August 11, 2018 : Issue #950

• Less Insulin for T2DM Patients That Add On An SGLT2 Inhibitor
• Late-Onset Diabetes Early Sign of Pancreatic Cancer Within African Americans and Latinos
• Elevated Hemoglobin A1c Associated With Diabetes Within 4 Years
• Neonatal Hypoglycemia Caused by Intense Glucose Management in Pregnancy
• Ambulatory Medication Reconciliation and its Impact on Patients with Diabetes
• Diabetes Linked to Risk for Parkinson’s Disease

This week we have a couple of features that could have been for my wife. The first is a feature that shows the value of e-bikes and fitness, and the second is an item from our PharmD candidate Kennen Munoz Munoz on the addition of an SGLT-2 Inhibitor to insulin dependent type 2 diabetes patients.

Four years ago my wife developed Insulin dependent Type 2 diabetes, and made changes to her food choices and exercise and started on insulin.

After watching me cycle 27,000 miles in the past 6 years and my daughter ride about 14,000 miles in the last 4 years, my wife decided to get a bike and ride. She was riding about 8 or 9 miles 4 days a week which helped control her glucose levels, but would always ride by herself or with a friend. Last March she had knee replacement surgery and was determined to get her riding skills back as soon as possible, as she was afraid her A1c would get out of control. When she was first diagnosed she was using 40-50 units of insulin and her levels were still high. As she changed her food and activity the levels improved; however, when we added an SGLT-2 her glucose levels went lower, and today she only uses about 20 units of insulin daily, and her last A1c was 6.

This June, I convinced her to join a group of 12 of us who were riding 6 days in the hills of Western Virginia. The smartest thing I did was to buy her an electric pedal assist bike. Instead of riding 6-7 miles at 9 MPH she was able to go 25-40 miles a day at about 16 miles per hour and ride with our group. You might have thought the e-bike did all the work, but all you needed to do was watch the power she had to exert and the great glucose levels she was able to maintain.

Now she rides with a group most every day and has an easy way to run to the grocery, or to the gym.

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We can make a difference!

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Dave Joffe

Editor-in-chief***

How comfortable are you with prescribing a SGLT-2 inhibitor? Follow the link to see how you and your colleagues compare.

Bigfoot is working on smart insulin pen caps and a paired app with a lofty goal: “Close the loop” for injection users. The caps will read how much insulin is in both long-acting and mealtime disposable insulin pens, send the data to a smartphone app, and then deliver recommended insulin dose changes based on patterns from a next-gen FreeStyle Libre continuous glucose monitor. The cap will include a screen, with one color cap to be used for long-acting and another for mealtime insulin. Bigfoot’s system will allow users to more easily switch between using pens and using a pump. The current plan is to make the whole insulin automation service available for one prescription and one monthly copay. Bigfoot hopes to launch both of its systems in 2020 with Abbott’s next-gen FreeStyle Libre CGM, an Inject system and its Loop system with a pump (hybrid closed loop).

A 72-year-old patient arrives in your office complaining of shakiness and sweating before he went to bed the previous night. He doesn’t recall checking his blood glucose level at the time, however he felt better after a glass of milk and a few graham crackers. His current medications are metformin, pioglitazone, and glyburide. Which one of the following medications is the most likely cause of his symptoms?

A. Metformin
B. Pioglitazone
C. Glyburide

Follow the link for the answer.

Recently I purchased a new eBike, and most people who I talk to have no idea what an eBike is. This new type of bike is going to be the next biggest craze. Using this eBike allows me to go faster and ride longer. No more worries about going too far and thinking I might not be able to get back home, or coming up to a hill or bridge and feeling I might not be able to make it to the top. At first, I thought, like you may be thinking, that when it comes to riding a bike for exercise, an eBike, which has a battery to help you peddle, is really cheating. But after reading a study published in the Clinical Journal of Sport Medicine, I knew I had to get one. I now can pass up people half my age and it enables me to ride with my kids and friends who are younger. These bikes are of 2 kinds — those that are peddle-assisted, which means you still have to peddle, but it is a lot easier, and those that have an accelerator, which is more like a moped, where you don’t have to peddle.  The study indicated that even though eBikes require less rider effort to travel at a given speed, they’re still a decent source of exercise. Now, a new study suggests that they’re (the pedal-assisted eBike) just as good as regular bikes at improving fitness, at least when it comes to riders with excess weight.

Conducted by scientists at Switzerland’s University of Basel, the study involved 32 test subjects. Twenty-eight of them were men, and all were considered to have excess weight, with a body mass index between 28 and 29. At the outset of the study, each person’s cardiorespiratory fitness was determined via oxygen uptake capacity (VO2) testing, which measures the body’s ability to take in and utilize oxygen. Seventeen of the participants were then supplied with a pedal assisted eBike, with the other 15 receiving a regular, non-electric bike. All of them were instructed to ride a minimum of 6 km (3.7 miles) at least three days per week for a four-week period. Some riders were equipped with GPS devices, and all of them cycled at a speed of their choice. When the four weeks were up, new VO2 tests indicated the fitness levels of both groups had improved significantly, and by similar amounts. Riders in the eBike group, however, maintained a higher average speed, and rode up steeper gradients on a daily basis. This indicates that the e-Bike can increase motivation and help older individuals and those with excess weight to maintain fitness training on a regular basis. Those who use eBikes on a regular basis benefit permanently, not only in terms of their fitness, but also in terms of other factors, such as blood pressure, blood glucose, fat metabolism, and their mental well-being.  Check these bikes out. Go into any bike store and they all offer Free Test Rides, because once you ride one of these eBikes you will want to buy one. Do a Google or Youtube search and check it out. Clinical Journal of Sport Medicine.

— Steve Freed, R.PH., CDE, Publisher www.diabetesincontrol.com

Adding an SGLT2 inhibitor to insulin therapy for patients with type 2 diabetes who’d required large doses of insulin helped them reduce their insulin dose.

New study finds late onset diabetes early sign of pancreatic cancer; African Americans with type 2 diabetes mellitus (T2DM) at a higher risk of developing pancreatic cancer relative to other ethnic groups.

It is time to wake up and smell the coffee (roses) — Study finds; by providing free A1c tests at all check-ups we could find most of those with prediabetes.

Diet control and insulin-treated gestational diabetes lead to neonatal hypoglycemia.

Medication reconciliation reduces emergency room visits in patients with diabetes.

Diabetes linked to risk for Parkinson’s disease: people with type 2 diabetes may have an increased risk of having a diagnosis of Parkinson’s later in life, according to a large study. In addition, the risk may be higher for younger people and those with complications from the disease.

Quote of the Week!

“Be happy for this moment. This moment is your life.”

…Omar Khayyam

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

Amanda Cortes, PharmD Candidate, LECOM School of Pharmacy

Kennen Munoz Munoz, Pharm. D. Candidate 2019, LECOM School of Pharmacy

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