April 15, 2017 : Issue #881

• A Major Shift in Diabetes Treatment Targets and Goals
• Treating Diabetic Neuropathy
• Diet and Diabetes Risk
• Global Warming and Diabetes
• SLGT-2 Inhibitors Gaining Traction as a Class in Preventing Cardiovascular Consequences
• Diabetic Ketoacidosis Increases Risk of Acute Renal Failure in Pediatric Patients with Type 1 Diabetes

This week, the AMA, in their journal, advised that they were in discussions to shift their focus from A1c and glucose readings as an indicator of successful diabetes management to a more cardiovascular outcomes and mortality data measurement of success. I am in total agreement that improving these numbers will make a difference, but how do we measure this success? It seems like that information can only be measured if something happens or doesn’t happen, and I can’t see a way to see this information if a patient is deteriorating  while you are waiting for the outcome.

Although it can be said that the same goals on different patients will deliver different results, there is significant data that shows improving glucose or A1c levels have a positive effect on not only cardiovascular outcomes but the other comorbidities that often occur with diabetes.

A better idea may be to meld the two together by using diabetes medications that can improve cardiovascular outcomes while improving glucose levels. Check out Item 1 and Item 5 to see how choosing the right diabetes medications can do just that.

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We can make a difference!

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Dave Joffe

Editor-in-chief

We recently discovered a software issue in the Accu-Chek Connect app versions 2.0.0, 2.0.1, and 2.1.0 that can result in incorrect bolus recommendations. This software bug may result in errors in the active insulin calculation, creating the potential for a false high insulin bolus recommendation. An insulin bolus delivered based on potentially incorrect bolus advice could lead to serious health consequences such as hypoglycemia.  Diabetic Investor 4-12-2017

Would you treat a patient with an A1c of 5.7-5.9%, who has diabetes in their family history and is a few pounds overweight with elevated cholesterol, with metformin along with diet and exercise, or just diet and exercise to get started?

1) Just diet and exercise to start
2) Diet and exercise along with metformin
3) Wait until their A1c is higher
4) Other

Follow the link to share your opinion!

Diamedic © Diabetes Logbook offers a unique solution for the diabetic to easily record every glucose reading, insulin injection, lab result, carb intake, weight, medication and exercise workout. Log sugar levels on the go, then monitor readings with instant graphs to help you maintain tight control.

A 23-year-old athletic, nonobese man presents with a low-density lipoprotein cholesterol (LDL-C) level of 196. He reports that he’s recently been eating more “bar food.” Both his parents have high cholesterol, and his father had a myocardial infarction at age 41 y. His physical exam is notable for bilateral corneal arcus and Achilles tendon xanthomas. What’s the best treatment option?

A. Treat with diet
B. Treat with diet + exercise
C. Treat with diet + exercise + low-intensity statin
D. Treat with diet + exercise + high-intensity statin

Did you get it right? Follow the link to see!

Even when body mass index of greater than 35 kg/m2, healthcare professionals are infrequently prescribing metformin for the treatment of prediabetes.  It was reported in Diabetes Care online in the April 3 issue that metformin is used less than 0.7% of the time, even when the patient is overweight.  Metformin has not been FDA approved for the use in prediabetes, so it is considered an off-label use even though metformin has been shown to:

•        Lower mortality in type 2 patients with comorbidities as chronic kidney disease, congestive heart failure and chronic liver disease
•        reduce cardiovascular risk factors
•        enhance cellular insulin sensitivity
•        inhibit excess intestinal absorption of sugar
•        reduce excess liver production of glucose
•        reduce appetite, wt, and body fat content
•        suppress the growth of some tumors and enhance the activity of anti-cancer drugs
•        have a mild effect on weight loss
•        increase insulin sensitivity
•        reduce or lower the chances of developing atherosclerosis
•        not cause hypoglycemia
•        help decrease FBG 60-70mg/dL
•        increases hypothalamo-pituitary sensitivity, which declines with age
•        reduce cholesterol and triglycerides
•        reduce risk for polycystic ovarian syndrome

The researchers found that 7,652 of 22,174 adults had prediabetes. Among those with prediabetes, the age-adjusted prevalence of metformin use was 0.7 percent. Metformin use correlated with elevated body mass index (BMI) (35.1 versus 29.6 kg/m²) and with higher glucose (fasting glucose, 114 versus 105 mg/dL; two-hour post-stimulated glucose, 155 versus 128 mg/dL; and hemoglobin A1c, 6.0 versus 5.6 percent). Even among those with a BMI ≥35 kg/m², metformin use was low. There was no variation in metformin use by race, poverty-to-income ratio, or education. “Metformin use was <1 percent among U.S. adults with prediabetes and only slightly more common among those with additional risk factors for diabetes,” the authors write.  Further study on how to implement metformin as a preventive intervention for type 2 diabetes is needed to truly does the paper say truly or is this our writer’s opinion. If our writer’s opinion, we should take out the word truly stem the tide of the diabetes epidemic. Remembering that all drugs have side effects also stem the tide of the diabetes epidemic. Remembering that all drugs have side effects also stem the tide of the diabetes epidemic. Remembering that all drugs have side effects also

Metformin Use in Prediabetes Among U.S. Adults, 2005–2012; Eva Tseng, Hsin-Chieh Yeh and Nisa M. Maruthur:  Diabetes Care 2017 Apr; dc161509. https://doi.org/10.2337/dc16-1509

Out with the old, in with the old and new?

What treatments can improve pain and quality of life?

Are beans really the magical fruit?

Incidence of diabetes linked to rising temperatures

Are we experiencing the next “magic bullet” in type 2 diabetes?

Condition often under-recognized, yet preventable and treatable.

Quote of the Week!

“Very often a change of self is needed more than a change of scene.”

…A. C. Benson

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

Mark T. Lawrence, University of Colorado-Denver, School of Pharmacy NTP

Tenzing Dolkar, Lake Erie College of Osteopathic Medicine, School of Pharmacy

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