February 3, 2018 : Issue #923

• Using Computers to Determine Type 2 Treatment
  • Part 4 of our special series, How To Overcome The Complexities of Treatment Decisions For Your Patients with Type 2 Diabetes
• Improving Cardiovascular Outcomes with Better Cholesterol Control
• Gestational Diabetes Mellitus: Revised Diagnostic Criteria Can Help Improve Pregnancy Outcomes
• A New Method To Get Your Patients To Exercise
• Is Weight Loss the Secret Behind Remission of Type 2 Diabetes?
• Are You Getting Enough “SPA” Time?
  • by Featured Writer Sheri R. Colberg
• Ken Fujioka on Weight Loss for Patients with Type 2

This would be a good week to set aside extra time to read the newsletter. There is so much information that I almost thought about splitting it up into 2 weeks but our publisher, Steve Freed, wouldn’t let me.

We begin by finishing up with Part 4 of our special series on using computers to determine the best treatment for each patient. If you have not been following the series then you need to start at Part 1 and catch up. This ties into a commentary from our Publisher, on the prevalence of “Fake News” from “experts” in diabetes.

One person you can always count on to deliver Real News is our fitness guru, Dr. Sheri  Colberg. This week she shares her ideas on spontaneous physical activity and why this can make a difference in diabetes care.

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We can make a difference!

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Dave Joffe

Editor-in-chief

What percentage of time do you recommend a sulfonylurea because that is what the patient can afford? Follow the link to see how you compare to your colleagues.

The insulin content in vials/cartridges should be 95 U/ml upon release. No independent confirmation of insulin concentration is available when purchased in the pharmacy (end of the cold supply chain). They quantitatively measured intact insulin in randomly acquired multidose human insulin vials by standard analytical methods. Eighteen 10 ml vials from Lilly and Novo were randomly acquired. The intact insulin concentration ranged from 13.9 to 94.2 U/ml, mean 40.2 U/ml. No vial met the minimum standard of 95 U/ml. These results imply the cold supply chain impacts insulin concentrations to a larger extent than anticipated. Both Lilly and Novo are investigating and will be reporting the results. J Diabetes Sci Technol. Published online December 21, 2017. Abstract

A new startup will soon be selling smart diabetic socks. Siren Diabetic Socks is said to detect any foot injuries sustained by a person diagnosed with diabetes, informing them of the injury via a smartphone app, text messages, or phone calls. The company claims that its product can detect foot ulcers, which helps people treat quickly and in turn prevents a rise in body temperature. The socks ship in pairs of seven for $179 and the company recommends that replacing the socks once every six months.

Integrated sensors monitor temperature changes between the person’s feet throughout the day. It is recommended they wear the socks daily to get accurate readings. The Siren app will send notifications when there is a possible injury. The Siren Plug sends notifications via a phone call, text, or if the user does not have a smartphone.  More information coming soon.

Ken Fujioka is director of the Nutrition and Metabolic Research Center and the Center for Weight Management in La Jolla California at the Scripps Clinic. His time is divided equally between clinical research and clinical practice. Research includes diets, medications, bariatric surgery, medical devices, web based weight loss programs, and outcomes in obesity treatment.

A 59-year-old patient who was diagnosed with type 2 diabetes five years ago presents to your clinic for an appointment. He has a history of hypertension and dyslipidemia, both currently well-controlled with medication. He has been taking metformin and a DPP-4 inhibitor. He tells you he is concerned about a sore on his foot that is taking a long time to heal. At today’s visit, his office A1C is 8.8%. After discussing his options, you decide to add basal insulin analogue detemir to his regimen. Compared to insulin NPH, what would you expect him to experience while taking detemir?

A. Less weight gain
B. More hypoglycemia
C. More weight gain
D. No weight gain or hypoglycemia difference

Follow the link for the answer.

If you were to do a Google search on the word “Diabetes” you will get 289,000,000 results within less than a second and most of them are FAKE information, not backed by good science. In a recent news flash, I came across this new study: “New Research Finds Drinking 100% Fruit Juice Does Not Affect Blood Sugar Levels. Juice Found to Have No Association with Major Diabetes Risk Factors.”

After years of diabetes education, I was insulted that a study would come up with these results. A glass of freshly squeezed OJ has about 60 grams of carbs for about 8 ounces. That many carbs will raise blood sugars. Don’t need to do a finger stick to figure that out. But, when a consumer reads this information, they most likely will continue to drink their daily fruit juice.

So, when I saw that study, I went to it and found that it was sponsored by the Juice Products Association. This is just one example of FAKE News or information that the Internet can provide.

To view the article and make your decision go to: https://www.newswise.com/articles/view/688051/?sc=sphr&xy=5026263

This is one of the reasons that A1c’s are elevated above normal for most patients with diabetes, as they have too much misinformation, whether it comes from the Internet, or just from family members and friends who want to provide helpful information.

So, what is the answer? The answer is getting your patients educated by a Certified Diabetes Educator or a program developed by a Certified Diabetes Educator.  And even with a program that is designed by a CDE, you have to use a little common sense. In my experience, I have found that CDE’s are not all the same, some believe in low carb diets, some believe in high protein diets, and others. So how do you know what to believe?

Every person is different; there are no two people with diabetes that are exactly the same.  Patients should follow the basic guidelines they are taught and then check their A1c results after 60-90 days. If it is going down from an elevated A1c, then they should stay with the program.  If they see it going up or unchanged, then they should consider making changes to their nutrition and physical activity by talking to their healthcare team.

When they find the right program, it should be explained to the patient that they will need to stay with this program probably for the rest of their lives. And warn your patients to contact you before making any changes on their own.

Steve Freed, R.Ph., Publisher

Part 4: Using Computers to Determine Type 2 Treatment: The first three articles in this series focused on what makes treating type 2 diabetes so difficult: the overwhelming number of medicines and combinations; finding effective treatments that work with our patients’ insurance coverage and household budgets; and incorporating factors beyond glucose control, such as body weight, adherence, and side effects, into our decisions. In this installment, we discuss how those problems can be represented in ways that computers can understand.

Does adding Zetia to a multifaceted drug therapy regimen help improve health outcomes?

A closer look into what’s new according to the WHO shows if more women are at risk for gestational diabetes than thought.

Letting your patients know how long they may survive and how to extend their survival time can get your patients to increase their physical activity or get them to start.

T2D diagnosed within last 6 years may be able to achieve remission if substantial weight loss is achieved.

By Sheri R. Colberg: Exploring the Benefits of Spontaneous Physical Activity

You’ve probably heard about the recent reports revealing just how dangerous it is to be sedentary. Simply sitting for too long at one time is now a recognized health hazard that everyone should be aware of. But if you suffer from diabetes or prediabetes, a sedentary lifestyle is particularly dangerous. Getting regular exercise and movement is one of the most important things you can do to keep your blood glucose under control, maintain a healthy body weight, and reduce your risk of developing complications related to diabetes.

Quote of the Week!

“Education is the most powerful weapon which you can use to change the world.”

…Nelson Mandela

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

Lamija Zimic, Doctor of Pharmacy Candidate 2018, USF College of Pharmacy

Adrianna Jackson, Doctor of Pharmacy Candidate 2018, LECOM College 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