October 31, 2015 : Issue #805

• To Use or Not to Use SGLT-2 Inhibitors
• Depression Often Untreated in Children with Diabetes
• AstraZeneca’s New Diabetes Drug Gets Delayed
• Blood Type May Predict Diabetes Risk After Gestational Diabetes
• Optimism Can Benefit Heart Disease Patients
• Cardiovascular Mortality Not Associated with Insulin Dosage
• The Influenza Vaccine Antibody Response in T2DM Patients
• Potential Benefit With Sensor-Augmented Insulin Pump Therapy
• Improvements Prompt Rise in Insulin Cost
• Management of Diabetes by Prescribing vs. Non-Prescribing Nurses

There has been a lot of press concerning the use of SGLT-2 Inhibitors and the possibility of DKA. Logically speaking it would seem that anything that lowers glucose would be of benefit in preventing DKA, but for some reason the human body seems to defy logic. With this in mind AACE and ACE put together a group of experts to evaluate all the data and see what really was going on. One of our Doctor of Pharmacy candidates was able to find an early release of what they had to say — click here to read Item # 1.

While we are talking about new medicines and potential problems that pop up you might want to check out Item #12 and find out which drugs had the least adverse effects when added to metformin for patients no longer reaching their target on one medication alone.

Finally, since we are talking about diabetes medicines and possible adverse affects, you may want to check out our latest insulin pocket guide to make sure you are maximizing therapy with the lowest possible risk of hypoglycemia.

Announcements:

LAST CHANCE to Enter to Win a $100 Gift Card!

Submit your best advice on how to prevent insulin errors at home, at pharmacies, and in the hospital. Contest closes at 11:59 PM ET Sunday, November 1st – enter now!.

dLifeTV.com: Sunday, November 1, 7PM ET

From dLife.com: “Find out how testing in pairs can lead to surprising diabetes revelations. Also, “Impossible Berry Pie” in the dLife Kitchen, and a high-flying veteran Marine Corps flier who won’t let diabetes keep him down. Then, Jim Turner talks about the essential diabetes tool everyone should have but few know about – a glucagon kit.” Sundays live online at dLifeTV.com at 7 PM ET, 6 PM CT, and 4 PM PT. Keep up on the latest dLife news at dLifeTV.com.

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We can make a difference!

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Dave Joffe, Editor-in-chief

See item #1

All the info on a pocket guide for all of the insulins, including the newest.  Insulin products available and defined according to derivation, onset, peak, and duration of action.  Insulin Pocket chart 2015 pdf

Getting closer in the quest to create a less-intrusive way to take medicine, Intarcia is looking beneath the surface –  that is, beneath your surface. The company’s ITCA 650 is a matchstick-sized device (at left) implanted under the skin that delivers a continuous dose of the type 2 medication exenatide. But while exenatide is traditionally delivered via twice-a-day or once-weekly injections, the ICTA 650 would need to be implanted only once a year. The device is currently in it’s final Phase 3 trials in humans, to test for any cardiovascular  risks, and the company plans to file for FDA clearance early next year.

Will the current information for SGLT-2 inhibitors prevent you from recommending it for diabetes treatment? Follow the link to take the poll!

One of your patients has referred her 21-year-old stepson for a new patient exam. He has recently arrived home from college for the summer and she is concerned because he always seems to be thirsty. When prompted, she recalls her husband saying his ex-wife struggled with her weight and took “pills for her blood sugar.” Physical examination is notable for mildly elevated BP (137/84) and BMI 26 kg/m2. He denies any cigarette or alcohol use, states his favorite activities revolve around video games, and that he doesn’t really enjoy any physical activities. Labs are notable for random plasma glucose 312 mg/dl, UA positive for glucose. What would your initial drug therapy strategy be? Follow the link to take the quiz!

After researchers gave 64 people with diabetes either 3 cups of chamomile tea or water daily for two months, they found that tea drinkers had lower blood sugar and higher antioxidant levels. The participants had regular blood tests and results published in the journal Nutrition showed that, after just eight weeks, the regular chamomile tea drinkers had lower blood sugar levels and higher antioxidant levels compared with those who drank water. The researchers, from Tabriz University of Medical Sciences in Iran, suggest the antioxidant quercetin has an effect on enzymes that play a role in the development of diabetes. Journal Nutrition Oct 2015 

Diabetes experts conclude diabetes treatment should continue with no changes in current recommendations.

Depressive symptoms are more common than diagnoses and treatment.

The FDA is requiring the drug company to submit more clinical data.

Blood group also possible indicator of development of gestational diabetes itself.

Positive outlook more likely to inspire positive lifestyle modifications.

The U.S. Preventive Services Task Force (USPSTF) is recommending that adults between ages 40 to 70 who are overweight or obese be screened for abnormal blood glucose. The guidelines are considered a way to lower the risk of developing heart diseases and type 2 diabetes.  Having abnormal blood glucose metabolism is a risk factor for heart disease and could progress to diabetes. The Task Force reviewed the available research and found evidence to support screening for abnormal blood glucose before it can progress to diabetes. The Task Force previously did not factor weight into its recommendations and instead recommended screening for type 2 diabetes in asymptomatic adults with high blood pressure in 2008. The U.S. Preventive Services Task Force Guidelines 10-2015

Patient history of CVD, higher A1C factored into risk.

New research shows similar response in seniors with diabetes as those without.

Findings suggest treatment may reduce urine albumin creatinine ratio in T1DM.

Medicaid reimbursement for insulin skyrocketed within the last decade.

A new study involving obese children found impressive results in lowering blood pressure and cholesterol in as little as 10 days. Scientists behind the study said it showed that sugar was “metabolically harmful not because of its calories” but because it is sugar.  The study looked at the effect of restricting sugar on metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke and type 2 diabetes.  A total of 43 children ages nine to 18 took part in the study. All the children had a Latino or African-American background and higher risk for certain conditions associated with metabolic syndrome, such as high blood pressure and high blood glucose levels. The children were all obese and had at least one other chronic disorder, such as high blood pressure.  Over a period of nine days, the children followed a meal plan that included all snacks and drinks, but restricted sugar intake.  The diet overall had the same fat, protein, carbohydrate, and calorie levels as their previous diets at home.  Initial fasting blood levels, blood pressure, and glucose tolerance were assessed before the new meals were eaten. Overall, the total dietary sugar in the meal plan was reduced from 28 percent to 10 percent, and fructose from 12 percent to 4 percent of total calories. Dr Robert Lustig, journal Obesity, 10-2015

Findings show longer relationships and longer consultations between prescribing nurses and diabetic patients.

Study finds NPs provide comparable quality of clinical care as physicians.

Combination does not alter myocardial infarction, hospitalization risks.

Quote of the Week!

“There is nothing either good or bad, but thinking makes it so.”

…William Shakespeare

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

Ashley Garringer, USF College of Pharmacy
Janice Li LECOM College of Pharmacy
Kristie Huynh, LECOM College of Pharmacy
Jaydeep Patel, USF College of Pharmacy
Yasmien  Ibrahim, FAMU College of Pharmacy
Tyler Fritsch, LECOM College of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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