April 20, 2019 : Issue #986

TOP STORIES — Diabetes News and Research

Canagliflozin Study Stopped Early Due to Positive Results in Reducing CKD, Death and ESRD
— with exclusive commentary from Dr. George Bakris

New Heart Rate Monitor Detects Hypoglycemia For Type 1 Patients

Diabetes Self-Management Support

I am not sure if you are like me, but often when I get a new medical journal or an online newsletter, I will take a look at the publication’s advisory board. From a personal perspective I like to see if I know any of them, and as a pharmacist I like to see if we are represented on the same advisory board. 

I also look at the articles to see if the advisory board members are just fancy names to lend credibility or if they actually participate in the journal. 

As you can guess we at Diabetes in Control have our own advisory board, and this week one of our most illustrious members, Dr. George Bakris, shares his opinions on the early stoppage of the 4,000 patient CREDENCE trial, and why that early stoppage is such a positive thing. 

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We can make a difference!

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Dave Joffe

Editor-in-chief

New study shows a 30% lower risk of dying from kidney failure or heart disease. See article 1.

Featuring exclusive comments from Dr. George Bakris
Studies are rarely stopped early; when it happens, we should take notice of the results.

Increased heart rate changes are one initial sign for hypoglycemia episode.

How important is support for patients who self-manage their diabetes?

We have known that oral corticosteroids can increase blood glucose and increase the risk for diabetes, but now we know that using topical products that contain corticosteroids can also increase blood glucose.  There is a positive association between use of topical corticosteroids and incident type 2 diabetes, according to a study published online April 1 in Diabetes Care.

Topical corticosteroids (CSs) are commonly used to treat inflammatory skin conditions including eczema and psoriasis. Although topical CS package inserts describe hyperglycemia and glycosuria as adverse drug reactions, it is unclear whether topical CS use in real life is also associated with an increased risk of type 2 diabetes (T2D).

Yuki M.F. Andersen, M.D., from the University of Copenhagen in Hellerup, Denmark, and colleagues assessed whether topical corticosteroid use in real-world settings is associated with an increased risk for T2D.  Two matched case-control studies and one cohort study were conducted using routinely collected health care data from Denmark and the U.K. A total of 115,218 and 54,944 adults were identified as case subjects with new-onset T2D in the Danish and U.K. case-control study, respectively. For the Danish cohort study, 2,689,473 adults were included. The main exposure was topical CSs, and the outcome was incident T2D.

In order to come to the conclusion that topical corticosteroids can increase the risk for diabetes, three studies were conducted, consisting of two matched case-control studies and one cohort study using routinely collected health care data from Denmark and the U.K. A total of 115,218 and 54,944 adults were identified as case subjects with new-onset T2D in the Danish and U.K. case-control study, respectively. For the Danish cohort study, 2,689,473 adults were included. The main exposure was topical CSs, and the outcome was incident T2D.

The results concluded that topical CS was significantly associated with T2D in the Danish case-control studies. Individuals who were exposed to topical CSs had significantly increased risk of incident T2D. They observed significant dose-response relationships between T2D and increasing potency of topical CSs in the two Danish studies. The results were consistent across all sensitivity analyses. They also found  a positive association between topical CS prescribing and incident T2D in Danish and U.K. adult populations. Moreover, a dose-dependent relationship was found between potency of prescribed topical CSs and T2D in the two Danish studies;2 more case subjects of T2D per 1,000 persons per year. Exposure to systemic CS and topical CS exposure represent a similar excess risk of type 2 diabetes, so clinicians should be cognizant of possible diabetogenic effects of potent topical CSs.

Diabetes Care 2019 Mar; dc182158.https://doi.org/10.2337/dc18-2158

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

Dahlia Elimairi, Pharm D student, UC Denver Skaggs School of Pharmacy

Ghazal Blair, Pharm.D. Candidate 2019, LECOM School of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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Ewing, NJ, 08628
USA
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