Discover and read the best of Twitter Threads about #T2DM
Most recents (19)
This week is #MentalHealthAwarenessWeek
Today’s short thread is about how living with #diabetes can affect psychological well-being🧵
Plus how #HCPs can effectively assess and support people living with the condition👩
Today’s short thread is about how living with #diabetes can affect psychological well-being🧵
Plus how #HCPs can effectively assess and support people living with the condition👩
1)
Living with #diabetes increases the risk of variable mental health conditions.
For this thread, we will be focusing on #depression , #anxiety and #diabetesdistress🔎
Living with #diabetes increases the risk of variable mental health conditions.
For this thread, we will be focusing on #depression , #anxiety and #diabetesdistress🔎
2)
The ‘Diabetes is Serious Report’ led by @DiabetesUK highlighted that almost half (47%) of people with #diabetes experience difficulties managing their condition.
Those from more deprived areas are at a higher risk🔼
The report is available at:
…production.s3.eu-west-1.amazonaws.com/resources-s3/p…
The ‘Diabetes is Serious Report’ led by @DiabetesUK highlighted that almost half (47%) of people with #diabetes experience difficulties managing their condition.
Those from more deprived areas are at a higher risk🔼
The report is available at:
…production.s3.eu-west-1.amazonaws.com/resources-s3/p…
Statins, given like Halloween candy to those with >10% risk of CVD, can cause insulin resistance & diabetes.
A prime example of "double think".
This 🧵 explores how statins impede insulin sensitivity & damage our pancreas.
#statins #diabetes #T2DM #CVD #cholesterol
A prime example of "double think".
This 🧵 explores how statins impede insulin sensitivity & damage our pancreas.
#statins #diabetes #T2DM #CVD #cholesterol
Let's start off by reminding ourselves that diabetes and the broader category of metabolic syndrome is one of the leading risk factors for CVD.
Any drug that claims to be protective of CVD, should not be impeding insulin sensitivity.
Any drug that claims to be protective of CVD, should not be impeding insulin sensitivity.
Statins are associated with increased incidence of T2DM, 10-28% in some studies.
One way this happens is by a reduction in insulin secretion - a hormone that facilitates glucose uptake from the bloodstream into cells.
One way this happens is by a reduction in insulin secretion - a hormone that facilitates glucose uptake from the bloodstream into cells.
Alright, who is ready for some truths about #InsulinReistance and #T2DM?
1️⃣ You can't prevent insulin reistance. It's coded in your DNA. It may be impacted by your environment. Studies have shown it has nothing to do with your BMI.
1️⃣ You can't prevent insulin reistance. It's coded in your DNA. It may be impacted by your environment. Studies have shown it has nothing to do with your BMI.
2️⃣ The term "pre-diabetes" is a PR stunt. The correct term is impaired glucose tolerance (or impaired fasting glucose) which is sometimes referred to as intermittent hyperglycaemia. It does not predict T2DM. It is best ignored and tested for every 3-5yrs.
3️⃣ there is no evidence that losing weight prevents diabetes. That's because you can't reverse insulin resistance. You can possibly postpone it by 2yrs? Furthermore there is evidence that those who are fat at the time of diagnosis fair much better than those who are thin.
1/ November 14th is #WorldDiabetesDay
Let’s look back at one of the most influential #RCTs for
how we given insulin in #T2DM?
the #RABBIT2 trial🐰🧵
#Insulin #MedTwitter
Let’s look back at one of the most influential #RCTs for
how we given insulin in #T2DM?
the #RABBIT2 trial🐰🧵
#Insulin #MedTwitter
2/ The #RABBIT2 study looked at the (1) efficacy and (2) safety of basal-bolus vs. sliding-scale #insulin in non-critical inpatients🏥.
Basal-bolus regimens consisted of a combo of #Glargine (basal) and #Glulisine (mealtime).
The primary outcome was average glucose🍬.
Basal-bolus regimens consisted of a combo of #Glargine (basal) and #Glulisine (mealtime).
The primary outcome was average glucose🍬.
3/ See below for a graphical depiction of how the study was performed👇:
1) Welcome to a new #accredited (0.75h CE/#CME) #tweetorial on challenging case presentations for pts with #cardiometabolic disease, #CaReMe #FOAMed.
