February 1, 2020 : Issue #1027

TOP STORIES — Diabetes News and Research

10 Ways to Get Motivated to Exercise (When You’re Not) 

Adjusting Insulin For Dietary Fat

Intensive Glucose Control and Macrovascular Complications 

This past week, our four interns learned about basal/bolus dosing and the value of an insulin pump and CGM for managing type one diabetes. We went through the standard calculations to figure out carb ratios and correction factors, and they got plenty of experience figuring out doses based on those ratios. We had them adjust for low glucose, high glucose, and they even managed to figure out how to accurately calculate the actual amount of carbs to raise glucose.

Their next project will be to prove they can make this dosing regimen understandable to patients. Although we know these numbers will work on paper, we often find that even our best calculations go awry in real life. One of the reasons is the composition of our meals and how the amount of fat can affect glucose peak. This week our intern, George McConnell from LECOM College of Pharmacy, gives you the results of a study along with recommendations for adjusting dosing for fat content.

*****************************

We can make a difference!

*****************************

Dave Joffe

Editor-in-chief

The FDA has approved a triple-combination tablet (Trijardy XR), comprising empagliflozin (Jardiance), linagliptin (Tradjenta), and extended-release metformin hydrochloride, for the treatment of adults with type 2 diabetes.

By Sheri Colberg, PhD 

Diabetes is a complex metabolic condition, and your blood glucose levels can impact you not only physically but also emotionally and mentally. Often, feeling depressed or anxious about diabetes management can be demotivating for taking better care of yourself. Whether that care involves getting more physically active or making more healthful food choices, getting and staying more motivated can only benefit you and your blood glucose. 

It may be time to start counting fat in addition to carbs to lower A1c effectively. 

Results from a 15-year observational study. 

Researchers randomly assigned 61 participants with type 2 diabetes to one of three weight-loss interventions: Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, or an intensive weight-loss program focused on cutting calories and increasing exercise. Patients were 47 years old on average, living with dangerously elevated blood sugar levels and obesity. The study lasted for five years, and even though this was a small study, the results show a dramatic difference between the three arms of the study.

Any degree of weight loss, even that achieved by non-surgical means (typically about 5% of starting weight as shown in this study), can help control health issues such as diabetes, lipids, and hypertension. After five years, six people who got the Roux-en-Y procedures, or 30%, achieved partial or complete diabetes remission, compared with four people, or 19%, of the participants who had gastric banding, the study found. No one in the diet-and-exercise group achieved remission. Also, 56% of the people who had Roux-en-Y procedures had stopped taking medications to manage diabetes by the end of the study, compared with 45% of the people who had laparoscopic adjustable gastric banding and none of the participants in the lifestyle group. People who had the Roux-en-Y bypass lost an average of 25% of their body weight, compared with about 13% with the lap-band and 5% in the group assigned to intensive lifestyle management.

The conclusion from the study was that people who undergo gastric bypass surgery are more likely to achieve remission of diabetes than those who try to lose weight by dieting and exercising. “The findings add to evidence suggesting that surgical weight loss may be the best approach to achieving diabetes remission,” said Dr. Courcoulas of the University of Pittsburgh Medical Center, the study’s lead author.

https://bit.ly/3ageNjt Journal of Clinical Endocrinology & Metabolism, online January 9, 2020. REUTERS

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

Nadeen Ayad, BCPS, PharmD Candidate, Skaggs School of Pharmacy, University of Colorado

Antonio Bess, Pharm D Candidate, Florida Agricultural & Mechanical University School of Pharmacy

Alessa Grieff, PharmD Candidate, University of South Florida College of Pharmacy

George McConnell, PharmD. Candidate, 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