Dear Friends,

Slowly but surely our expansion plan is becoming realized. Dina Block, MD our newest endocrinologist is now seeing patients in the clinic for all general endocrinology, diabetes and prediabetes concerns. She also authored an overview of Hashimoto's disease in this month's newsletter.  This autoimmune condition occurs in 30-40% of our type 1 diabetes patients and Dr. Block increases our ability to treat these patients.  Next, we need to find donors to help us expand into a new space, since we are rapidly outgrowing the space we have.

We have also expanded our diabetes education offering by adding Learning Sessions. We have hosted four sessions already and have more planned for next year. If you haven't attended one yet, read more about these offerings and send your suggestions for session times and topic ideas to Mary Rose.

The major highlight in diabetes news has been the continuing announcements of the heart health and kidney benefits of medications approved for use in people with type 2 diabetes. There are early hints of benefits from a third drug in the injectable GLP-1 class of medications. More details will be released at the 2019 ADA meeting in June.

The SGLT2-inhibitor Invokana also joined Jardiance in having FDA approval for reducing cardiac and heart failure events.  In the first quarter of 2019 the FDA will hear evidence on the benefit of this class of medication, including a new agent known as an SGLT-1,2-inhibitor (sotagliflozin), in people with type 1 diabetes.

It is great to have an expanded choice in continuous glucose monitoring; the flash Abbott Libre is extending to 14-day wear and the Dexcom G6 is expected to be available for Medicare patients next year. We are even seeing TV ads for these systems. We welcome the competition in CGM devices and applaud the expansion of using these options to provide patients with much better outcomes than previously possible.

Tandem has added a predictive low glucose suspend feature to their X2 insulin pump and expects to have a software update next year to offer additional automation features. This will join the Medtronic 670G system in providing an FDA approved hybrid closed-loop option. There is active development in this field and additional systems are expected in the coming years.  Meanwhile many of our patients are not waiting for the FDA and are very successfully using their own “Do-It-Yourself” (DIY) systems.

Once again, our wonderful patients who have donated to our clinic have provided to funds to launch our own pilot research trial using a system we developed using remote daily CGM monitoring with telemedicine towards the goal of prevention hypoglycemia in our older type 1 diabetes participants. The pilot data will be used for an NIH grant application to expand the approach to a larger trial. Your continuing support allow us to self-fund this cutting-edge research and expand our community programs on the Eastside of town.

In my own professional life my claim to fame is in the world of diabetes technology.  I chair the Endocrine Society Technology Committee, the ADA Diabetes Technology Interest group, and the JDRF Provider Device Education Initiative.  I was recently asked to be a member of the ADA Professional Practice Committee, which generates all of the ADA guidelines.  At this point in my life my goal is to use any accumulated wisdom I have to help guide policy and to mentor and train young physicians to lead us forward into the future.  I am fortunate to have an amazing group of young mentees (both at CHLA and USC) who are thriving, getting grants, publishing articles, running programs and giving me hope for the future of diabetes care.

I wish for all to have a healthy, safe holiday season.  I am exceedingly lucky to have the best patients anywhere, who make all the hard work worth it.





Message from the Director