March 12, 2016 : Issue #824

• Extreme Exercise
• Clinical Opportunities for Biosimilar Insulins
• Get Off the Diabetes Couch
• Empagliflozin: Potential New Approach to Treating T2DM
• The New Biology of Diabetes
• Reprogramming Human Skin Cells to Produce Insulin

Letter from the Editor
March 12, 2016

You may have seen a recent study that has brought into question the safety of SPLENDA®, leading to the downgraded safety rating of sucralose by the Center for Science in the Public Interest (CSPI). As we have seen before, these studies seem to find their way in to the press regardless of the credibility associated with them. This time it is a study only done on mice and published in the International Journal of Occupational and Environmental Health. This is a small journal and features studies completed by the Ramazzini Institute in Italy. In past years safety officials have not given much credit to their studies, and it is almost impossible to find any of their studies in larger, more widely accepted medical journals.

This  study will get publicity regardless of what the U.S. Food and Drug Administration, the European Food Safety Authority, Health Canada and the World Health Organization have to say.  There will be a bunch of natural sugar zealots who will cause many of our patients to stay away from sucralose-containing products.

It is too bad that good news doesn’t garner ad revenues like bad news does, even if the bad is seemingly not true.

While we are talking about untrue facts, you may want to look at our featured article, which weighs in on the idea of extreme exercise in diabetes patients. To help you sort out the facts, you may read commentary by our own Sheri Colberg to learn the real story.

Announcements:

Diabetes Summit 2016

DIC Publisher Steve Freed will be attending the GTCbio 2016 Diabetes Summit, to be held April 25-27, 2016 in Boston, MA.  This unique event encompasses the drug discovery and partnering aspects of diabetes in two individual conferences that take place concurrently. Click here for more information.

Free CME Courses
Our web site CME resource is back online! Be sure to check out the new CME courses posted there. Courses are currently available on topics including: Advances in the Medical & Surgical Management of Obesity; Diabetic Retinopathy; Strategies to Improve Prevention and Treatment of Diabetes; and more!

dLifeTV.com: Sunday, March 13, 7PM ET

From dLife.com: “A visit with Insulindependence, a group that encourages teens and young adults with type 1 to reach new heights. Also, a savory soup from the dLife kitchen, and another extreme diabetes makeover.” Sundays live online at dLifeTV.com at 7 PM ET, 6 PM CT, and 4 PM PT. Keep up on the latest dLife news at dLifeTV.com.

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We can make a difference!

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Dave Joffe, Editor-in-chief

Do you talk with patients about prescription drug costs? Follow the link to respond.

The American Diabetes Association has developed a free resource for accessing their print-on-demand patient materials. The new Patient Education Library has a variety of patient materials that can be saved and printed as needed. Topics include diabetes, prediabetes, complications, nutrition and prevention. You can individualize the information for your patients and have it available prior to their appointment.  New pieces are added as they become available, so check back regularly for new content. Search the materials.

Test Your Knowledge

Question #824

Mrs. Hunter is a 36-year-old African-American who comes to your office for her annual wellness exam. She is overweight (BMI 27 kg/m2), but is otherwise healthy. She jokes that she “just can’t seem to lose that extra baby weight” after giving birth 3 years ago. However, her daughter recently started preschool, so she has been able to go to her new gym several times per week. In fact, one of the added bonuses of her membership is the free, weekly nutrition and exercise support groups. In addition to her routine labs, you order an A1C, which comes back elevated at 7.1%. This measurement is confirmed several days later. Based on Mrs. Hunter’s profile, you encourage lifestyle modifications and start metformin with an A1c target of less than 7%.

You and Mrs. Hunter set a goal for A1C less than 6.5%. She returns 3 months later for a follow-up visit and her office labs show an A1C 6.8%. You congratulate her on her progress and ask her to return in another 3- 4 months. When she does, she is above her goal with an A1C 8.1%. She explains that she has gone back to full-time work and just doesn’t have the time to get to the gym anymore. At this time, what would your next step be and what would her individualized glycemic targets be?

Select one answer:
A. Encourage lifestyle modifications and start metformin with a target A1C less than 6.5%
B. Encourage lifestyle modifications and start metformin with a target A1C less than 7.5%
C. Encourage lifestyle modifications and start a 2-drug combination target A1C target less than 7%
D. Encourage lifestyle modifications and and continue with metformin

Follow the link to see the correct answer.

In a randomized controlled trial, researchers found that the threat of losing money was more effective in getting overweight and obese adult employees to exercise than was promising extra pay. Researchers took 281 adult employees and randomized them to one of three groups: a gain incentive with promise of $1.40 given each day the goal of 7,000 steps per day was achieved; a lottery incentive; or a loss incentive of $1.40 per day after being given a lump sum upfront. Over the 13 weeks of the intervention, the mean proportion of participant-days hitting the goal was 0.30 (95% CI 0.22-0.37) in the control group; 0.35 (95% CI 0.28-0.42) in the gain-incentive group; 0.36 (95% CI 0.29-0.43) in the lottery-incentive group; and 0.45 (95% CI 0.38-0.52) in the loss-incentive group. This study was the first to test the loss aversion principle in a prospective study of employees with physical activity as an outcome. About 80% of large employers in the U.S. promote financial incentives for healthy behavior, but the optimal design to make these programs successful is still unknown. Published online Feb.16, 2016 in the Annals of Internal Medicine.

Extreme Exercise

A professional society looks into how much physical activity is good for a healthy lifestyle.

What will be the impact of the new biosimilar insulins now in development?

A sedentary lifestyle may lead to type 2 diabetes and metabolic syndrome.

Empagliflozin is proving to be a strong proponent for monotherapy in patients with T2DM.

Could study of FOXO transcription factors one day lead to new therapies?

Conversion to pancreatic cells may lead to new cell replacement therapies.

Quote of the Week!

“Reach for the stars.”

…Christa McAuliffe

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

Javeria Fayyaz,  LECOM College of Pharmacy

Devon Brooks,  LECOM College of Pharmacy

Jennifer Zahn,  USF College of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
810 Bear Tavern Road Suite 102
Ewing, NJ, 08628
USA
www.diabetesincontrol.com