Diabetes In Control. A free weekly diabetes newsletter for Medical Professionals. News and information for Medical Professionals.
Letter from the Editor
Just a little over 19 years ago, Steve Freed and I sent out our first Diabetes in Control newsletter. We had no journalism experience and we were definitely not webmasters, if the term even existed back then. We did have a great desire to share what we had learned about diabetes, and what was new in diabetes, with our colleagues.
Over those past 19 years we have had a chance to meet some of the greatest minds in diabetes care and research, as well as keep you, our readers, up to date on everything diabetes. One of the greatest pleasures and rewards for me has been to bring young pharmacists into the diabetes arena and give them an opportunity to share their penchant for medicine and research. During that time span we have had over 310 Doctor of Pharmacy interns help us to research and publish the best of the best.
This week we are happy to present you with Issue 1000 of our newsletter, and to kick it off we have an article by our current intern Usif Darwish, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, that looks at selecting medications for our patients that can be kidney protective and lower A1c’s.
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We can make a difference!
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Dave Joffe
Editor-in-chief
Newsflash: New Treatment For Hypoglycemia Approved by FDA
The FDA approved Baqsimi nasal powder, the first glucagon therapy approved for the emergency treatment of severe hypoglycemia that can be administered without an injection. The efficacy and safety of Baqsimi nasal powder glucagon to treat severe hypoglycemia was evaluated in two studies of 83 and 70 adults with diabetes, comparing a single dose of Baqsimi to a single dose of glucagon injection in causing a blood sugar response to insulin-induced hypoglycemia. Baqsimi adequately increased blood sugar levels. In a pediatric study of 48 patients over the age of four with type 1 diabetes, similar results were observed. The FDA granted the approval of Baqsimi to Eli Lilly and Company.
TOP STORIES -- Diabetes News and Research
Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) worldwide.
Higher birth weights are associated with better academic outcomes in children, except when the mother has diabetes during pregnancy.
Both type 1 and type 2 diabetes increase the risk of depression.
Did You Know: Which is More Effective To Intensify Diabetes Therapy, HbA1c or CGM Metrics?
Researchers retrospectively analyzed end-of-study HbA1c levels and >2 weeks of continuous glucose monitoring data collected from 530 adults with type 1 diabetes or insulin-requiring type 2 diabetes during four randomized trials. Each trial lasted ≥24 weeks and provided central laboratory end-of-study HbA1c levels and continuous glucose monitoring data from the preceding 3 months. Participants were assigned to groups based on either HbA1c levels or continuous glucose monitoring-derived glucose values.
Results showed that the HbA1c was strongly correlated with mean glucose value (r=0.80), time spent with glucose values in the 70-180mg/dL.(3.9-10.0 mmol/l) range (time in range; r=-0.75) and percentage of glucose values > 250mg/dL(13.9 mmol/l) (r=0.72), but was weakly correlated with the percentage of glucose values <70mg/dL.(3.9 mmol/l) (r=-0.39) or <54mg/dL.(<3.0 mmol/l) (r=-0.21). The median percentage of glucose values <54mg/dL.(<3.0 mmol/l) was <1.2% (<20 min/day) for all HbA1c -based groups, but the median percentage of values >250mg/dL.(>13.9 mmol/l) varied from 2.5% (0.6 h/day) to 27.8% (6.7 h/day) in the lowest and highest HbA1c groups, respectively. More than 90% of participants with either <2% of glucose values >250mg/dL.(>13.9 mmol/l), mean glucose <141mg/dL.(<7.8 mmol/l), or time in range >80% had HbA1c levels ≤98mg/dL.(≤53 mmol/mol (≤7.0%). For participants with HbA1c ≥8.0% (≥64 mmol/mol), the median time in range was 44%, with 90% of participants having a time in range of <59%.
So, glycemic control can be assessed with HbA1c or with descriptive statistics from continuous glucose monitoring (CGM) data. And, HbA1c is highly correlated with the average CGM‐derived glucose value. It was also found that using HbA1c and CGM data from this clinical trial, HbA1c was found to be highly correlated with the percentage of CGM values indicating hyperglycemia, but poorly correlated with the percentage of CGM values indicating hypoglycemia. Because CGM data revealed hypoglycemia among participants with HbA1cvalues ≥126mg/dl.(69 mmol/mol) (≥8.5%), relaxation of HbA1c goals is not an effective strategy for hypoglycemia prevention. So, when using CGM reports to inform therapy intensification strategies in people with suboptimally controlled diabetes, clinicians may wish to focus on strategies to increase TIR and limit the duration of hyperglycemic excursions.
From the results it was concluded that t continuous glucose monitoring-derived metrics may help guide diabetes therapy intensification efforts in an HbA1c -independent manner.
Diabetic Medicine: A Journal of the British Diabetic Association
Diabetes in Control gratefully acknowledges the assistance of the following pharmacy doctoral candidates in the preparation of this week’s newsletters:
Usif Darwish, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences
Onyi Ibeji, PharmD. Candidate, LECOM School of Pharmacy
Kassey James, Pharm.D. Candidate, LECOM School of Pharmacy
Amber Satz, PharmD Candidate, LECOM School of Pharmacy
Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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