May 27, 2017 : Issue #887

• Current Video Interviews: Dr. Scott Isaacs
• Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors (CVD-REAL)
• Reducing Risk of Cardiovascular Events and Death By Lowering A1c
• Elevated Fasting Glucose Associated with Cardiovascular Disease and Death
• Liraglutide and Acute Pancreatitis in Patients With Type 2 Diabetes
• More Complications from Diabetes
• Using The One-Hour Postload Glucose Can Predict Future Diabetes

For those of you who read our Clinical newsletter, the recent Disaster Averted looked at different strengths of insulin and how we have to be aware that if anything can possibly go wrong, it will. We could not have been any more timely with that example as we have just received an advanced copy of the the new ISMP Guidelines for Optimizing Safe Subcutaneous Insulin Use in Adults. If you have patients on insulin, it is worth reading yourself scared.

Dr. Scott Isaacs, MD, FACP, FACE has prepared some short video interviews for quick study, and one of them looks at the difference in treating type one and type two diabetes, and why knowing the different insulins is so important.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Which test do you use to determine if a patient has prediabetes?
1) fasting blood sugar
2) A1c
3) OGTT
4) Random blood sugar

Follow the link to see how you and your colleagues compare!

For years, insulin has been shown to be associated with more medi   cation error-related harm than any other drug. The new ISMP Guidelines for Optimizing Safe Subcutaneous Insulin Use in Adults are designed to help healthcare practitioners prevent errors and improve outcomes for patients with diabetes who use insulin. The guidelines provide recommendations for avoiding errors and at-risk behaviors involving subcutaneous insulin across the entire medication use process, including prescribing, preparation, administration, monitoring, and patient education. The document also addresses evolving practices, devices, and technologies that aim to enhance the safety of insulin use, such as with concentrated insulin and insulin pen devices.

For a copy:  ISMP Guidelines for Optimizing Safe Subcutaneous Insulin Use in Adults  or Visit www.ismp.org/sc?id=2917 or download here.

ISMP Guidelines for Optimizing Safe Subcutaneous Insulin Use in Adults (2017)

A 52-year-old Asian-American man presents for a wellness visit. He has borderline elevated blood pressure (136/84 mm Hg), a BMI of 27 kg/m2, and a family history of diabetes and myocardial infarction. He is a nonsmoker, drinks 1-2 glasses of wine nightly, and jogs 4-5 times/wk for 40 min. Total cholesterol is 173 mg/dL (high-density lipoprotein cholesterol, 40 mg/dL; low-density lipoprotein cholesterol, 112 mg/dL). His 10-y atherosclerotic cardiovascular disease risk is 7.5%, and takes no medications. According to the 2013 American College of Cardiology/American Heart Association cholesterol guidelines, what’s the first step you should take with this patient?

A. Prescribe atorvastatin 20 mg daily
B. Check high-sensitivity C-reactive protein
C. Check carotid intima-media thickness test
D. None of the above

Follow the link to see the right answer!

While there is evidence to support older adults taking statins for secondary prevention of cardiovascular disease — such as to prevent a second heart attack or stroke — there is limited evidence on the risks and benefits of this age group taking the cholesterol-lowering medication to prevent a first cardiovascular event. Now, an analysis of data from a clinical trial that compares it with usual care finds no benefit in use of a statin for primary prevention in older adults with high blood pressure and moderately high cholesterol.

The data was analyzed on a subgroup of older adults who took part in a randomized clinical trial called the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial – Lipid-Lowering Trial (ALLHAT-LLT). The researchers analyzed results on a subgroup of 2,867 participants age 65 and older with high blood pressure and no evidence of plaque buildup in their arteries (a hallmark of atherosclerotic cardiovascular disease) at baseline. The study participants were randomly assigned to receive one of two cholesterol-lowering treatments. Of these, 1,467 were assigned 40 milligrams per day of pravastatin sodium treatment, and the other 1,400 were assigned the usual care from their doctors. The analysis found no significant differences between the two groups in three types of result: deaths due to all causes, deaths to specific causes, and coronary heart disease (CHD) events.  Among participants ages 65 to 74, there were more deaths in the pravastatin group (141) than in the usual care group (130). This was also the case in those age 75 and older (92 and 65 deaths, respectively).– JAMA Intern Med. 2017 May 22. doi: 10.1001/jamainternmed.2017.1442. [Epub ahead of print]

Diabetes in Control speaks with top endocrinologists and other medical professionals to bring you the latest in diabetes news and research. This week, we have a special interview with one of the presenters at the AACE 26th Annual Scientific & Clinical Congress in Austin, Texas, Dr. Scott Isaacs, who shares his knowledge about endocrinology, obesity, and medical weight loss.

Results from the ongoing first large real-world evidence study of its kind published in the American Heart Association.

Study focused on type 2 diabetes patients who initiate metformin.

Study from Women’s Health Initiative sought to determine whether low fasting glucose levels are associated with cardiovascular events and/or mortality.

Study focuses on elevation of amylase and lipase levels as predictors of pancreatitis.

Cognitive decline can accelerate, making patients especially vulnerable to mental impairment and dementia as they age.

12-year community-based cohort study investigated whether 1-h glucose concentration could be better indicator of diagnosis.

Quote of the Week!

“Accept the challenges so that you can feel the exhilaration of victory.”

…George S. Patton

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Steve and Dave
Diabetes In Control
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