News of the Center
News Archive — Summer 2019
Message from the Director
Dear Friends,
At this year’s annual ADA Scientific Sessions much of the news was about the benefits of the newer type 2 diabetes medications on the kidney and the heart. However, I was most interested in the research about people with type 1 diabetes. Among other studies, the WISDM Trial, which we participated in, showed that continuous glucose monitoring in people aged 60 and older, can reduce episodes of hypoglycemia.
Of particular note was the first ever finding that a medication that suppresses the immune system (Teplizumab) can slow progression to diabetes in people at high risk for type 1. It basically meant 2 years more time before insulin was needed. This is not a cure, but two years without insulin can be quite a relief for people who are getting close to needing it.
There were topline results about a new oral medication know as a glucokinase activator that may help treat people with type 1 diabetes. It didn’t stop the need for insulin, but it lowered A1C’s and insulin requirements and it may make diabetes easier to manage. It is now being studied in larger groups of people.
Finally, many technology companies showcased their ever advancing systems for treating diabetes. Certain systems, like the Tandem pump with Control IQ looked particularly promising and should be out by the end of the year.
The most disappointing news come from the diabetes prevention trial that hope to show that vitamin D could prevent the progression from prediabetes to type 2 diabetes. Our East Los Angeles location was one of the trial sites. The details of the results are reported in our East LA research update. The one positive finding was that if the vitamin D level was very low (12 or below) vitamin D did seem to help.
The San Francisco location of this year's ADA meeting is the nation's hotbed of policy innovations to reduce the consumption of sugary beverages. Mark created several videos on this and other topics that will be shown on Medscape (free registration is required). Keep an eye for updates on either the USC Westside Center for Diabetes Twitter stream or Facebook page to know when the videos post.
Closer to home, we very excited about our new capability to conduct telehealth visits. This took two years to implement and we are one of the first at USC to have this capacity. Our nurse educator, Mary Rose, was the leader on this initiative. Our doctors, nurse practitioner and diabetes educator can perform follow-up visits through a secure video connection and reduce the need to travel to clinic. I personally love this new way to have a clinic visit for those where driving to clinic is a barrier. Here is how the system works.
We also have research updates from both the East and West side of town, and new Learning Sessions for people with type 1 and type 2 diabetes.
Many of our patients have been asking if there was a way to support our programs and research directly. There are several ways to do this. For more information contact Valerie Ruelas: 323-361-8416 or vruelas@usc.edu.
Sincerely,
Anne
Diabetes Learning Sessions
These sessions are opportunities to learn about your diabetes in small groups of 5-15 participants. The sessions are held at 9033 Wilshire, check-in and pre tests are required before the session. Registration starts 30 min prior to the session in the clinic. Most sessions will be billed to your insurance as an education visit.
July 31st 4-6pm: New Technology, Medications & Research for Type 1 Diabetes
What are the recent updates in continuous glucose monitoring, insulin pump technology and closed-loop system options? Are any of them right for you? We now also have new connected insulin pens and medications available.
Before a product is marketed it needs to be shown to be safe and effective in a clinical trial. We have also been conducting trials designed to change policy. Mark will review the recent research at the USC Westside Center for Diabetes and tell you what is involved in participating in a clinical trial and how can you become a research participant.
July 10th 10am-12pm: Using Continuous Glucose Monitors in Type 2 Diabetes
Continuous Glucose Monitors (CGM) are often used by people with type 1 diabetes and they are very useful for helping them make the multiple insulin dose adjustments throughout the day. People with type 2 diabetes (T2D) who use long-acting and mealtime insulin could use CGMs in the same way, but there is also a place for CGMs in T2Ds who are taking pills only or using one injection a day or week.
There are two simple devices know as flash CGMs that can provide a spot check to see how well your current medication is working or to provide extra data before your clinic visit. One version of the Freestyle Libre simply collects data for 14 days and we download the information in the clinic, the other version allows the person wearing the device to see the data by scanning the sensor. You can use the data to adjust your diet and see the impact of exercise and we can use the data to make adjustments in your treatment plan.
The session will review the device options and discuss how they may be useful to you.
July 17th 3-5pm: Advanced Insulin Pumping
Insulin pumps are sophisticated devices with many advanced features, but we find many people are only using the basics. We will teach you about how to find and the buttons to give a temporary basal rate to adjust for exercise, prevent a lows or make gentle corrections.
You can also use advanced bolus features to better match the glucose impact of different foods - think pizza - or to adjust for your digestion pattern. You can do this with the extended bolus or a dual or square wave bolus depending on the pump brand. The bolus calculator on your pump is great for doing the math, but there are times to use temporary basal rates based on the arrow direction of your CGM or for exercise.
Many of these techniques are being used in the new hybrid closed-loop pumps and we will briefly discuss how those systems work and talk about the current options.
The Type 1 Diabetes Self-Care Manual
The manual that Dr. Peters co-authored with leading pediatric endocrinologist Jamie Wood, MD is now available as either a free PDF download or if you prefer it can still be purchased as a paperback book.
The Type 1 Diabetes Self-Care Manual helps guide you through the different phases of life with type 1 diabetes and share the science and clinical information that is required to successfully manage type 1 diabetes, and it also includes many patient stories and tips on how they have managed their condition.
While you may appreciate the medical insights and advice, what really makes this book different is reading the personal insights from our patients who contributed their stories to the book. For the newly diagnosed, you may be surprised about the stories of boiling to sterilize and reusing syringes, what life was like before blood glucose meters, or even imagining a time before continuous glucose monitors. Most of all you will learn that people manage their diabetes in different ways. Some will rave about getting an insulin pump and others revel in returning to shots. There are many ways to manage life with type one diabetes and you will learn as much from other patients as you will from the doctors.
Thanks to a grant from the Leona M. and Harry B. Helmsley Charitable Trust, this valuable guide is now freely available to download from the American Diabetes Association website.
Download the free PDF version of the publication.
Purchase the hard copy of the publication.
What are you waiting for? If you have type 1 diabetes or know someone who needs authoritative answers on exercising, being safe at school, nutrition, setting glucose goals, managing complications and more - this guide is for you.
TeleCare
The newest capability at the USC Westside Center for Diabetes is the ability to have a secure telehealth visit with your provider. USC is calling this TeleCare and the visits can be arranged with all of our physicians, Drs. Peters, Orrange and Block, our nurse practitioner Donna Miller, or diabetes educator Mary Rose Deraco. This will be a major time-saver for our patients who have long commutes to come to the clinic or simply have a busy life and want to have a telehealth visit.
The video chat visits connection can be made either with a camera-equipped computer or an iPhone. For a computer connection, an email link is sent for a connection and there is an iPhone USC TeleCare app that can be used to make the connection. Instructions will be sent before your visit and you can choose how you want to make the connection.
For diabetes visits, it is useful to upload your diabetes devices before the session using either Tidepool, sending in your Dexcom Clarity code or a Libre report or meter download. We can also send a request to a local lab to collect A1c and other lab tests before you connect. Check with your provider and the front desk on the steps you will need to take and for instruction on how to have a remote clinic session.
Each provider will have their own rules on how their use the service. Some may want an in-person visit before using telehealth, or there may be a requirement to been in the clinic once a year. We have had a number of successful visits already and you can call the front desk at 310-272-8204 to schedule an in-person or telehealth visit.
