October 2, 2015 : Issue #801

• Cardiac Abnormalities Associated with Sulfonylureas
• FDA Approves New Long-Acting Insulin: Tresiba and Ryzodeg
• Correlation of Thyroid-Stimulating Hormone levels and Risk of Developing Type 2 Diabetes
• New Combination Potential for Type 2 Diabetics
• The Use of Metformin in Obese Youth Type 1 Diabetics
• High-Protein Diet Can Help Type 2 Diabetes Patients Control Blood Sugar
• Sleep Disturbances Worsen Glucose Metabolism in Older Adults
• Importance of Appropriate Resuspension of NPH Before Subcutaneous Injection
• Napping May Be Linked with Type-2 Diabetes
• Team-Based Physician Strategy May Further Improve Diabetes Care

We’re excited to announce the relaunch of the DiabetesInControl.com website! The new site features the same great content in a fresh design optimized to deliver great user experience. Please note: some of our most popular content, “Tools for Your Practice,” is now subscriber-exclusive to reward our loyal readers. In order to access this content, you will need to register your subscription email address on the new website.  It’s free!

You’ll also want to check out our new contest! We’d like to hear your best suggestions to help prevent insulin errors at home, at pharmacies, and in the hospital. The contestant who submits the winning idea will receive a $100 Amazon gift card! See details below.

One of the best reasons to read Diabetes in Control is to learn how our editorial staff manages to find information about new trends in care and how we are usually on the cutting edge when it comes to changing trends. There is nowhere this is seen in greater extent than with Type one children and adolescents. This week we are sharing information on the use of Metformin in obese type 1 teens, something no professional would have done 10 years ago. Click here to check it out.

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Announcements:

dLifeTV.com: Sunday, October 4, 7PM ET

From dLife.com: “What’s the secret to living a long and active life with diabetes? dLife talks to people who have done it. Plus, a trip to the dentist to find out how oral health impacts diabetes health; learning how to change the behaviors and habits that can derail diabetes management; and down-home cooking in the dLife kitchen.” 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

The #1 app to bring food transparency and effectively access reliable information such as the nutritive value for a variety of foodstuffs. Follow link for more information.

Last Friday, the FDA — after rejecting them once — finally approved Novo’s two new Insulins, Tresiba and Ryzodeg. (See article for details.) Do you feel comfortable in recommending either to your patients? Follow the link to respond.

Tresiba is a long-acting insulin analog indicated to improve glycemic control in adults with type 1 and 2 diabetes. Dosing of Tresiba should be individualized based on the patient’s needs. Tresiba is administered subcutaneously once daily at any time of day.  Ryzodeg 70/30 is a mixture of insulin degludec, a long-acting insulin analog, and insulin aspart, a rapid-acting human insulin analog. It is indicated to improve glycemic control in adults with diabetes. (See full article.)

Diabetes Motion was founded in 2014 by Dr. Sheri Colberg, one of the world’s leading experts on diabetes and exercise, and a member of the Diabetes in Control advisory board. The mission of Diabetes Motion is to provide practical guidance about blood glucose management to anyone who wants to be physically active with diabetes. Whether someone is new to exercise or a sports enthusiast, diabetes can get in the way of being active. This site will guide anyone with diabetes on what to do, how to do it and, most importantly, how to manage diabetes safely and effectively for exercise. This a great program to show your patients how exercise can play a role in controlling their blood glucose and how to do it safely.  Diabetes Motion

How to Prevent Insulin Errors

For the last 25 years, insulin has been the number one drug for errors. Diabetes in Control has been invited to a summit which will bring together about 50-60 practitioners, CDE’s, regulators , Insulin vendors and ASHP, FDA NPSF, patients, and ISMP for the purpose of improving the safety of Insulin administration, patient education, and transition to home.

Because this is so important, we’d like you to send us your suggestions on how we could prevent some of these errors. Your advice can contribute to the new guidelines to prevent insulin errors at home, at pharmacies, and in the hospital, and to enhance the patient’s level of understanding in the management of insulin therapy.

The most helpful entries will be featured on DiabetesInControl.com and the winner will receive a $100 Amazon gift card. Click here to enter! You may submit as many entries as you wish. Deadline to enter is November 1^st.

