September 10, 2016 : Issue #850

• Early Short-term Intensive Insulin Causes the Remission of Type 2 Diabetes
• Fenofibrate Therapy in Diabetic Retinopathy
• Chronic Kidney Disease and the Incidence of Diabetes
• Once-Monthly Exenatide Shows Promising Results for Adequate Glucose Control
• Metabolic Effects of Metformin in Patients with Acute Renal Failure
• Could Influenza Vaccination Prevent More than Just the Flu?

There have always been conversations amongst medical professionals on the best way to get patients to take the diagnosis of type 2 diabetes seriously. Most of these patients have no symptoms and find out by accident when labs are done or they go to a health fair screening. Because the disease may take years to affect a patient’s perception of their health, they often do not do the things that we recommend and are often hard pressed to even listen to any of our recommendations. A couple of years ago during a treatment roundtable, I first floated the idea of putting newly diagnosed patients on insulin from day one.

My reasoning was based on the idea that you could start them on insulin and then offer to move them to oral medications and stop the insulin if they adjusted things like physical activity and food choices for the better. Also this insulin may result in the “resting” of the pancreas to allow it to recover some increased production at a later date. This concept led to some heated conversation, with other educators and prescribers taking sides.

Most of the naysayers felt that trying to scare people with insulin in order to get them to do the right thing had been tried for years, but others pointed out that there was a difference between threatening and actually using. Over those past 2 years, we have tried the insulin-first option in a few patients and the results have been mixed, and there was never really anything out there that looked at the concept in a controlled setting. This week, our first item looks at studies published in 2 peer-reviewed medical journals that support the “insulin-first concept” for not only improving diabetes care, but also for remission of diabetes in certain patients.

Take a look at this great feature and let me know if you have had similar successes with using insulin upon diagnosis.

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We can make a difference!

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Dave Joffe, Editor-in-chief

If the FDA approved, and if it would cause their diabetes to go into remission for 1 or 2 years — giving them time to use lifestyle changes to delay or prevent having diabetes return – would you recommend to your newly diagnosed patients with type 2 diabetes, a 2- or 3-week treatment with insulin twice a day? Follow the link to share your opinion!

• Novo Nordisk Inc. issues voluntary nationwide recall of six batches of GlucaGen® HypoKit® (glucagon [rDNA origin] for injection) due to detached needles on the syringe in the kit 

  Novo Nordisk Inc. is recalling six batches of the GlucaGen® HypoKit® in the U.S.due to detached needles on the syringe with Sterile Water for Injection (SWFI). GlucaGen® HypoKit® is indicated for the treatment of severe hypoglycemia (low blood sugar) in patients with diabetes who are treated with insulin. A syringe with a detached needle cannot be used as prescribed.For detailed information pertaining to this Recalls, Market Withdrawals and Safety Alerts message, please click here. 

• The U.S. FDA has delivered another twist in the race to win approval for an insulin-GLP-1 agonist combination product. Having handed the lead to Novo Nordisk last month by delaying a decision on Sanofi hopeful, the FDA has now reordered the field once again. The latest action sees the FDA delay its decision on Novo’s IDegLira by three months, resulting in the Danish drugmaker having to wait until December before it learns its fate. By then, the FDA should have made a decision on whether to approve IGlarLixi, the insulin-GLP-1 agonist combination drug Sanofi is developing as a rival to IDegLir.

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin (a hormone made by the pancreas) to absorb the glucose, convert it into energy, and either use it or store it for later use.

Here’s another test of your graph-interpreting skills! Follow the link to see this graph at full size and indicate the parameter that best describes Curve 2.
1. Insulin Secretion
2. Postprandial glucose
3. Fasting glucose
4. Insulin Resistance

The American Heart Association has released new guidance recommending that youths ages 2 to 18 have only 6 teaspoons or 25 grams of added sugars per day. This is equivalent to 100 calories of any sugars used in processing and preparing foods or beverages, added to foods at the table or eaten separately. Additionally, they should drink no more than 8 ounces of sugar-sweetened beverages per week, and the guidelines advise against any added sugar intake for children younger than age 2. The new recommendations, which were published in the AHA journal Circulation, come about three months after the Food and Drug Administration finalized a new rule that forces manufacturers to list a percent daily value for added sugars on product labels, starting in July 2018.

Starting patients diagnosed within the last 7 years on 2-4 weeks of intensive insulin therapy could help keep them off additional medications for at least 48 weeks.

Studies suggest fenofibrate can prevent microvascular changes, decrease need for surgery.

Tighter glucose and blood pressure control found to decrease incidence.

A phase 2 randomized controlled trial demonstrated clinically significant changes in glycemic control.

Metformin use has been associated with significant disturbances in acid-base balance.

Influenza vaccination may reduce cardiac-related hospital admissions and all cause mortality in patients with diabetes.

Quote of the Week!

“In health there is freedom. Health is the first of all liberties.”

…Henri Frederic Amiel

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

Pablo A. Marrero-Núñez, USF College of Pharmacy

Alysa Redlich, University of Rhode Island

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