Our expert author is Claire Davies. @claireyrivs is a specialist diabetes & endocrinology #pharmacist working in Gateshead in 🇬🇧.
Our expert author is Claire Davies. @claireyrivs is a specialist diabetes & endocrinology #pharmacist working in Gateshead in 🇬🇧.
2) She is a member of UKCPA Diabetes & Endocrinology committee @UKCPADiabetes & works across #diabetes, #endocrinology, & emergency/acute care in Secondary Care. She is currently involved in development of regional guidelines & education to support medicines optimisation for PLWD
3a) This program is intended for healthcare professionals and is supported by an educational grant from Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company.
1a) Welcome to one of our favorite events on the @academiccme #accredited #tweetorial feeds: a takeover of our programming from @GoggleDocs! The focus of this tweetorial is data from #ADA2022 on #SGLT2i beyond cardiac disease. Our expert author is @GoggleDocs' @drpatrickholmes.
1b) Check out our other #ADA2022 recap #tweetorial by new @GoggleDocs family member @Ines_VFonseca who focused on the cardiac data presented: ckd-ce.com/dkd13_ada22a/
2) This program is #accredited for CE/#CME #physicians #physicianassociates #nurses #pharmacists #nursepractitioners & is supported by an educational grant from the Boehringer Ingelheim Pharmaceuticals Inc and Eli Lilly Company. It is intended for healthcare professionals.
1) Welcome to a new #accredited #tweetorial, Prevention and Management of Heart Failure in T2 Diabetes: The Cardiologist’s Perspective! Our expert author is Giuseppe Galati MD, MMSc in Heart Failure, @GiuseppeGalati_ , Consultant #Cardiologist #HeartFailure & #Cardiomyopathies
2) @GiuseppeGalati_ is at San Raffaele Research Hospital, Milan 🇮🇹 @SanRaffaeleMI. This program is intended for #healthcare professionals & is accredited for 0.75h CE/#CME credit for #physicians #physicianassistants #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇬🇧🇪🇺.
3) @cardiomet_CE is supported by educational grants from AstraZeneca, Bayer, Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company, & Chiesi. Earn credit from archived programs at cardiometabolic-ce.com. Disclosures at cardiometabolic-ce.com/disclosures/.🙏 FOLLOW US !
1) Welcome to a new #accredited #tweetorial, Prevention and Management of Heart Failure in T2 Diabetes: The Diabetologist’s Perspective! Our expert author is Melanie J Davies CBE FMedSci @profmjdavies, Prof of Diabetes Medicine, U Leicester, Leicester Diabetes Unit @LDC_Tweets
2) This program is intended for #healthcare professionals and is accredited by @academiccme for 0.75h CE/#CME credit for #physicians #physicianassistants #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇬🇧🇪🇺. FOLLOW US for #cardiometabolic education from expert authors!
3) @cardiomet_CE is supported by educational grants from AstraZeneca, Bayer, Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company, and Chiesi. See archived programs still available for credit at cardiometabolic-ce.com. Disclosures at cardiometabolic-ce.com/disclosures/
1) Welcome to a new #accredited #tweetorial on Cardiorenal Disease in T2D & the Impact of Blocking the MR in Patients w/DKD, another CE/#CME program by one of the @GoggleDocs, this time our friend @AmarPut, Diabetes & Endocrine Consultant in the West Midlands 🇬🇧. #CaReMe #FOAMed
2) This program is supported by an educational grant from Bayer & is intended for #healthcare providers. Author disclosures can be found at ckd-ce.com/disclosures/. Prior programs, still available for CE/#CME credit, are at ckd-ce.com. CE/#CME credit 🇬🇧🇪🇺🇨🇦🇺🇸
3) So first – the ‘triple threat’ . . . We know of the link between the 🫀 and the kidneys and the ‘#cardiorenal’ syndrome, but what about in the setting of #diabetes?
I say this NOT from a political standpoint, but from a medical one. #SOTU
#POTUS said $35 cap is for Type I #diabetes. Helps ~1M. That's good!
The 1 in 10 ppl have diabetes is mostly those w/Type II: 37,000,000 ppl. THAT's where high costs are!
cdc.gov/diabetes/data/…
#POTUS said $35 cap is for Type I #diabetes. Helps ~1M. That's good!
