March 17, 2018 : Issue #929

• How Many Types of Diabetes Are There? Two? Five? Or Eleven?
• Safety and Efficacy of Metformin in Severe CKD
• Study Explores Mechanisms Behind Cardiovascular Benefits of SGLT2 inhibitors
• Incidence of End-Stage Renal Disease in Childhood-Onset Type 1 Diabetes
• Benefits of Obesity Management in Type 2 Diabetes
• Exclusive: Thomas Seck on Empagliflozin Data & Research

As our knowledge of diabetes has grown from just a deficiency of insulin to a disease caused by more than 10 problems, there has always been a problem classifying the different stages, severities and types. This has often led to much confusion and underuse of aggressive treatment algorithms for care. This week, we have a feature from the Lancet that sets up 5 distinct types. But is that number really accurate? After you read item one be sure to follow the link to Dr. Stanley Schwartz’s interview and slides on the New Classification of Diabetes.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Which of the classes of drugs have you seen the best results in lowering A1c for type 2 diabetes? DPP-4, GLP-1, or SGLT-2?

Follow the link to share your response.

The first smart CGMS designed by Medtronic to alert patients with diabetes of potential hypoglycemia or hyperglycemia up to 60 minutes in advance has received FDA approval. The Guardian Connect CGM, indicated for people with diabetes ages 14 to 75 years, features the Sensor 3, also used in Medtronic’s hybrid closed-loop system, and was shown to accurately alert patients of 98.5% of hypoglycemic events. Care partners can use the system to track glucose readings in real time or receive glucose readings via text alerts. The Guardian Connect system could be available between May and July 2018.

What drugs affect glucose levels? Knowing the drugs that can affect blood glucose levels is essential in properly caring for your diabetes patients. Some medicines raise blood sugar in patients while others might lower their levels. However, not all drugs affect patients the same way.

The list includes:

Drugs that may cause hyperglycemia
Drugs that may cause hypoglycemia
Drugs that may cause hyper or hypoglycemia
Drugs that mask hypoglycemia

Thomas Seck is Vice President of US Clinical Development and Medical Affairs Primary Care at Boehringer Ingelheim. Thomas earned his medical degree from the University of Mainz in Germany. He completed his residency and fellowship within the Department of Endocrinology and Metabolism, at the University of Heidelberg, Germany.

Mrs. O’Doole is a 34-year-old of Irish descent. She works as a florist and is married with three children. She arrives at your clinic for her annual wellness exam. Her blood pressure is 130/84 mmHg, pulse 65, BMI 24 kg/m2 and her physical exam is notable for acne and mild hirsutism. Her only current medication is oral birth control pills. She recalls starting OCP 15 years prior, due to irregular menses.
What clinical diagnosis would suggest screening Mrs. Hernandez for type 2 diabetes?

A. Thyroid dysfunction
B. Cushing syndrome
C. Polycystic ovary syndrome
D. Premature ovarian failure

Follow the link for the answer.

In a current study, it was shown that higher waist size and waist-to-hip ratio increases risk for myocardial infarction(MI). The study, published online February 28 in the Journal of the American Heart Association, involved 265,988 female and 213,622 male participants ages 40 to 69 years (mean, 56 years) in the prospective UK Biobank study between 2006 and 2010. Exclusion criteria included a history of cardiovascular disease or BMI less than 15 kg/m2 or greater than 60 kg/m2. Compared with body mass index (BMI), waist-to-hip ratio was an 18% stronger predictor of MI in women and a 6% stronger predictor of MI in men. During a mean follow-up of 7.1 years, there were 5,710 MIs, of which 28% were in women. What was learned was that excess weight matters but that women who have an apple shape might be at even greater risk; awareness is needed not only among women but also among physicians to discuss with their patients. Journal of the American Heart Association. 2018;7:e008507

More specific classifications for the disease could lead to more personalized treatments in the future. Is it time?

Study confirms recent guideline changes on metformin use in moderate-to-severe chronic kidney disease.

Researchers complete examination of class of type 2 medication.

Very low incidence of end stage renal disease (ESRD) was found in patients with childhood-onset diabetes type 1 in Norway.

Management of obesity by dietary, pharmacologic, and surgical intervention can provide very positive results.

Quote of the Week!

“There are two ways of spreading light: to be the candle or the mirror that reflects it.”

…Edith Wharton

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

Vidhi Patel, Pharm. D. Candidate 2018, LECOM 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