October 22, 2016 : Issue #856

• Making the HbA1c Value More Accurate
• New Technique to Improve HbA1c Accuracy by More Than 50 Percent
• Can Our Economic Insecurity Really Increase Our Risk for Diabetes And Heart Disease?
• Head to Head Study: Insulin vs. GLP-1 Receptor Agonists
• Medical Professionals Not Providing Weight-Loss Education to Low Income Adults

The A1c has become the gold standard in diabetes care evaluation. It is quick, it is easy, and it requires only one stick every 3 months. The only downside is that it is an average, and so many people get a false sense of control because their “average” glucose is good. We all know of the type one patient who will be at 400 mg/dl 2 hours after a meal, but bottoms out at 80 mg/dl at night. The problem is that when you do a traditional A1c, it comes out good. Based on some information from one of our medical researchers, we found that there may be a better way to hone in on why A1c’s often don’t tell the right story. Our Publisher, Steve Freed, looked at the information in Item 1 and knew there had to be more to it.

That is why Steve tracked down John Higgins, MD, Associate Professor, Department of Systems Biology, Harvard Medical School, to learn more about the idea of using a mathematical algorithm to get the real value of an A1c, and how to correctly interpret it.

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We can make a difference!

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Dave Joffe, Editor-in-chief

What do you feel is the primary reason for the high cost of insulin?
1) Greed
2) Research and Development
3) Corporate Salaries
4) Stockholders Needing a Return on Investment
5) Other

Follow the link to share your opinion — and see what others think!

Introducing the new DietSensor app for iOS and Google devices. This App will allow you to scan your food and drinks and get accurate counts to better judge how much insulin to use.

This oral drug class focuses on the incretin system and its use leads to increased postprandial GLP-1 and G1P levels:
1. Bile Acid sequestrants
2. DPP-4 inhibitors
3. Dopamine-2 agonists
4. Alpha-glucosidase inhibitors

Did you get it right? Follow the link to find out!

In adults with type 2 diabetes and known cardiovascular disease, each 1% decrease in HbA1c is associated with a relative risk reduction in microvascular and macrovascular complications, according to results presented at the 52nd European Association for the Study of Diabetes Annual Meeting.  Samiul A. Mostafa, PhD, MBChB, BSc, MRCP, a clinical lecturer and specialist registrar in the diabetes and endocrinology diabetes trials unit at the University of Oxford, wrote, “Running the [United Kingdom Prospective Diabetes Study] Outcomes Model for individual patients could give personalized risk reduction estimates to help inform their diabetes management.” These simulated outcomes provide patients and clinicians with an overview of the potential glucose-lowering benefits that might be obtained when targeting progressively lower HbA1c values. They analyzed data from 5,717 patients with type 2 diabetes and known CVD participating in the TECOS trial (mean age, 66 years; 28% women; 85% white; type 2 diabetes duration, 11 years; 11% current smokers).  Using the UKPDS Outcomes Model, researchers estimated 10-year risks for micro- and macrovascular complications for five different HbA1c measurements, running the model with values held constant at 10%, 9%, 8%, 7% and 6%; all other risk factors were also held constant at their initial values. Cumulative risk estimates were used to calculate RR decrements at progressively lower HbA1c values.  For a patient with an HbA1c of 10%, the 10-year estimated median risk for MI was 22.3%, with the risk progressively lowering at each 1% HbA1c decrement. Cumulative RR reductions for each modeled 1% decrease in HbA1c were 4.6% for an HbA1c of 9%, 9.3% for an HbA1c of 8%, 15.1% for an HbA1c of 7% and 20.2% for an HbA1c of 6%.  The researchers observed similar trends for stroke, single-eye blindness, amputation and all-cause mortality. According to models, reducing HbA1c from 10% to 7% led to a 10-year RR reduction of 19.6% for stroke, 52.3% for amputation, 37.1% for single-eye blindness and 3.9% for all-cause mortality. — Mostafa S, et al. Poster #1137. Presented at: 52nd EASD Annual Meeting; Sept. 12-16, 2016; Munich.

New approach reduces significant errors from about one in three to about one in 10.

Interview with Dr. John Higgins, M.D., and Steve Freed, Publisher of www.diabetesincontrol.com. John Higgins, MD, Associate Professor, Department of Systems Biology, Harvard Medical School, Department of Pathology, Massachusetts General Hospital.

Job insecurity found to prompt 19% increase in diabetes, myocardial infarction or coronary death risk.

Study focuses on differences in clinical outcomes between initiating glucagon-like peptide-1 receptor agonist (GLP-1 RAs) vs. insulin treatment in patients with type 2 treated with oral glucose-lowering medications (OGLM).

Study finds clinicians less likely to counsel less educated, and younger and older patients.

Quote of the Week!

“Nothing makes one feel so strong as a call for help.”

…Pope Paul VI

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