The 1 in 10 ppl have diabetes is mostly those w/Type II: 37,000,000 ppl. THAT's where high costs are!
cdc.gov/diabetes/data/…
Again, NOT political, just can't help myself from trying to disentangle potentially confusing medical stats.
The common citation is how common Type II diabetes is (1 in 10), but the program is meant to address Type I diabetes costs (about 1 in 500 kids).
beyondtype1.org/type-1-diabete…
The common citation is how common Type II diabetes is (1 in 10), but the program is meant to address Type I diabetes costs (about 1 in 500 kids).
beyondtype1.org/type-1-diabete…
With the more common Type II diabetes (#T2DM), there are a lot of other healthcare costs, due to the many comorbidities in this patient population.
Lowering insulin costs for kids with Type I is a good start, but we also need to prevent / manage Type II!
ncbi.nlm.nih.gov/pmc/articles/P…
Lowering insulin costs for kids with Type I is a good start, but we also need to prevent / manage Type II!
ncbi.nlm.nih.gov/pmc/articles/P…
THREAD: SGLT2 inhibitors for #diabetes
1/5 Dr. Jamie Falk @jamisonfalk presented "A Deep Dive into #SGLT2i: What Comes to the Surface for Individuals with Diabetes"
👉🏽Watch the presentation here: bit.ly/3FRCEoM 🧑🏾💻
#T2DM #medsafety #FOAMed #MedEd
1/5 Dr. Jamie Falk @jamisonfalk presented "A Deep Dive into #SGLT2i: What Comes to the Surface for Individuals with Diabetes"
👉🏽Watch the presentation here: bit.ly/3FRCEoM 🧑🏾💻
#T2DM #medsafety #FOAMed #MedEd
2/5 #AdverseEffects for #SGLT2i to be aware of: genital infections, hypovolemia, DKA, amputations
✅Check out the image ⬇️ for the risk estimates
✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾💻
#T2DM #medsafety #FOAMed #MedEd #diabetes #ptsafety
✅Check out the image ⬇️ for the risk estimates
✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾💻
#T2DM #medsafety #FOAMed #MedEd #diabetes #ptsafety
3/5 Evidence to date for #SGLT2i:
The first of the two new classes of medications for type II diabetes to reduce ↘️ risk of CV #AdverseEvents and mortality
✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾💻
#T2DM #medsafety #FOAMed #MedEd #diabetes
The first of the two new classes of medications for type II diabetes to reduce ↘️ risk of CV #AdverseEvents and mortality
✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾💻
#T2DM #medsafety #FOAMed #MedEd #diabetes
Welcome to our final Goggledocs tweetorial from this #EASD2021 takeover!
Over the last few days we have discussed all things cardio-reno-metabolic including SGLT2s, GLP1s, dual agonists, triple agonists….but not mentioned much about type 1 diabetes…
Over the last few days we have discussed all things cardio-reno-metabolic including SGLT2s, GLP1s, dual agonists, triple agonists….but not mentioned much about type 1 diabetes…
So today we are going to end on a cardiometabolic focused look at Type 1 Diabetes with data from #EASD2021 interwoven in... stay tuned!
One of the key sessions and guidance from @EASDnews #EASD2021 was the formalized joint ADA-EASD consesnsus report for management of type 1 diabetes… care.diabetesjournals.org/content/early/…
Patients with T2DM, CVD, conditions of hyperinsulinaemia, have lower: bone remodelling and osteocalcin levels, and increased rates of fragility fractures.
T2DM “hyperinsulinaemia-osteofragilitas” bone phenotype presents with normal to increased BMD mdpi.com/2227-9059/9/9/…
T2DM “hyperinsulinaemia-osteofragilitas” bone phenotype presents with normal to increased BMD mdpi.com/2227-9059/9/9/…
Hyperinsulinaemia and IR positively associate with increased BMD and fragility fractures
Hyperinsulinaemia enforces glucose fuelling, decreasing NAD+-dependent antioxidant activity:
➡️⬆️ ROS & mt fission,
➡️⬇️ OxPhos ATP production capacity, needed for osteoblasto/cytogenesis.
