April 17, 2021 : Issue #1124

TOP STORIES — Diabetes News and Research

Targets in Elderly Patients with Type 2 Diabetes

The Effects of Age, Diabetes & High Systolic Blood Pressure

The Effect Of COVID-19 on Children with Type 1 Diabetes

Years ago we were happy with a 7.5 A1c for our patients. Over time we have kept lowering the number to 6.0, but we know that euglycemic patients are usually lower than 5.4, so why stop at 6.0?

Part of the reason is the increased risk of hypoglycemia in patients over 65. This arbitrary age line has caused many practitioners to worry about even getting to 6.0. It is important to evaluate your patient’s overall health before you decide the age to back off of therapy. I have a 79 year old cycling friend with type 2 diabetes, who can average 18-20 mph for a couple of hours and gets in about 5000 miles a year. When his doctor told him that he could let his A1c slip up because of his age, he got a new doctor.

Not all of our senior patients with diabetes are in that good of shape, but even for those who are not, there is no reason to give up on lower targets. We have medications now with low or almost nonexistent risk of hypoglycemia, making the management of lower A1c’s easier. This week in our Laterpay feature, our intern, Laura Martínez López, PharmD. Candidate Lake Erie College of Osteopathic Medicine, College of Pharmacy, has a review of the reasons that intensive control can work on most older patients and why keeping the A1c as low as possible makes 100% sense.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Intensive glucose-lowering techniques can have positive outcomes in patients >65 years.

Researchers found that every ten mmHg increase in systolic blood pressure observed was associated with an increased risk of cardiovascular diseases. 

Study found children with a new diagnosis of type 1 diabetes experienced higher rates of diabetic ketoacidosis in the COVID-19 pandemic.

We have seen multiple studies that show that patients with diabetes are at greater risk for CVD. A study presented in the European Journal of Preventive Cardiology has found the obverse: patients with coronary artery disease have about three times greater odds of having diabetes than the general population. This was an analysis of the CLARITY registry, which included 32,684 patients with chronic coronary syndromes from 45 countries. Patients were enrolled in 2009 and 2010 and followed up for five years.

The results showed that 30% of those patients with coronary artery disease also had diabetes (compared to about 9% diabetes prevalence in the general population). All adverse clinical outcomes measured in the study occurred more frequently among heart patients with diabetes than those without diabetes. When the researchers compared the likelihood of poor results in those with diabetes compared to those without, the analyses were adjusted for multiple factors that could influence the relationship, including age, sex, smoking status, body mass index, blood pressure, medications, etc.

After the adjustments, they found that among patients with stable coronary heart disease, those with diabetes had a 38% higher rate of death during the five-year follow-up. They also had a 28% higher risk of the combined outcome of heart attack, stroke, or death from a cardiovascular cause.

So, what comes first? Diabetes or CVD?

Over time, high blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. The longer you have diabetes, the higher the chances that you will develop heart disease. People with diabetes tend to develop heart disease at a younger age than people without diabetes.

European Journal of Preventive Cardiology, April 6, 2021

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

Destiny Funchess, PharmD Candidate, Tougaloo College, South College School of Pharmacy

Oluwatayo Ishola, PharmD. Candidate, South College, School of Pharmacy

Laura Martínez López, PharmD. Candidate 2021, Lake Erie College of Osteopathic Medicine, College of Pharmacy

A’Kira Shavers, PharmD Candidate, South College School of Pharmacy

Olivia Shenouda, PharmD. Candidate, Florida A&M University School of Pharmacy

Sandra Zaki, PharmD Candidate, Florida A&M University

Your Friends in Diabetes Care
Steve and Dave

Diabetes In Control
www.diabetesincontrol.com