November 13, 2015 : Issue #807

• Mortality Among Persons with Type 2 Diabetes
• Burst Exercise in Newly Diagnosed Diabetes Patients Improves Cardiometabolic Status
• Can Human Cells Be Reprogrammed to Act as Pancreatic Beta Cells?
• Dapagliflozin Added to Saxagliptin Plus Metformin in Type 2 Diabetes
• Biomarkers of Major Adverse Outcomes in Diabetes
• Cutting Back on Saturated Fats? The Benefit Depends on the Replacement
• Diabetes Patients with Obesity Should Have Increased Bariatric Surgery Priority
• Abdominal Fat Early in Pregnancy Predicts Gestational Diabetes
• Statins May Decrease Efficacy of the Flu Shot
• Weight and Physical Activity Correlated with Cognition Among Children

Oftentimes we are challenged to start a patient with prediabetes on a diabetes drug. We never are sure if that is the right thing to do. This week, we have the results of a 3-year study using the active ingredient in a popular diabetes drug in patients who have not been diagnosed with diabetes. Scroll down to Fact #1 to see the details.

Sheri Colberg, Ph.D. shares her ideas on taking back control of your exercise time and why it is necessary. She also tosses in some ideas on how one or two changes to your daily regimen can make a huge difference over a year’s time.

dLifeTV.com: Sunday, November 15, 7PM ET

From dLife.com: “A special report on the global pandemic of diabetes; a pharmacist explains how your medicines can interact with your diabetes treatment; and dLife’s doctor on call answers your questions about insulin and weight gain. Plus, Chef Michel Nischan with a crispy veggie taste treat.” 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 treat any patient with prediabetes with any type of oral medication, such as metformin or other drug, along with diet and exercise? Follow the link to respond!

Normally we do not repeat a new product as it progresses through the approval process, but this is a product we want to stay on top of until the FDA gives its approval to put it on a child with type 1 to change their life’ forever. The iLet made breakthroughs that will be life changing. As when they ran a trial with 32 patients, aged 12 to 20 years for 160 days, and they had no problems. The bionic pancreas achieved mean glucose values, that corresponded to an HbA1c of less than 7% in nearly all volunteers, while at the same time reducing hypoglycemia dramatically.  They have designed and tested a system that delivers both insulin and glucagon under the control of autonomously adaptive algorithms. These algorithms require no information about the patient other than body weight to start, and the device can quickly adapt to changing insulin needs. No carbohydrate counting is required. Stay tuned, for updates as they become available. — New England Journal of Medicine, 2014.

It has long been known that regular physical activity is essential for good health. Even well over 2,000 years ago, Hippocrates (460-370 BC) noted, “Eating alone will not keep man well; he must also take exercise. For food and exercise work together to produce health.” Why, then, is it so hard for us to embrace this concept of being active now?

A 47-year old patient returns for a follow-up visit. He currently takes metformin 2000 mg daily, but is not achieving his glycemic target of A1C less than 7%. His current A1C is 8.0%. You would like to add a second medication to his regimen, however he voices concern that he is no longer covered by any health insurance and is worried about how to pay for his medications. Taking his concern into consideration, what drug would you add to metformin? Follow the link to answer!

Patients on liraglutide (Saxenda) had sustained weight loss over three years with diet and exercise, researchers reported. Mean weight loss was 6.1% of body weight with the drug versus 1.9% with placebo for the more than 2,000 patients in an extension of a phase III trial who had either prediabetes and obesity, or were overweight with comorbidities (an estimated treatment difference of 4.3%, 95% CI -4.9 to -3.7; P<0.0001). Half of the patients on liraglutide achieved ≥5% weight loss as opposed to 24% of those on placebo (odds ratio 3.2, 95% CI 2.6-3.9; P<0.0001). A quarter of patients on the drug, versus 9.9% in the placebo group, achieved >10% weight loss (OR 3.1, 95% CI 2.3-4.1; P<0.0001).  Of 2,254 patients, 1,128 completed 160 weeks of the trial (52.6% of those on liraglutide and 45.0% of those on placebo). And the time to onset of type 2 diabetes was 2.7 times longer with liraglutide than with placebo (95% CI 1.9-3.9), while the risk of developing diabetes was lower with liraglutide (1.8% versus 6.2%; P<0.0001). The authors concluded that the drug was “generally well tolerated.” Patients were randomized 2:1 to once daily liraglutide 3.0 mg or to placebo, and all were advised to consume a 500kcal/day deficit diet (i.e., eat 500 kcal less than their estimated daily energy expenditure) and 150 minutes per week of exercise. Le Roux C, et al “Reduction in the risk of developing type 2 diabetes (T2D) with liraglutide 3.0 mg in people with pre-diabetes from the SCALE obesity and pre-diabetes randomized, double-blind, placebo-controlled trial” Obesity Week 2015; T-P-LB-3843.

Risks of death varied depending on age, glycemic control and renal complications.

HbA1c and lipids show improved with high-intensity physical activity.

New technique may lead to novel treatment options for type 1 diabetes patients.

New study suggests triple therapy improves glycemic control.

Study findings suggest that group medical visits can turn the tide for patients with obesity who struggle to lose weight, offering them the chance to focus more intensely on eating habits and weight loss goals in a more supportive setting. There are a number of benefits to holding group medical visits for weight loss, said Ingrid Lobo, MD, an associate professor at the University of Colorado School of Medicine who has led group medical visits for five years in clinical practice. Studies show participants in group visits, which typically enroll up to 15 patients at a time for a predetermined number of sessions, had decreased hospitalizations, emergency room visits and subspecialty referrals, and that improved metabolic outcomes seem to be associated with the group visit curriculum. Visits also result in an overall decreased cost of care and increased provider productivity. Lobo I. Group medical visits for treatment of obesity. Presented at: Obesity Week; Nov. 2-6; Los Angeles.

Recent study suggests that compelling biomarkers may predict major adverse outcomes, including death, in diabetes.

Carbohydrate substitutes do not decrease heart disease risk.

Benefits of surgery result in substantially lower healthcare costs for diabetic patients.

Higher fat in midsection poses increased risk for gestational diabetes later in pregnancy.

The anti-inflammatory effects may interfere with immune responses.

A new study identifies a key pathway used by cancer cells to make the lipids by integrating oncogenic signaling, fuel availability and lipid synthesis to support cell division and rapid tumor growth. The researchers identified a critical molecule in that pathway that, if blocked, might cripple lipid production by cancer cells and slow tumor growth. This approach would be a new strategy for treating a lethal type of brain cancer called glioblastoma multiforme, as well as other malignancies. This discovery also has significant therapeutic implications on other metabolic disorders with deregulated lipid metabolism, such as atherosclerosis, obesity and diabetes. The study discovered that activation of the epidermal growth factor receptor (EGFR), which triggers enhanced uptake of glucose, leads to a chemical change in a molecule called SCAP. This enables SCAP to transport a second molecule called SREBP, and this leads to the activation of genes that regulate the production and uptake of lipids. SREBPs are key proteins for regulating lipid metabolism. Journal Cancer Cell Nov. 9, 2015.

Normal weight, physically active children thought to have higher executive function.

Elevated FFA levels may be earlier marker of diabetes.

Quote of the Week!

“Even if you fall on your face, you’re still moving forward.”

…Victor Kiam

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

Janice Li, LECOM College of Pharmacy
Jaydeep Patel, USF College of Pharmacy
Shawn Vahabzadeh, USF College of Pharmacy
Tyler Fritsch, LECOM College of Pharmacy

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