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News and Trends—March 2016

| March 1, 2016

The Endocrine Society Offers Obesity CME at 2016 Annual Meeting April 1–4, 2016, in Boston, Massachusetts
The Endocrine Society’s annual meeting, ENDO 2016, offers current American Board of Obesity Medicine diplomates and doctors interested in certifying as obesity medicine specialists the opportunity to engage and network with peers while earning Continuing Medical Education credits on the topic of obesity.

While the conference takes place April 1-4, 2016, in Boston, Massachusetts, doctors with an interest in obesity medicine can arrive a day early, March 31, to attend the pre-conference workshop, Obesity Management 2016, co-sponsored by The Obesity Society. This workshop focuses on advanced practice challenges and emerging treatment therapies and strategies for preventing, diagnosing, and managing obesity. Speakers include ABOM Diplomates Dr. Caroline Apovian and Dr. Louis J. Aronne. This session is eligible for up to 6.75 AMA PRA Category 1 Credits™ and up to 5.25 ABIM MOC credits. Separate registration is required.

The main conference also offers numerous opportunities to cover topics related to obesity medicine. Below are just a few of the obesity focused sessions taking place at ENDO 2016.
For more information, view the complete scientific program: https://endo.confex.com/endo/2016endo/webprogram/programs.html

•    The Year in Obesity: This one session catches up you on all of the changes to practice in the last year.

•    Bariatric Surgery: Changing Your Jeans: Bariatric surgery is the most effective treatment for weight-loss; however, the operative mechanisms are still unknown. This symposium will discuss adaptive and maladaptive responses to bariatric surgery. (Speaker: ABOM Diplomate Dr. Lee Kaplan)

•    New Aspects of Adipose Regulation: Adipose as an endocrine organ is crucial for energy balance. In this symposium, new data on the mechanisms of adipogenesis, inflammation, and thermogenesis will be addressed.

•    Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline: Learn from the authors of this new guideline about the recommended changes to practice in this case-based session.

•    Meet-the-Professor Sessions, Case-based sessions:
• Bariatric Surgery Nutritional Management
• Diet and Exercise Recommendations: Implementing Effective Behavior Change
• Post-Bariatric Surgery Hypoglycemia
• Exercise Prescriptions for Patients with Type 2 Diabetes
• Obesity Medications (Speaker: ABOM Diplomate Dr. Louis J. Aronne)

For more information about ENDO 2016, visit endo2016.org.

For more information about ABOM eligibility requirements, including details about the CME pathway requirements, visit http://abom.org/eligibility-requirements/

Obesity Medicine Association Releases 2016 Obesity Algorithm
The Obesity Algorithm®, presented by the Obesity Medicine Association (OMA), is a free resource for physicians and health care professionals who treat patients affected by obesity. Providers can reference the algorithm when developing personalized treatment plans for their patients, use it as a training tool for staff members and residents learning about clinical obesity treatment, and review it while studying for the American Board of Obesity Medicine (ABOM) certification exam.

Since its original release in 2013, the algorithm has undergone annual revisions to reflect the changing landscape of the obesity medicine field. The 2016 version includes expanded nutrition and bariatric surgery sections, as well as the most up-to-date information about patient evaluation, motivational interviewing, anti-obesity medications, and much more.
The latest version of the Obesity Algorithm is available for free download at www.ObesityAlgorithm.org. Authors of the algorithm will discuss the updates live in an educational session at Obesity Medicine 2016, OMA’s annual spring conference, taking place in San Francisco on April 6-10. Obesity Medicine 2016 offers comprehensive obesity medicine education for health care professionals, with the Review Course for the ABOM Exam, Practice Management Essentials, Nutrition Course, and Spring Obesity Summit all offered at the conference. Preview the full conference schedule in the preliminary program.

Expert Assembly Spearheaded by American Association of Clinical Endocrinologists/American College of Endocrinology Calls for Expanded Use of Continuous Glucose Monitoring Technology in the Care of People With Diabetes
WASHINGTON, D.C.—A consensus conference convened by the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) February 20, 2016, advocated for expanded use of continuous glucose monitoring (CGM) in the management of diabetes.
The diverse cross-section of diabetes care thought leaders included scientific and medical societies, patient advocacy groups, government, insurance, and pharmaceutical and medical device manufacturers.

The key conclusions concerning CGM use in diabetes include the following:
•    Robust data support benefits in many people with diabetes, particularly those with type 1 diabetes
•    Technological advances have improved reliability and accuracy
•    Use has reduced hypoglycemia while improving control of blood glucose, ensuring patient safety
•    Data suggest benefits in other patient populations, such as patients with type 2 diabetes on intensive insulin therapy
•    Studies are needed to demonstrate the value of CGM technology in other patient populations
•    Access should be expanded to all patient populations with proven benefits

“This conference was a necessary and critical step to help ensure that persons with diabetes who can benefit from CGM technology gain access to the best clinical care possible,” said Dr. Vivian Fonseca, FACE and Chair of the Consensus Conference. “By incorporating the practical knowledge and insights of experts across the diabetes care spectrum, we are in a position to advance this cause considerably.”

