February 8, 2020 : Issue #1028

TOP STORIES — Diabetes News and Research

MODY Testing in Patients Newly Diagnosed with Type 1 Diabetes 

Low Cognitive Function With Low Glucose

How Ultra-Processed Foods Affect Diabetes 

I was reviewing basal/bolus dosing with our interns and we got on the subject of on-board insulin. One of the problems of not taking this into consideration is the onset of severe hypoglycemia. I explained that many patients walk around with a 500mg/dl blood glucose and don’t feel bad, but give someone a severe case of hypoglycemia and they will never want to go low again.

We know that hypoglycemia can have multiple health problems, one of them being low cognitive function, but now a new study looks at the differences between long term hypoglycemia and recent severe bouts. Since we all have a hand in controlling glucose levels, this would be a great article to read.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Recently there have been reports that N-NItrosodimethylamine (NDMA) was found in the generic drug metformin.  The FDA has been investigating the reports and has posted the laboratory results showing N- Nitrosodimethylamine (NDMA) levels in some metformin products. The results determined that the levels of NDMA in metformin products tested ranged from not detectable to low levels. To date, no sample of metformin that the FDA has tested exceeds the acceptable daily intake for NDMA. FDA has not recommended metformin recalls in the U.S.  FDA will continue to monitor NDMA in metformin, along with other drugs products, and will provide timely updates of new developments, including product recalls. For more information about NDMA, visit FDA’s nitrosamines webpage. 

What if some patients with diabetes didn’t require insulin therapy?   

Is brain health significantly lower in subjects that have been exposed to recent or lifetime severe hypoglycemia? 

The prevalence of Ultra-Processed food in our diets has many consequences; is type 2 diabetes among them?

The rapid insulin-alone artificial pancreas improves glycemia in type 1 diabetes but daytime control remains suboptimal.  A randomized crossover trial was done with 28 adults with type 1 diabetes, comparing a rapid insulin-alone artificial pancreas with rapid insulin-and-pramlintide and with regular insulin-and-pramlintide artificial pancreas systems in adults with type 1 diabetes. 

The results showed that, compared with the rapid insulin-alone artificial pancreas system, the rapid insulin-and-pramlintide system increased the time in range from 74% (SD 18) to 84% (13; P = 0.0014), whereas the regular insulin-and-pramlintide system did not change the time in range (69% [19]; P = 0.22). The increased time in range with the rapid insulin-and-pramlintide system was due to improved daytime control (daytime in range increased from 63% [23] to 78% [16], P = 0.0004). There were 11 (1 per 2.5 days) hypoglycemic events (<3.3 mmol/L with symptoms or <3.0 mmol/L irrespective of symptoms) with the rapid insulin-alone system, compared with 12 (1 per 2.3 days) and 18 (1 per 1.4 days) with the rapid and regular insulin-and-pramlintide systems, respectively. Gastrointestinal symptoms were reported after 0% (0 of 112) of meals with the rapid insulin-alone system, compared with 6% (6 of 108) and 11% (11 of 104) with the rapid and regular insulin-and-pramlintide systems, respectively; none of the symptoms were severe.

Diabetes Care 2020 Jan, 2020   (ClinicalTrials.gov number NCT02814123). 

Diabetes in Control gratefully acknowledges the assistance of the following pharmacy doctoral candidates in the preparation of this week’s newsletters:

George McConnell, PharmD. Candidate, LECOM School of Pharmacy

Alayna Marteal Wyre, Pharm. D. Candidate, South College School of Pharmacy 

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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