September 15, 2015 : DCMS #258

CLINICAL GEMS — The Best from Diabetes Texts
Practical Diabetes Care, 3rd Ed., Excerpt #30: Hypertension Part 5 of 5

DISASTERS AVERTED — Near Miss Case Studies
Play It Safe With at Least TWO Pharmacies

HOMERUN SLIDES — Great Clinical Presentation Highlights
The Present and Future of Insulin Therapy Part 7

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners
George Bakris, MD: SGLT2 Mechanism for BP Reduction Part 6 of 6

TOP SHARED ARTICLES OF THE MONTH
What A Can of Coca-Cola Really Does To Your Body
Skipping Breakfast Can Be Hazardous Especially For Those With DiabetesNext Generation Google Glucose Monitoring Devices in the Making

Editor’s Note – DCMS-258

I was reading this week’s Clinical Gem about the use of diuretics for reducing heart failure and blood pressure values. There was a mention of the differences in responses among certain ethnic groups and the difficulty that we often have with African-American patients. There was a lot of focus on the ALLHAT trial and the results. While doing some research, our current intern from the University of South Florida College of Pharmacy, Jaydeep Patel, found the results of the A-HeFT trial, and how the Nitric Oxide Pathway is very important in the minorities. We have his research for you.

Our Homerun Slides look at the use of GLP-1 analogs instead of insulin and our Disasters Averted looks at why having your patients use a local pharmacy is so important.

In this week’s Exclusive Interview, George Bakris, MD, gives his final advice to doctors about how to treat hypertension and kidney disease.

Your partner in diabetes care,
Dave Joffe
Editor-in-chief

David Levy, MD, FRCP
Diuretics
Thiazide diuretics have been the mainstay of antihypertensive treatment since the first potent thiazide was introduced in 1957, and have often been the agents against which other drug classes have been compared in important clinical trials [18]. They are especially useful in low-renin (salt-sensitive) states, for example older people, and black or obese patients. Resistant hypertension (see below), common in these groups, is frequently due to inadequate diuretic therapy. Despite half a century of use, disagreement continues about their optimum dosing and whether blood pressure lowering effects and cardiovascular benefits are common to all agents in the class. There is continuing controversy about their potential metabolic disadvantages – concern about these, together with their low pharmaceutical profile, prevents their being used in many patients – but there is no evidence that these in any way blunt their cardiovascular benefits, even in people with diabetes (Box 11.7). They are as effective in reducing coronary events as any other class of antihypertensive agents, but in ALLHAT were more effective in reducing heart failure and stroke than lisinopril or amlodipine…

With the prevalence of mail-order pharmacies, I’ve always recommended that my patients use their local pharmacy for at least one prescription. Why? If an emergency arises, and they need a medication or supplies right away, they can get great service locally because they have established a relationship

In this week’s Homerun Slides, incretins, an explanation of the glucose-stimulated secretion of insulin and the effect of exenatide versus glargine insulin on insulin secretion in type 2 diabetes…

This week George Bakris, MD, does some quick math to determine the cost of diabetes as it relates to dialysis and contemplates the future of dialysis equipment. He also shares current dialysis treatment options that may offer some flexibility to patient currently bound to visiting treatment centers….