February 26, 2019 : DCMS #438

TOP STORIES — Diabetes News and Research

• Benefits of Non-Sugar Sweeteners and Health Outcomes: Conflicting
• The Residual Thrombotic Effects of Hypoglycemia in People with Type 2
• How Hypertension Increases Risk for Diabetes and CVD

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Catherine Champagne on Fad Diets, Artificial Sweeteners, and Nutrition

HOMERUN SLIDES — Great Clinical Presentation Highlights

Diabetes Apps Presentation Part 5

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #166: Molecular Genetics of Type 1 Diabetes Part 3

MOST POPULAR ARTICLES OF THE MONTH

#1 Can Green Tea Increase The Risk For Type 2 Diabetes?
#2 CGM Simplicity Can Be Complex Information for Beginners
#3 Why Suggest A Low Carb Diet for Your Patients?

This week we have an interesting post-hoc article on the results of the Da Qing Diabetes study. This retrospective examination looks at how hypertension increases the risk for diabetes and how that in turn increases the risk for cardiovascular disease. There are great details that make this article worth reading, but the long and the short of it points to the need to increase hypertensive control in IGT and diabetes probable patients.

The use of ARB’s as a first line treatment has helped many clinicians get these patients to goal without multiple medications for their hypertension, but in the past 6 months that ability has decreased. Likely one or more of you has had a call from a pharmacist letting you know that valsartan and losartan, the 2 most often prescribed ARB’s, were recalled because of widespread contamination of the active ingredient. It appears there is actually only one supplier for all of these products, and there does not seem to be a solution in sight.

This has caused many prescribers to search for other options. At this time there are a couple of other generic choices, candesartin and olmesartin, and one brand name product, Edarbi (azilsartan).

Based on the Da Qing Diabetes study, you would be wise to move your patients to one of these ARB’s rather than trying a different class.

Dave Joffe

Editor-in-chief

While increased cancer risk was not found, overall study of sweeteners vs sugar remains inconclusive.

Downstream thrombotic and inflammatory effects of increased glucose assessed as potential link to cardiovascular mortality.

New study shows 25% increase in diabetes for each 1-mmol/L increase in 2-hour plasma glucose at baseline.

Catherine M. Champagne, PhD, RDN, LDN, FADA, FAND, FTOS  is a professor at the Pennington Biomedical Research Center at Louisiana State University. Dr. Champagne’s research areas currently concentrate in studies which include dietary counseling and/or dietary intake assessment of subjects. She directs the Nutrient Database activities for the Center. She is also coordinator of the Women’s Nutrition Research Program at Pennington, a research, education, and outreach program specifically targeted to women.

In this week’s Homerun Slides, compelling decision support for the use of diabetes apps.

Other HLA-encoded susceptibility determinants: The DR and DQ genes cannot completely explain the association between T1DM and the HLA gene region. Teasing out the contribution of other HLA loci, however, is complicated by the high level of linkage disequilibrium within the region, combined with the strong effects of DR and DQ. A number of different approaches have been employed to address this issue, including the analysis of case/control data matched for specific DR-DQ combinations, investigation of the transmission to affected and unaffected offspring of heterozygous markers from parents homozygous for DR-DQ alleles, conditional logistic regression and conditional haplotype analysis.

People consistently drinking green tea may not be getting all the benefits as hoped.

Woman, 55 years of age visited with me 3 weeks ago. Her glucose levels were in the 200-250 mg/dL range. She was actually a new patient of ours; her A1C was 9.2%. We recommended a CGM. She purchased one and brought it to the office for me to teach her how to use it. I did so. This patient is well-educated and seemed tech-savvy. When she left the visit, she “seemed” to understand CGM, what it is, what to do, and how to insert the sensor, get readings, interpret readings, etc.

People with diabetes can benefit from a lower portion of carbohydrates in their diet, but this adjustment may lead to other risks.