Diabetes In Control. A free weekly diabetes newsletter for Medical Professionals. News and information for Medical Professionals.
Letter from the Editor
Announcements:
dLifeTV.com: Sunday, May 8, 7PM ET
From dLife.com:”Joy Pape RN, CDE answers your diabetes questions from the dLife mail; Michel Nischan prepares a delicious zucchini pancake; dLife revisits Pastor and CDE Jeannette Jordan; and travel tips to get you better prepared for traveling with diabetes.” 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
This Week's Poll
How often do you recommend an A1c test for your type 1 patients?
1) Every month
2) Every 3 months
3) Every 6 months
4) Yearly
Follow the link to see how your answer compares!
Clinician App
Vigilant is a companion to diabetes monitoring that uses advanced pattern recognition technology to notify you of upcoming periods of risk. Seeing patient patterns and risk of diabetes complications in just a few seconds, this software can alert you to risk of severe lows in the next 24 hours.
Test Your Knowledge
Mrs. Wilson is an overweight 71-year-old African-American patient who has come to your clinic today for a new patient visit. She recently moved to the area to live with her daughter and is concerned about her diabetes care plan. She was diagnosed with type 2 diabetes 12 years ago at a wellness check through routine screening. In hindsight, she wonders if maybe she “went undiagnosed for a while” because she “didn’t get to the clinic very often and was having some problems with frequent urination at night” before she was screened. She currently takes metformin, glyburide, captopril, pravastatin, aspirin and has recently titrated to .6 U/kg/day insulin NPH as a nightly basal dose. Her current A1C goal is below 7.5% and she has been working hard to get to that level. However, for the first time in her life, she is finding herself to be nauseated and irritable in the morning, but always feels better after a little breakfast. She states she feels “pretty good for her age” although she occasionally has “a little chest tightness when walking more than 4 or 5 blocks.” Last time she remembered to check it a few days ago, her postprandial glucose was a little high at 214 mg/dL. Her office A1C is 8.6%.
Based on her history, what would be an acceptable individualized A1C goal for this patient?
A. A1C less than 6.5%
B. A1C less than 7.0%
C. A1C less than 8.0%
D. A1C greater than 8.0%
Are you right? Follow the link to find out!
Fact: Metformin Safe for Some Diabetes Patients with Renal Problems, says FDA
The US Food and Drug Administration (FDA) announced that the diabetes drug metformin can be used safely in patients with mild and, in some cases, moderate kidney impairment after decades of warning against it. Metformin previously had been contraindicated for patients with renal disease or dysfunction, as suggested by serum creatinine levels at or above 1.5 mg/dL for men and 1.4 mg/dL for women, or abnormal creatinine clearance.
The FDA now says that after reviewing a number of studies, it has concluded that this contraindication is no longer necessary for certain patients with reduced kidney function.
The FDA is advising metformin manufacturers to revise their label information to incorporate both the new guidance and a new measure of kidney function to determine whether a patient should receive the drug. The new labels will recommend switching from serum creatinine concentration, a single laboratory parameter, to the glomerular filtration rate estimating equation (eGFR). The agency deems the latter superior because in addition to blood creatinine concentration, it factors in a patient’s age, sex, race, and other parameters. Under the FDA’s latest recommendations, clinicians should obtain a patient’s eGFR before starting metformin. If the eGFR is below 30 mL/minute per 1.73 m2, the drug is contraindicated. The FDA also does not recommend that clinicians start metformin therapy in patients with an eGFR between 30 and 45 mL/minute per 1.73 m2. All patients taking metformin should have their eGFR checked at least annually. The elderly and others at increased risk for renal impairment should be tested more frequently, according to the FDA.–More information on today’s announcement is available on the agency’s website.
A year after the FDA warning, a strong response to the question: are SGLT-2 inhibitors safe?
This is the fourth drug to treat diabetes that also can reduce the risk of heart disease.
A secondary analysis of the TECOS trial affirms sitagliptin does not increase heart failure risk for patients with type 2 diabetes.
According to a new study, one more disease is associated with diabetes: twin study suggests genetic link between obesity, psoriasis and diabetes.
Study shows effect low levels of the hormone have on blood glucose.
Insulin may not be the culprit in poorer outcomes, according to TUXEDO sub-study.
Quote of the Week!
“A dream doesn’t become reality through magic; it takes sweat, determination and hard work.”
…Colin Powell
Your Friends in Diabetes Care
Steve and Dave
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