Purpose of reviewPatients with type 1 diabetes (T1D) are typically viewed as lean individuals. However, recent reports showed that their obesity rate surpassed that of the general population. Patients with T1D who show clinical signs of type 2 diabetes such as obesity and insulin resistance are considered to have “double diabetes.” This review explains the mechanisms of weight gain in patients with T1D and how to manage it.Recent findingsWeight management in T1D can be successfully achieved in real-world clinical practice.SummaryNutrition therapy includes reducing energy intake and providing a structured nutrition plan that is lower in carbohydrates and glycemic index and higher in fiber and lean protein. The exercise plan should include combination stretching as well as aerobic and resistance exercises to maintain muscle mass. Dynamic adjustment of insulin doses is necessary during weight management. Addition of anti-obesity medications may be considered. If medical weight reduction is not achieved, bariatric surgery may also be considered.

The growing burden of diabetes is fueled by obesity-inducing lifestyle behaviors including high-calorie diets and lack of physical activity. Challenges in access to diabetes specialists and educators, low adherence to medications, and inadequate motivational support for proper disease self-management contribute to poor glycemic control in patients with diabetes. Simultaneously, high patient volumes and low reimbursement rates limit physicians' time spent on lifestyle behavior counseling. These barriers to efficient diabetes care lead to high rates of diabetes-related complications, driving healthcare costs up and reducing the quality of patients' lives. Considering recent advancements in healthcare delivery technologies such as smartphone applications, telemedicine, m-health, device connectivity, machine-learning technology, and artificial intelligence, there is significant opportunity to achieve better efficiency in diabetes care and increase patient involvement in diabetes self-management, which ultimately may put an end to soaring diabetesrelated healthcare expenditures. This review explores the patient-driven diabetes care of the future in the technology era.

Purpose of ReviewThe prevalence of combined obesity and diabetes has increased dramatically in the last few decades. Although medical and surgical weight management are variably effective in addressing this epidemic, it is essential to parallel these strategies with a hypocaloric diet comprising the appropriate macronutrient composition to induce weight loss, enhance glycemic control, and improve cardiovascular risk factors. This review reports the current evidence of the role of carbohydrates and fat-based diets for weight management in patients with combined type 2 diabetes (T2D) and obesity.Recent FindingsLow-carbohydrate diets were shown to decrease postprandial glucose levels whereas high-carbohydrate, low-fat diets are considered cardio-protective.SummaryA diet with an optimal macronutrient composition remains uncertain for patients with combined T2D and obesity. Further research is still needed to define the best dietary composition that achieves the maximum benefits on weight management, glycemic control, and cardiovascular risk factors.

In comparison to standard care, patients with T1D and obesity who participated in an IMWM programme achieved significant weight loss and significant reduction in daily insulin dose at 1 year. Weight reduction was associated with improvements in glycaemic control compared to baseline.

Objectives Diabetes-specific nutritional formulas (DSNFs) are frequently used by patients with type 2 diabetes (T2D) as part of nutrition therapy to improve glycemic control and reduce body weight. However, their effects on hunger and satiety hormones when compared to an isocaloric standardized breakfast are not fully understood. This study aims to evaluate the postprandial effects of two DSNFs—Glucerna (GL) and Ultra Glucose Control (UGC)—versus oatmeal on selected satiety and hunger hormones. Method After an overnight fast, 22 patients with T2D (mean age 62.3 ± 6.8 years, A1C 6.8 ± 0.7%, body weight 97.4 ± 21.3 kg, and BMI 33.2 ± 5.9 kg/m²) were given 200 kcal of each meal on three separate days. Blood samples for amylin, cholecystokinin (CCK), ghrelin, glucagon, leptin, and peptide-YY (PYY) were collected at baseline and 30, 60, 90, 120, 180, and 240 min after the start of each meal. Incremental area under the curve (iAUC0-240) for each hormone was calculated. Results iAUC0-240 for glucagon and PYY were significantly higher after GL and UGC than after oatmeal (p < 0.001 for both). No difference was observed between the three meals on postprandial amylin, CCK, ghrelin, and leptin hormones. Conclusions Intake of DSNFs significantly increases secretion of PYY and glucagon, two important satiety hormones. While subjective satiety was not directly evaluated, the increased effect on satiety hormones may partially explain the mechanism of body weight loss associated with DSNF use.

Purpose of ReviewObesity and type 2 diabetes (T2D) are closely linked metabolic diseases. Most individuals with T2D are overweight or obese, which raises their cardiovascular risk. The etiology of both diseases is multifaceted, thus requiring a multidisciplinary approach to control them. This review describes the most effective multidisciplinary approach to weight management in patients with T2D in real-world clinical practice.Recent FindingsWeight management programs in real-world clinical settings lead to long-term weight loss for up to 5 years.SummaryMultidisciplinary approach to manage obesity and T2D through weight reduction is feasible in real-world clinical practice and is recommended as part of the treatment plan for patients with T2D who are overweight or obese. Recent data demonstrates that multidisciplinary approach to weight management in patients with T2D results in long-term weight loss and is associated with improved cardiovascular risk factors.

Vitamin D deficiency/insufficiency is prevalent among pregnant women. Factors causing this epidemic need investigation. Promoting consumption of vitamin D-fortified foods and supplements among pregnant women is suggested.

Background: The Veterans Health Administration (VHA) has an existing teleretinal screening program that uses nonmydriatic fundus photography to screen for diabetic retinopathy in primary care clinics. Concurrently, optical coherence tomography (OCT) has become a routine screening modality in eye clinics for the diagnosis and management of retinal diseases. Introduction: This study aimed to evaluate the first year of a pilot tele-OCT program that used existing resources within the VHA. Without the tele-OCT program, all patients would have been referred to retina clinic for an in-person evaluation. Materials and Methods: This is a retrospective chart review study of patients evaluated by a retina specialist through asynchronous tele-OCT evaluation in 2019. Electronic medical records were used to assess patients' demographic and clinical characteristics, tele-OCT consult results, and patient adherence to tele-OCT follow-up plans. Results: There were 158 tele-OCT consults originating from optometry and nonretinal ophthalmology clinics in 2019. After tele-OCT evaluation, 113 (71.5%) patients were recommended to be monitored in their originating eye clinic, 27 (17.1%) were referred to intravitreal injection clinic, and 12 (7.6%) were referred to retina clinic for in-person evaluation. Patient adherence to tele-OCT follow-up plans was 76.4%. Patients with decreased central vision (p = 0.007) and patients referred to intravitreal injection clinic (p = 0.043) were most adherent to follow-up.Discussion: The tele-OCT program reduced unnecessary inperson clinic visits and enabled more retina clinic availability. Follow-up adherence was greatest among symptomatic patients and those requiring treatment. Conclusions: Tele-OCT can extend tertiary care resources and improve patient care in a large multidisciplinary eye care practice.