March 5, 2019 : DCMS #439

DISASTERS AVERTED — Near Miss Case Studies

Consider More Accountability as a Treatment for Some Patients

TOP STORIES — Diabetes News and Research

• Why There Is Low Participation in Diabetes Prevention Programs
• Benefits of Pioglitazone In Patients with Prediabetes Who Had a Stroke
• Advanced Stages of Breast Cancer and Type 2 Diabetes

EXCLUSIVE INTERVIEW — Candid Video Interviews with Top Practitioners

Tim Dunn on Real-World CGM Research

HOMERUN SLIDES — Great Clinical Presentation Highlights

Diabetes Apps Presentation Part 6

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #167: Molecular Genetics of Type 1 Diabetes Part 4

MOST POPULAR ARTICLES OF THE MONTH

#1 Can Green Tea Increase The Risk For Type 2 Diabetes?
#2 Aiming for an Ideal Exercise Blood Glucose
#3 CGM Simplicity Can Be Complex Information for Beginners

Last week, we had some information on the Da Qing Diabetes study, and I mentioned the problem with availability of the most popular ARB’s. Many of you asked for more information and we are completing a special report on what is going on and some possible solutions. Look to our next main newsletter for a complete explanation.

Most of us are on Facebook and certainly have figured out that if you look at a product anywhere on the web, it turns up as an ad on your Facebook page. It seems that somewhere along the way, I looked a some ads for clinical studies in diabetes and I got tagged. Just this morning, four out of the first 10 posts on my page were for diabetes-related studies. They included CGM’s, medications, and therapies for neuropathies.

All this advertising makes you realize how hard it is to get patients to participate in programs even when they are getting paid. This likely explains why Diabetes Prevention Programs have low participation. This week our UC Denver Skaggs School of Pharmacy Candidate Dahlia Elimairi has information on why the NDPP has such low participation, and the reason will likely surprise you.

Dave Joffe

Editor-in-chief

Male, 57 years of age, type 2 diabetes. He started with us 6 months ago. When he started seeing us, he was taking  glipizide 10mg twice a day and metformin 1,000 twice daily for his glucose. His A1C was 7.5%, his BMI was 24. We stopped his glipizide and started him on a SGLT-2 and a weekly GLP-1. He met with the dietitian and made some big dietary changes, at least at the start. He also started wearing a CGM and was in our remote monitoring program. He sent me his CGM readings weekly for 4 months. He was doing so well, we decided he need not send me his weekly numbers but rather we’d review during his visits.

Tim Dunn, Ph.D., is the director of Clinical and Computational Research and an Abbott Volwiler Research Fellow.  He also serves as Chair of the Scientific Research Review Committee for investigator-initiated studies. His major areas of expertise are clinical trial strategy and trial design and real-world data analysis.

In this week’s Homerun Slides, we conclude with a look at the future direction of diabetes apps.

The CTLA4 gene on chromosome 2q33.2 encodes a transmembrane co-receptor expressed on the surface of T cells. This functions as a negative regulator of T-cell activation via interaction with the B7 molecule on antigen-presenting cells (Figure 30.3). The G allele of the +49A/G SNP in exon 1 of CTLA4 has been implicated as a susceptibility marker for T1DM, but was rejected as a causal SNP by a fine-mapping study, which showed that its effect could be explained by more strongly associated variants in a 6.1 kb noncoding region, 3′ of the gene.

Lilly announced that it will sell a version of its popular insulin Humalog at half the price.  The lower-priced version will be called Insulin Lispro—the same molecule as Humalog—and will be available in vial and pen options. The list price of a single vial will be $137.35. The list price of a five-pack of KwikPens will be $265.20.

Only a minority of U.S. adults with prediabetes eligible to participate in a national diabetes prevention program are doing so.

Pioglitazone shown to be effective for secondary prevention in patients who have had a stroke and have prediabetes, according to a post hoc analysis of the IRIS trial.

Women with type 2 diabetes are at increased risk of developing breast cancer.

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

By Sheri R. Colberg, PhD, FACSM

There is no official ideal blood glucose range to start with and maintain during physical activity, but we do know that being too low negatively impacts performance, as does being too high. As for what blood glucose target or range most athletes aim for, it depends on a number of factors, including the type, intensity, and duration of their activity. A consensus statement about exercise and type 1 diabetes published in The Lancet in 2017 suggested that a reasonable target for most people doing aerobic exercise lasting up to an hour is 126 to 180 mg/dL (7.0 to 10.0 mmol/L), only aiming higher for added protection against lows in some situations.

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.