March 20, 2021 : Issue #1116

TOP STORIES — Diabetes News and Research

Metformin: A Potential Anti-Cancer Agent

Diabetes May Lead to an Increased Risk of Sarcopenia

Gut Microbiota Modifications in Patients with Type 2 Diabetes

It is a “no brainer” that when you deliver insulin or sulfonylureas there is an effect on diabetes care and immediate glucose levels. To all of us it seems obvious that any diversion from prescribed timing of these medications makes a difference. While it is easy to think that way when it comes to diabetes, we often don’t care when our patients take medications for such things as hypertension or elevated lipids, as our main concern is adherence.

A few weeks ago an article describing the The Hygia Chronotherapy Trial appeared in the European Heart Journal and shed a lot of light on how the timing of hypertensive medications can be life saving. Check out the overview that our publisher put together in this week’s Did You Know? and then if you are interested, click on the link to read the entire article.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Use of metformin was associated with a 16% reduced risk for overall mortality in patients with type 2 diabetes and pancreatic cancer. 

Patients with T2DM may be at an increased risk of lower muscle performance and strength, putting them at risk for developing sarcopenia. 

Researchers found larger amount of gut microbiota in the digestive system of individuals with type 2 diabetes than in those without the disease. 

Nocturnal blood pressure dips by about 15% compared with daytime values in healthy individuals. Patients who don’t have this blood pressure drop at night, often called non-dippers, are at increased risk for cardiovascular mortality, heart failure, and stroke. This has led many researchers to consider the issue of chronotherapy — the idea that when you take a pill is as important as, or possibly more important than, which medication you take. Most patients take their blood pressure medications in the morning. But blood pressure is supposed to decrease at night, and switching some blood pressure medication to bedtime rather than morning makes sense. In the Hygia Chronotherapy trial, they reported substantial decreases in stroke, MI, and death with nighttime dosing of antihypertensives. However, there were several problems with the study.

First, the magnitude of the benefit was extremely large for a minimal change in blood pressure. Even nighttime blood pressure measurements showed only minor differences between both groups. Meta-regression studies have suggested that even with a 10-point reduction in blood pressure, one should expect around 20% relative risk reduction in cardiovascular disease, stroke, and all-cause mortality. But the Hygia trial suggested that cardiovascular disease was nearly cut in half for a much smaller decrease in BP.

Second, switching blood pressure medication from morning to nighttime administration reduced CVD death and total death, i.e., all-cause mortality. Why the timing of blood pressure medications should affect non-cardiovascular mortality to such a large degree is unclear. Essential questions about medical therapy need to be decided by well-conducted randomized trials.

For now, it’s not clear whether the timing of blood pressure medication affects clinical endpoints to any significant degree. —European Heart Journal

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

Alexis Dunn, PharmD. Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences

Zahra Hashemy, PharmD. Candidate, USF Taneja College of Pharmacy

Shana Indawala, PharmD Candidate, University of South Florida Health, Taneja College of Pharmacy

Shadrielle Robbins, PharmD Candidate, South College School of Pharmacy

Mit Suthar, PharmD. Candidate, LECOM School of Pharmacy 

Your Friends in Diabetes Care
Steve and Dave

Diabetes In Control
www.diabetesincontrol.com