April 9, 2016 : Issue #828

• Severe Hypoglycemia in Type 2 Diabetes Linked to Progression of Coronary Artery Disease
• Battle of the GLP-1 Agonists: Liraglutide vs. Exenatide
• Bromocriptine-QR for Prevention of Cardiovascular Events in Type 2 Diabetes
• How to Find Your Patient’s Diabetes Knowledge
• Type 2 Diabetes Genetic Predispositions
• CGMS Update

From time to time we check out some kind of fitness equipment that might help our patients increase their activity and reduce the risk of diabetes.

For the past couple of months I have been using the Misfit Flash Cyclist edition. As many of you know, I road bike whenever I have a chance, and when I am home I have my high tech Garmin that measures my speed, heart rate and cadence (the RPM’s of pedaling). However, when I am traveling I will often rent a bike and although I can see my speed, I could never see my cadence; and if the terrain was different I would often feel out of sync because I could never gauge my shifting correctly.

I found by clipping the Flash on my bike shoe and starting the app, I could see real time how many RPM’s I was turning, and if I was climbing this information was perfect for knowing when best to shift. Even if you are a casual rider you will find the device worthwhile. Most fitness devices cannot count your steps while on a bike, but the new Flash Cyclist can. This means that those of your patients who try to reach the 10,000 step mark will get credit for each revolution they turn riding their bikes.

Oh, and don’t forget if you think you are as smart as our writers and researchers, then I challenge you to click here and take the A1C Challenge.

Announcements:

Diabetes Summit 2016

DIC Publisher Steve Freed will be attending the GTCbio 2016 Diabetes Summit, to be held April 25-27, 2016 in Boston, MA.  This unique event encompasses the drug discovery and partnering aspects of diabetes in two individual conferences that take place concurrently. Click here for more information.

dLifeTV.com: Sunday, April 10, 7PM ET

From dLife.com: “An Olympic legend shares his troubles with and inspiring triumphs over diabetes. Plus, a low carb Asian appetizer in the dLife kitchen, and a profile of MLB pro pitcher Brandon Morrow.” 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

Would you prefer a single-payer insurance program?

Follow the link to cast your vote!

Mr. Carlson is a 52-year-old Caucasian grocery store manager you saw last week for a new patient visit. His labs from that visit were significant for elevated random plasma glucose 166 mg/dL, A1C 7.4% and elevated lipids (TG=175 mg/dL, LDL 148 mg/dL, HDL 38 mg/dL, total cholesterol 221 mg/dL). He has returned to your clinic for a follow-up appointment. His physical exam is notable for central abdominal obesity (waist circumference 42”), left eyelid xanthelasma, BP 147/91, HR 72, RR 18, BMI 36 kg/m2, but otherwise normal. A repeat A1C test shows A1C 7.6%. Mr. Carlson smokes between 1 and 1.5 packs of cigarettes daily. After discussing the labs and your findings with Mr. Carlson, you begin collaborating on a management plan. You write prescriptions for metformin, a statin and ACE inhibitor. Mr. Carlson doesn’t think “taking medication will be too tough,” but expresses skepticism about your recommendations for a change in his diet, exercise and smoking programs because he has tried them, without success, in the past.

You are concerned about Mr. Carlson’s cigarette use because cigarette smoking has been shown to have multiple physiological impacts on health. Which one of the following statements regarding smoking and type 2 diabetes is true?

A. It equally affects all-cause mortality in individuals with and without diabetes.
B. In individuals with diabetes, it causes more rapid progression to micro- and macroalbuminuria.
C. It has not been linked to worsening glycemic control.
D. The use of bupropion is contraindicated in diabetes.
Follow the link to see the correct answer!

Gilles R. Dagenais, M.D., from the University Laval in Quebec City, and colleagues examined the prevalence of diabetes in 119,666 adults from three high-income (HIC), seven upper-middle-income (UMIC), four low-middle-income (LMIC), and four low-income (LIC) countries. They examined the correlations between diabetes and its risk factors within these country groupings. The researchers found that the poorer countries had the highest age- and sex-adjusted diabetes prevalences, while the wealthiest countries had the lowest prevalences (LIC, 12.3 percent; UMIC, 11.1 percent; LMIC, 8.7 percent; and HIC, 6.6 percent; P for trend < 0.0001). Diabetes risk was significantly higher with a five-year increase in age, male sex, urban residency, low versus high education level, low versus high physical activity, family history of diabetes (FH), higher waist-to-hip ratio, and body mass index (BMI) in the overall population. In higher versus lower income country groups, the correlation between diabetes prevalence and both BMI and FH differed (P for interaction < 0.0001). Diabetes prevalences continued to show a gradient after adjustment for all risk factors and ethnicity (LIC, 14.0 percent; LMIC, 10.1 percent; UMIC, 10.9 percent; and HIC, 5.6 percent). Including the fact that, “conventional risk factors do not fully account for the higher prevalence of diabetes in LIC countries,” the authors write. — Published online before print March 10, 2016, doi: 10.2337/dc15-2338 Diabetes Care March 10, 2016

Patients treated with standard therapy for blood glucose control show link between serious hypoglycemia and CAC progression, increasing risk of heart attack and stroke.

Liraglutide may help type 2 diabetes patients achieve tighter glycemic control with fewer side effects than exenatide.

Bromocriptine-QR may reduce CVD risk in type 2 patients independent of its effect on glycemic control.

Is the Diabetes Knowledge Test 2 (DKT2) a reliable way to show where you need to start in educating your patient for self-care?

Whites and blacks with a genetic predisposition to type 2 diabetes have an increased risk of mortality.

Innovation and improvement in CGMS technology has risen dramatically over the last 2 years, paving the way for the artificial pancreas.

Quote of the Week!

“Man never made any material as resilient as the human spirit.”

…Bernard Williams

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

Devon Brooks, LECOM College of Pharmacy

Sabair Pradhan, USF College of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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Ewing, NJ, 08628
USA
www.diabetesincontrol.com