Hyperinsulinaemia enforces glucose fuelling, decreasing NAD+-dependent antioxidant activity:
➡️⬆️ ROS & mt fission,
➡️⬇️ OxPhos ATP production capacity, needed for osteoblasto/cytogenesis.
Osteocytes directly mineralise and resorb bone, & inhibit mineralisation of their lacunocanalicular space via pyrophosphate.
Hyperinsulinaemia decreases vitamin D availability via adipocyte sequestration, reducing dendrite connectivity, and compromising osteocyte viability.
Hyperinsulinaemia decreases vitamin D availability via adipocyte sequestration, reducing dendrite connectivity, and compromising osteocyte viability.
FIGARO -DKD
FIGARO-DKD Finds Finerenone Offers CV Benefits in Mild to Moderate Kidney Disease With T2D; Cuts HF Hospitalization 29% @escardio #ESCCongress @JJheart_doc @AnastasiaSMihai @ESC_Journals @ShelleyZieroth @mmamas1973 @hvanspall @JavedButler1 @DrNasrien @aayshacader
FIGARO-DKD Finds Finerenone Offers CV Benefits in Mild to Moderate Kidney Disease With T2D; Cuts HF Hospitalization 29% @escardio #ESCCongress @JJheart_doc @AnastasiaSMihai @ESC_Journals @ShelleyZieroth @mmamas1973 @hvanspall @JavedButler1 @DrNasrien @aayshacader
A statistically significant 13% lower risk among those treated with finerenone, a benefit that was driven by a reduction in HHF (HR 0.71; 95% CI 0.56-0.90)
@escardio #ESCCongress @ShelleyZieroth @hvanspall @mmamas1973 @AnastasiaSMihai @DrNasrien @lamcardio @JavedButler1
@escardio #ESCCongress @ShelleyZieroth @hvanspall @mmamas1973 @AnastasiaSMihai @DrNasrien @lamcardio @JavedButler1
The combined patient-level analysis of FIGARO-DKD and FIDELITY-DKD included 13,171 patients with #T2DM of whom 40% had preserved kidney function as defined by the eGFR ≥ 60 mL/min/1.73 m2 but elevated UACR
@escardio #ESCCongress @ESC_Journals @lamcardio @FaiezZANNAD
@escardio #ESCCongress @ESC_Journals @lamcardio @FaiezZANNAD
#NFHS5 report released by @MoHFW_INDIA . Here are some snippets
-% women having a mobile phone that they themselves use has increased from 47 to 62 in #Karnataka compared to previous survey.
-Women who are overweight or obese (BMI ≥25) has increased from 23.3 to 30.1
1 of N
-% women having a mobile phone that they themselves use has increased from 47 to 62 in #Karnataka compared to previous survey.
-Women who are overweight or obese (BMI ≥25) has increased from 23.3 to 30.1
1 of N
Ever-married women age 18-49 years who have ever experienced spousal violence has increased from 20.6 to 44.4 %. It either means that reporting has improved or we are becoming more regressing societies. 2 of N
Breastfeeding practices are not improving and have dropped in initiation with one hour of birth. #NFHS5
@srinidhikoya et al reported from @_MAASTHI regarding the determinants and consequences of ineffective breastfeeding practices in India. 3 of N
@srinidhikoya et al reported from @_MAASTHI regarding the determinants and consequences of ineffective breastfeeding practices in India. 3 of N
1/11 WHAT IS THE BEST DIET FOR HUMANS?
A Twitter thread...
I've spent the last 10 years wondering about this. A TED Talk and paper by @segal_eran (refs at end) has completely blown my mind 🤯
He provides some of the answers - but they may not be what you think
Here goes....
A Twitter thread...
I've spent the last 10 years wondering about this. A TED Talk and paper by @segal_eran (refs at end) has completely blown my mind 🤯
He provides some of the answers - but they may not be what you think
Here goes....
2/11 The incidence of diet-related disease has ⬆️⬆️ in last 30 years
In 🇺🇸 70% of population are overweight, diabetic or have NAFLD (fatty liver)
38% are obese 😲
10% have type 2 diabetes 😲
Diet and lifestyle are the major drivers
In 🇺🇸 70% of population are overweight, diabetic or have NAFLD (fatty liver)
38% are obese 😲
10% have type 2 diabetes 😲
Diet and lifestyle are the major drivers
3/11 So why don't we know what is the best diet for humans?