Conference participants tackled the full spectrum of CGM-related topics during the Conference. Among the issues rigorously examined:

•    Identification of patient populations who may benefit from personal and/or professional CGM use
•    Standardization of CGM reporting to facilitate consistent interpretation in clinical practice
•    Definition of a protocol for effective analysis of CGM data for clinical utilization
•    Impact of using CGM to reduce healthcare costs associated with diabetes (e.g., severe hypoglycemic events)
•    Strategies to remove barriers for successful use of CGMs by patients and healthcare providers for improved diabetes management
•    Use of CGM in a rapidly evolving healthcare environment
•    Use of CGM in the evolving healthcare environment, (e.g., the Patient-Centered Medical Home model, alternative payment)

A complete summary of the conference conclusions can be found online at https://aace.newshq.businesswire.com/press-kit/2016-continuous-glucose-monitoring-consensus-conference-summary-statement.
“It’s crucial that we embrace the technological advances in diabetes management that enhance our capacity to provide the highest level of care to people with diabetes,” added AACE President Dr. George Grunberger, FACP, FACE. “Our Conference participants’ examination of the clinical and economic issues affecting expanded use of CGM was invaluable.”
A comprehensive white paper describing the necessary steps toward a concerted, collaborative effort necessary to addressing and overcome current barriers to optimal diabetes care will be published in a future issue of Endocrine Practice, AACE’s monthly, peer-reviewed medical journal.

About the American Association of Clinical Endocrinologists (AACE). The American Association of Clinical Endocrinologists (AACE) represents more than 6,500 endocrinologists in the United States and abroad. AACE is the largest association of clinical endocrinologists in the world. The majority of AACE members are certified in endocrinology, diabetes and metabolism and concentrate on the treatment of patients with endocrine and metabolic disorders including diabetes, thyroid disorders, osteoporosis, growth hormone deficiency, cholesterol disorders, hypertension and obesity. Visit our website at www.aace.com.

About the American College of Endocrinology (ACE). The American College of Endocrinology (ACE) is the educational and scientific arm of the American Association of Clinical Endocrinologists (AACE). ACE is the leader in advancing the care and prevention of endocrine and metabolic disorders by providing professional education and reliable public health information; recognizing excellence in education, research and service; promoting clinical research and defining the future of clinical endocrinology. For more information, please visit www.aace.com/college.

Ketoacidosis Is Bariatric Surgery Risk in Type 1 Diabetes
From Ketoacidosis Is Bariatric Surgery Risk in Type 1 Diabetes. Medscape. Feb 08, 2016.

Diabetic ketoacidosis (DKA) appears to be a fairly common adverse event following bariatric surgery in patients with type 1 diabetes and may also occur rarely in insulin-deficient patients with type 2 diabetes, according to new findings from a single bariatric surgery center.

Data from 10 years of experience at the Cleveland Clinic — the largest case series of its kind to date — were published online January 28 in Diabetes Care by Ali Aminian, MD, staff surgeon at the clinic’s Bariatric and Metabolic Institute, and colleagues.

Precipitating Factors: Inadequate Insulin, Noncompliance, or Infection
From 2005 through 2015, the researchers identified a total of 12 patients who developed DKA within 90 days following bariatric surgery, at a median of 12 days. Eight of the patients had type 1 diabetes and four had type 2 diabetes.

Those numbers corresponded to incidences of 25% of the 32 total type 1 patients who underwent bariatric surgery during the study period and 0.2% of the approximately 3000 total type 2 patients.

Most of the DKA in the type 1 patients was moderate to severe, while in the type 2 patients it was milder, Dr Aminian noted.

All but one of the patients were taking insulin prior to surgery, and all had poor glycemic control, with a median HbA1c of 9.3%. Three patients had a past history of DKA, and one developed DKA twice postsurgery. Nausea, vomiting, and abdominal pain were the most common presenting symptoms.

Inadequate insulin therapy or noncompliance was the precipitating factor in eight of the 12 cases. In three of these, DKA developed in the immediate postoperative period in the hospital, possibly due to a combination of insulin undertreatment and surgical stress.

In some of these cases, patients had been inappropriately instructed by a member of the surgical team to withhold basal insulin the morning of surgery, Dr Aminian noted, adding that all team members have since been educated about the need for insulin optimization prior to surgery.

Infection was a precipitating factor for DKA in four (33%) of the patients, and poor oral intake could have been a contributing factor in three (25%) patients.

All patients were medically managed with insulin infusion. Two required intubation and mechanical ventilation, two experienced acute kidney injury, and one each had deep vein thrombosis, aspiration pneumonia, and iatrogenic pneumothorax. None died.

Six Key Points to Reduce Risk of DKA in Bariatric Surgery.
Based on this experience, Dr Amanian and colleagues have devised six key points applying to all insulin-treated patients undergoing bariatric surgery:
•    High risk patients — particularly poorly controlled patients with type 1 diabetes — should be informed about warning symptoms, signs, and predisposing factors of postoperative DKA.
•    These predisposing factors include anesthesia and surgical stress, abrupt discontinuation of insulin or inadequate treatment in the perioperative period, postoperative infection, prolonged poor oral intake, and severe dehydration.
•    Preventive measures include optimizing glycemic control before surgery, not withholding basal insulin on the morning of surgery, and keeping the patients on insulin intravenous infusion protocols in the perioperative period.
•    Endocrinologists and diabetes nurse practitioners should be involved in the adjustment of basal insulin dosage before surgery when the patient is on a low-calorie diet (usually beginning 2 weeks prior) and also in the immediate postoperative period and after hospital discharge. Insulin dose adjustment may also be necessary if infection develops postsurgery.
•    Recognition that postbariatric surgery DKA can cause abdominal pain, nausea, and vomiting should prevent unnecessary imaging studies to rule out intra-abdominal surgical complications such as leaks or abscess.
•    Early detection and aggressive diabetes care are needed to treat this serious adverse event.

To read the full article from medscape, visit http://www.medscape.com/viewarticle/858538.

To download the article published in Diabetes Care, visit http://care.diabetesjournals.org/content/early/2016/01/26/dc15-2647.full.pdf+html

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