Diabetes In Control. A free weekly diabetes newsletter for Medical Professionals. News and information for Medical Professionals.
Letter from the Editor
Whenever you look at the slide from the international diabetes center that shows the progression to diabetes, there is always an arrow pointing to the decline in insulin production as resistance increases. Supposedly fixing this problem was the target of the first oral diabetes medication, chlorpropamide, which became available in 1958.
Over the years we have seen this class of drugs increase the occurrence of hypoglycemia, quicken pancreatic burnout, and increase the incidence of cardiovascular disease.
This week Taylor-Eugene Simmons, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate, looked at multiple studies pointing to the current thinking that sulfonylureas should go the way of the Clinitest strips and Reflectance monitors and be retired forever.
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We can make a difference!
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Dave Joffe
Editor-in-chief
TOP STORIES -- Diabetes News and Research
After almost 50 years, is the age of sulfonylureas coming to an end?
The results of a recent phase III study may offer children with diabetes a new route for better glycemic control.
The study findings explore the gastric bypass results of different age groups in hopes of learning more about the procedure and the potential risks and benefits that come with it.
Did You Know: How Cannabis Affects Blood Sugars?
After adjusting for sex, age, and HbA1c in 932 type 1 diabetes patients who were cannabis users, researchers looked at the frequency of diabetic ketoacidosis (DKA) compared with nonusers in the T1D Exchange clinic registry (T1DX). The association between cannabis use by total substance score for cannabis (TSC) and DKA in the past 12 months was examined using a logistic regression model adjusted for potential confounders among adults in the T1DX. Of 932 adults with type 1 diabetes, 61 had a TSC >4, which classified them as moderate cannabis users. What they concluded was that those with moderate risk on a cannabis substance use instrument had 2.5 times the odds of hospitalization for diabetic ketoacidosis within the preceding 12 months. Although there may be significant unmeasured confounding, the observation is worthy of attention. Anecdotally, marijuana use may drive overeating and may impair decision-making concerning insulin dosing and diabetes self-management. A suggested biological mechanism, cannabinoid inhibition of gut motility, has been shown in human and animal studies, and the rate of gastric emptying is associated with glycemic excursions. Studies with pharmacologic treatment that delays gastric emptying, such as glucagon-like peptide one analogs, have been shown to improve glycemic control. However, it was hypothesized that unpredictable gastric dysmotility and severity of gastroparesis among cannabis users with cannabis hyperemesis syndrome (CHS) might result in suboptimal glycemic control.
CHS is characterized by cyclic episodes of nausea and vomiting and may result in an increased risk for DKA. CHS has been observed primarily in heavy cannabis users, and this phenotype was not present in the T1DX participants, limiting our ability to assess CHS and DKA. As marijuana becomes legal in more states, clinicians should become aware of the possible risk and continue substance use screening and counseling. Diabetes Care 2019 Oct; dc190365.https://doi.org/10.2337/dc19-0365
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
Adam Chalela B.S., PharmD Candidate, USF College of Pharmacy Class of 2020
Usif Darwish, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences
Taylor-Eugene Simmons, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate
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