64-year female presents to your office for her 3-month follow-up. She has previously been diagnosed with mild diastolic heart failure, secondary to hypertension. She currently takes an ace-inhibitor and a diuretic with good control of her heart failure symptoms and hypertension. At her last visit, she had a FPG 118 mg/dl. In a subsequent conversation with her, you discussed how she has developed prediabetes and suggested lifestyle modifications. Since her last visit, she has taken up very gentle walking four times/week and has changed her diet to a more healthful one. Despite these positive changes, this visit’s labs return an A1C 7.8%; her remaining labs are within normal limits. Which one of the following antihyperglycemic medication classes would you choose to initiate treatment?

A. Sulfonylureas
B. Biguanides
C. Insulin
D. Thiazolidinediones
For the complete question and answer, just follow the link!

People who experience psychological distress in childhood, later in life, or consistently over time face elevated risk of diabetes, heart disease or stroke in adulthood. Researchers followed over 6,700 people from age 7 to 42, then checked markers of health at age 45. Risks were highest for those who consistently experienced mental stress, but even those who experienced stress only as adults or only as children faced higher risks. The most striking and perhaps sobering finding in our study is that high levels of childhood distress predicted heightened adult disease risk, even when there was no evidence that these high levels of distress persisted into adulthood.  Sept. 28, 2015, Journal of the American College of Cardiology

Study adds further evidence to the proposed causal relationship between sulfonylureas and adverse cardiovascular events.

FDA approved new long-acting insulin degludec for treatments of diabetes mellitus.

Increasing TSH levels rather than baseline TSH levels may elevate the risk of developing type 2 diabetes.

“Combination of dextromethorphan and sitagliptin showed strongest effect in OGTT”.

Findings suggest that Metformin may help overcome pubertal insulin resistance and aid in better glycemic control.

Fidgeting may mitigate some of the negative effects of prolonged sitting, one study contends. Mortality risks for women who sat for long periods of time, but were moderately or very fidgety were similar to those for women who were more physically active. Researchers conducted a study involving 14,245 British women ages 35 to 69. Each participant answered questions regarding their health behaviors, chronic disease, 24-hour activity, physical activity levels, and fidgeting. As expected, the researchers found that women who did a lot of sitting and were only “slightly” fidgety had a higher risk of premature death than women who were more physically active and didn’t sit as much. However, women who did a lot of sitting, but were either moderately or very fidgety had a risk of early death that was similar to that of more active women. The results support the suggestion that it’s best to avoid sitting still for long periods of time, and even fidgeting may offer enough of a break to make a difference.  American Journal of Preventive Medicine, Sept 23, 2015

A new clinical study suggests that diets high in protein, independent of caloric intake, improve metabolic health.

Sleep disturbances associated with insulin resistance and incidence of type 2 diabetes in older adults.

Lack of resuspension alters PK/PD and result in poor glycemic controls.

Naps of 60 minutes per day or longer were associated with an increased risk of 50% for risk of type 2 diabetes.

Pay changes and team-based care changed diabetes care.

Adults with hypertension who do not have diabetes have a lower risk for developing the disease when taking their blood pressure medication at bedtime compared with adults who take the medication upon awakening, according to recent findings. Researchers also found that adults who took antihypertensive medications at bedtime significantly decreased their ambulatory BP. Ingesting hypertension medications at bedtime, a zero-cost intervention, was found to improve asleep BP control and markedly reduce the risk of diabetes by 57%. Hermida RC, et al. Diabetologia. 2015;doi:10.1007/s00125-015-3749-7.

A follow-up study has looked into long-term DM survival with hyperbaric-oxygen therapy…

Findings suggest further study regarding Increased risk for type 2…

Quote of the Week!

“Courage is what it takes to stand up and speak; courage is also what it takes to sit down and listen.”

…Winston Churchill

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

Ashley Garringer, USF College of Pharmacy
Bic Huynh, LECOM College of Pharmacy
Shawn Vahabzadeh, USF College of Pharmacy
Kristie Huynh, LECOM College of Pharmacy
Jaydeep Patel, USF College of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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