Missouri Dental Association, a managed care organization has agreed to remove an authorization tool it was requiring dentists to use prior to using sedation.




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ADA provides suggestions to help protect dentists from employee theft




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Snapshots of American Dentistry

Advanced dental education program enrollment by gender




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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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Study: Dental fluorosis generally less noticeable over time

Results from a University of Iowa College of Dentistry study suggest that mild and moderate dental fluorosis is generally less noticeable over time, validating the beliefs of some supporters of community water fluoridation that there have been overestimates of fluorosis prevalence made by anti-fluoridation activists.




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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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Study: Evidence does not support classifying fluoride as cognitive neurodevelopmental hazard

The National Academies of Sciences, Engineering, and Medicine announced March 5 that it does not find that the National Toxicology Program adequately supported its conclusion that fluoride is “presumed” to be a cognitive neurodevelopmental hazard to humans.




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Snapshots of American Dentistry

Allied dental vs predoctoral dental graduates




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Association warns members on potential coronavirus-related phishing emails

The Association is asking member dentists and their dental teams to increase their vigilance over phishing emails as a result of the coronavirus, known as COVID-19.
Attackers often use emergencies as an opportunity to send fake emails tailored to that situation, the association said.




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ADA, other dental organizations ask Labor Department to help small businesses

The ADA, along with a large group of other dental organizations, told the U.S. Department of Labor that they are concerned about provisions in HR 6201, the Families First Coronavirus Response Act as related to family and medical leave and paid sick leave.




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ADA, other organizations outline economic response needs to survive pandemic

The ADA and nearly 100 other organizations are asking Congress and the White House to help businesses survive the coronavirus crisis by reducing their costs and increasing their cash flow as much as possible in the coming weeks.




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ADA initiates grassroots campaign in response to CARES Act

The ADA is calling on dentists everywhere to contact their legislators today ahead of the Senate’s vote on the Coronavirus Aid, Relief and Economic Security Act.




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ADA president thanks dentists for grassroots efforts in response to CARES Act

As the Senate works to pass a stimulus package aimed at granting relief to the millions of Americans affected by the COVID-19 pandemic, the ADA is thanking dentists across the nation for making their voices heard in Washington on that same legislation.




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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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ADA Member Advantage-endorsed company, Lenovo, offers remote work and school solutions

Given recent school cancellations and state orders to shelter in place, some households may be experiencing the strain of sharing family computers. ADA Member Advantage states that members are eligible for savings of up to 46% on select items from their endorsed technology provider, Lenovo, during a special sale on computers.




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University of Minnesota dental school appoints Dr. Keith A. Mays as interim dean

The University of Minnesota School of Dentistry announced March 19 that it named Dr. Keith A. Mays, Ph.D, as its interim dean for two years beginning May 15.




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ADA joins other health care organizations in appeal for more PPE, other supplies

The ADA and other health care organizations signed a public statement March 27 saying they “strongly” support emergency efforts at the federal level to dramatically increase the production and distribution of personal protective equipment (PPE) and other necessary medical equipment and supplies during the COVID-19 pandemic.




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ADA will share Paycheck Protection Program information as soon as it becomes available

The Association is waiting for clear guidance from the Small Business Administration on the best way to help dentists considering applying for Paycheck Protection Program 7(a) loans.




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Small Business Administration: Dentists can apply for both economic injury disaster and paycheck protection program loans

Dentists can apply for both Economic Injury Disaster Loans and Paycheck Protection Program 7(a) loans, the Small Business Administration told the American Dental Association on April 6.




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SBA announces funding no longer available for Economic Injury Disaster Loans, Paycheck Protection Program

The Small Business Administration said that as of April 16, the agency is unable to accept any new applications for the Paycheck Protection Program or the Economic Injury Disaster Loans due to a lack of funding.




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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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Wisconsin dentists donate personal protective equipment amid COVID-19 pandemic

Wisconsin dentists have answered the call for personal protective equipment by organizing drives and donating their surplus supplies to hospitals and urgent care facilities treating patients with COVID-19.




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Senate votes to expand small business aid

The Senate passed new coronavirus relief legislation April 21 calling for much-needed funding for depleted federal loan programs that could help businesses nationwide, including dentists and dental practices, recover from the economic fallout of the pandemic.




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Labor ends temporary nonenforcement of paid leave protections

The U.S. Department of Labor announced April 20 that it is ending the temporary period of non-enforcement of paid leave protections under the Families First Coronavirus Response Act.




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American College of Emergency Physicians endorses ADA's antibiotics guideline

The American College of Emergency Physicians has endorsed the American Dental Association's clinical practice guideline on the use of antibiotics for the management of pulpal- and periapical-related pain and swelling.




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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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ADA, others ask lawmakers to include nonprofits in COVID-19 legislation

As Congress works on the next coronavirus-related relief package, the ADA and 37 other health care organizations are asking lawmakers to support nonprofit groups in those efforts.




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ADA streams webinar April 27 on respiratory protection

A recorded webinar will stream April 27 outlining the Association’s interim recommendation for personal protective equipment in dental settings as some states consider loosening social distancing mandates.




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House of Representatives passes Paycheck Protection Program and Health Care Enhancement Act

The House of Representatives passed a new coronavirus relief bill April 23 that calls for additional funding for federal loan programs to help businesses nationwide, including dental practices, recover from the economic fallout of the pandemic.




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SBA will resume accepting Paycheck Protection Program applications April 27

The Small Business Administration will resume accepting Paycheck Protection Program loan applications at 10:30 a.m. EST on April 27 from “approved lenders on behalf of any eligible borrower,” the agency said.




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Snapshots of American Dentistry




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Organized dentistry asks Congress for flexibility in Paycheck Protection Program loans

The Organized Dentistry Coalition is asking Congress for flexibility in the Paycheck Protection Program to allow dentists to purchase personal protective equipment as states begin the reopening phase of the COVID-19 pandemic.




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Dow, Total part of group that raised $1B to clean plastic in ocean

Some 30 companies including Dow, Total and other big makers of plastic raised $1 billion to contribute to cleaner ocean waters.




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Cancer patients on Medicaid might not benefit from experimental treatments, study finds

Cancer patients on Medicaid or who don't have insurance benefit less from experimental treatments, even if they get into clinical trials, a study published Thursday by JAMA Network Open has found.




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Blood clots, skin lesions among newly identified possible COVID-19 symptoms

Blood clots, skin rashes and other lesions might be among the symptoms some people experience with COVID-19, according to new research released Thursday.




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Blood test may effectively spot multiple cancers

A new blood-test approach for cancer screening was able to identify 26 previously undetected cases of the disease, according to the findings of a new study published Friday by the journal Science.