It's because we are asking the wrong question
Much of what constitutes the best diet depends on the individual human every bit as much the food
Nutrition needs to be personally tailored to each individual
It's because we are asking the wrong question
Much of what constitutes the best diet depends on the individual human every bit as much the food
Nutrition needs to be personally tailored to each individual
1/8 In the midst of a pandemic that predominantly affects people with poor metabolic health, why is nobody talking about nutrition?
A Twitter thread..
This is the ELEPHANT IN THE ROOM discussed in the fab @EuropeScientist article by @DrAseemMalhotra 👍
europeanscientist.com/en/article-of-…
A Twitter thread..
This is the ELEPHANT IN THE ROOM discussed in the fab @EuropeScientist article by @DrAseemMalhotra 👍
europeanscientist.com/en/article-of-…
2/8 Evidence (refs at end) tells us some medical conditions are strongly associated with poor outcomes and death ⚠️in #Covid_19 eg:
Hypertension (high BP) 2.5x⬆️
Diabetes 10x⬆️
Overweight/obesity (accounts for 73% of 🇬🇧hospital admissions with #COVID19 )
Heart disease 10x⬆️risk
Hypertension (high BP) 2.5x⬆️
Diabetes 10x⬆️
Overweight/obesity (accounts for 73% of 🇬🇧hospital admissions with #COVID19 )
Heart disease 10x⬆️risk
3/8 What have these conditions got in common?
ANSWER: They're all associated with poor metabolic health
Some people can be TOFI - Thin Outside Fat Inside
It's not just about your weight says @DrAseemMalhotra
"THERE’S NO SUCH THING AS A HEALTHY WEIGHT, ONLY A HEALTHY PERSON"
ANSWER: They're all associated with poor metabolic health
Some people can be TOFI - Thin Outside Fat Inside
It's not just about your weight says @DrAseemMalhotra
"THERE’S NO SUCH THING AS A HEALTHY WEIGHT, ONLY A HEALTHY PERSON"
Insulin is NOT a first choice medicine in type 2 diabetes mellitus (T2DM).
Exceptions:
- Short-term use in #T2DM:
(1) ketosis
(2) sepsis
(3) extremely high blood glucose
- Long-term use in #T2DM:
(4) secondary oral medication failure (also called ß-cell failure)
@sambit_dash
1.
Exceptions:
- Short-term use in #T2DM:
(1) ketosis
(2) sepsis
(3) extremely high blood glucose
- Long-term use in #T2DM:
(4) secondary oral medication failure (also called ß-cell failure)
@sambit_dash
1.
The guideline chart attached above is very clear - lifestyle modifications should be the first choice ± #metformin. Metformin is cheap.
I am least influenced by industry, and use long-term insulin in <5% T2DM, mostly for reason (4), usually after exhausting other options.
2.
I am least influenced by industry, and use long-term insulin in <5% T2DM, mostly for reason (4), usually after exhausting other options.
2.
Those <5% are at a secondary level care hospital, and not at primary care. In primary care, that number will be even lower.
For those who NEED, both biphasic insulin and glargine are available in @pmbjpbppi #JanAushadhi kendras too. Insulin is quite inexpensive there.
3.
For those who NEED, both biphasic insulin and glargine are available in @pmbjpbppi #JanAushadhi kendras too. Insulin is quite inexpensive there.
3.
NEW THREAD on #LCHF-raud & #KetoDiet.
.
The following article I wrote has references to over 1200 studies on nutrition, including Randomized Control Trials. 👉arespectfullife.com/2018/06/25/why…
.
The following article I wrote has references to over 1200 studies on nutrition, including Randomized Control Trials. 👉arespectfullife.com/2018/06/25/why…
5 Reasons I Don't Recommend a Keto Diet by Dr. Michelle McMacken @Veg_MD 👉arespectfullife.com/2018/03/23/5-r…
Gary Taubes, author of several books and articles on low carb high fat #LCHF-raud diet (fad), FINALLY concedes that saturated fats are the enemy in this BMJ article: 👉 bmj.com/content/361/bm…
