November 17, 2018 : Issue #964

• Your Insights Needed for Exclusive Research: Pumps vs. Daily Injections: What’s the Future of Insulin Delivery?
• Ethnicity Plays A Role In Diabetes Drug Selection
• Misdiagnosis of Latent Autoimmune Diabetes in Adults
• Clock Ticking for Food Label Overhaul
• Coffee Consumption and Diabetes: The Final Word?
• Interrupting Sedentary Behavior With Physical Activity Has Benefits
• A Simple Way to Calculate Beta Cell Functional Decline in People with Diabetes

My wife sometimes fills in as a substitute teacher for the public school system, working with grade-school students. We often talk about the behavior of the kids and how she often feels more like a babysitter than a teacher because of behavior of many of the kids in the class.

There seem to be a lot of factors that cause this behavior, including things like early class times, early lunch and a lack of physical activity during the day. Kids will be kids and they need to get a chance to use some of that fidgeting energy during the whole day. She has often told me they need to have some activity breaks during the day to “let off some steam.”

This week, Angela Reyes, our Pharm.D. Candidate from LECOM College of Pharmacy, has a great article on interrupting sedentary behavior in the classroom. It appears that if we gave kids six minutes per hour to move around, not only would we have better behaved students, but we can have a positive effect on insulin sensitivity, obesity, and more. Check out Item #5 and share with all your teacher friends.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Do you provide pharmaceutical treatment for your patients who have prediabetes besides motivating them to change lifestyles? Follow the link to share your experience.

This display of both versions of the USDA food label can be downloaded and shared with your patients and their families. See the article on the modified food label, Clock Ticking for Food Label Overhaul, then download the .pdf that shows differences between the old and new Nutrition Facts labels.

Which of the following is accurate regarding the diagnosis and workup of patients with hypertriglyceridemia?

A. The Endocrine Society recommends using nonfasting triglyceride levels over fasting triglyceride levels for the diagnosis of hypertriglyceridemia.
B. Type IV hyperlipidemia is characterized by abnormal elevations of VLDL, and triglyceride levels are almost always less than 1000 mg/dL; serum cholesterol levels are normal.
C. A standard lipid profile using the Friedewald equation to calculate the LDL cholesterol value is only useful if the triglyceride level is more than 400-500 mg/dL.
D. he Endocrine Society recommends routinely measuring lipoprotein particle heterogeneity in patients with hypertriglyceridemia.

Follow the link for the answer.

When the temperature is frigid, you are more likely to have a heart attack. In a 16-year study, researchers analyzed the weather and heart attack data from 1998 through 2013 for 274,029 patients, half of whom were age 71 or older. Based on more than a decade and a half of medical and weather data, researchers linked an increased incidence of 280,000 heart attacks and 3 million weather data points to lower air temperatures, lower atmospheric pressure, higher wind velocity, and shorter durations of sunshine, according to the report in JAMA Cardiology. What was unique about this study is that all the heart attacks were monitored in one country for 16 years with the weather data for the day the heart attack occurred. While lower air temperature, lower atmospheric air pressure, higher wind velocity, and shorter sunshine duration all were associated with statistically meaningful increased risk of heart attack, the most pronounced effect was from temperature.

The researchers found a higher incidence of heart attack on days when air temperatures were below freezing. The rates of heart attack declined when temperatures rose to more than 3 to 4 degrees Celsius, or 37.4 to 39.2 degrees Fahrenheit. Overall, each temperature increase of 7.4 degrees Celsius (about 13 degrees F) was tied to a 2.8 percent decrease in heart attack risk, the study authors calculated. Colder temperatures increase vasoconstriction in the arteries, which causes them to clamp down. In someone with 70 to 80 percent blocked arteries — which might not be causing any symptoms normally — the arteries can be clamped down enough that the blood supply doesn’t match demand, plus cold can also increase clotting. There are other factors related to winter that can increase the risk of heart attacks, such as shoveling snow, which raises blood pressure to levels that could disturb vulnerable plaques. And caffeine has a similar clamping down effect on arteries, albeit a lot smaller.  So the worst thing you can do is go out in subzero temperatures, shovel snow, and then come in and drink coffee to warm up. The best strategy to minimize the increased risk brought on by cold weather is to dress appropriately. If your patients are at high risk (of a heart attack), researchers said, they may want to avoid going out in really cold, windy weather. Or maybe move to a warmer climate. —  bit.ly/2D2yLkk. JAMA Cardiology, online October 24, 2018.

The best medication therapy for an individual with type 2 diabetes can depend on many factors, including ethnicity and multiple drug options.

Although there are no guidelines for LADA, prescribers should take a closer look at their patients before diagnosing T2D.

The Nutrition Facts label that you may read when buying packaged foods or preparing a meal has undergone a makeover.

Conflicting data exists about the association between coffee consumption and its effects on blood glucose, insulin concentration, and risk of type 2 diabetes.

Small but frequent activity helps improve insulin concentrations and sensitivity in children with excess weight and obesity.

Study looks at using easy-to-measure variables to calculate the decline of a patient’s beta cells and incorporating this into routine tests.

Quote of the Week!

“Efforts and courage are not enough without purpose and direction.”

…John F. Kennedy

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

Angela Reyes, Pharm.D. Candidate, LECOM College of Pharmacy

Arsalan Hashmi, PharmD. Candidate, LECOM College of Pharmacy

Seema Badrbigi, PharmD Candidate

Your Friends in Diabetes Care
Steve, Dave, and Joy
Diabetes In Control
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Ewing, NJ, 08628
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www.diabetesincontrol.com