October 8, 2016 : Issue #854

• What to Do If Metformin Fails To Get Patients To Target
•  New SGLT-2, Ertugliflozin Shows Promising Results for Diabetes Management
•  Combination of Insulin Glargine and Lixisenatide = LixiLan
• Identifying Treatment Intensification Patterns for Type 2 Patients with Poor Control
• Incretin Therapy: Role in Gallbladder and Bile Duct Diseases
• Exclusive: Dr. Tim Garvey
  • Part 1, Clinical Practice Guidelines for Patients with Obesity
  • Part 2, Tools to Combat Obesity

This week the take home message asks us to change from “start low and go slow,” to “be aggressive not repressive.” More and more documentation shows the value of adding newer classes of medications sooner to get our patients to target. Part of this comes from the sheer acknowledgement that our patients are developing diabetes at a younger age, and they have years longer to develop complications. And another part is the increased desire to get patients to goal to maximize ratings. Whichever one you think is more likely is okay, because the end result should better care.

We start off with the combination of SGLT-2 inhibitors with a long acting GLP-1 Analog, then we look at the combination of basal insulin along with another GLP-1 analog. And just to point out exactly how bad of a job we do of intensifying therapy quickly, we have a study with 11.000 patients that looked at intensification, and you have to see the results to determine if we are doing a good job.

Looking ahead: Monday, watch for our special issue all about how “The Biological Clock” can impact blood glucose control.

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We can make a difference!

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Dave Joffe, Editor-in-chief

Should we be more aggressive for people with prediabetes and use more of the drugs we have available, rather than waiting until they progress to diabetes?
Follow the link to share your opinion!

The results from a Global Burden of Disease study published today in The Lancet indicate that across the world deaths from chronic kidney disease (CKD) are increasing among both women and men.  Mortality due to CKD is increasing, it rose between 2005 and 2015 by 32% to 1·2 million deaths worldwide.

Special note from Diabetes in Control: It is not often that we provide information on nutritional products.  But when it is developed and recommended by one of the top specialists in neuropathy, then we feel comfortable in providing more information that can help patients with neuropathic pain.

This special formula was developed by Dr. Aaron Vinik, MD, the Director of Research and Neuroendocrine Unit at Eastern Virginia Medical School. NutriNerve is a combination of natural ingredients that address the chemical imbalances that are the root cause of neuropathic pain. NutriNerve contains a proprietary blend of Alpha Lipoic Acid, Gamma-Linolenic Acid (GLA derived from Borage Oil) and Benfotiamine (Vitamin B-1). These nutritional building blocks are specifically combined to help reverse the cause of neuropathic pain by giving your body what it needs to help the body to rebuild and restore nerve health naturally.*

*This statement has not been evaluated by FDA and the product is not intended to diagnose, treat, cure or prevent any disease.  For more information, see this product page. Also, read “Breakthrough for Neuropathy.”

Please select the drug class that best fits the description.
This shorter-acting insulin secretagogue may be associated with less hypoglycemia than the other secretagogues.

1. Biguanides
2. Sulfonylureas
3. Meglitinides
4. Thiazolidinediones

Did you get it right? Follow the link to check your answer.

Though employers and health insurers are increasingly handing out wearable devices to help plan members stay healthy, wearing a Fitbit or similar device may not help you shed any pounds, according to a recent study.  Researchers at the University of Pittsburgh tested 470 overweight or obese adults ages 18 to 35 to test if wearable devices combined with behavioral health interventions would increase weight loss compared with those who did not wear a tracking device. The study may mean bad news for the many employers and health insurers who tout wearable devices as a way for plan members to stay engaged in their health.  The study published in JAMA showed that participants were placed on a low-calorie diet, prescribed increases in exercise, and went to weekly group counseling sessions on health and nutrition for the first six months and then less frequently for the remainder of the 24-month study. At the six-month mark, participants began receiving telephone counseling sessions, text message prompts and access to study materials through a website over the next 18 months. Also at six months, half of the participants were given wearable devices to monitor their diet and exercise routines. The other half self-monitored their diet and physical activity using only a website designed for the study. At the end of the 24-month trial, participants who were given wearable devices lost an average 7.7 pounds, while those who tracked their progress through the website lost an average 13 pounds.

The findings showed that adding (wearable devices) to behavioral counseling for weight loss that includes physical activity and reduced calorie intake does not improve weight loss or physical activity engagement. Therefore, within this context, these devices should not be relied upon as tools for weight management in place of effective behavioral counseling for physical activity and diet. — JAMA, September 20, 2016, Vol 316, No. 11

Combination therapy resulting in superior glycemic control, weight loss versus either agent alone

Ertugliflozin provides clinically significant reductions in blood glucose levels.

A single, once-daily injection to lower both fasting and postprandial blood glucose

Are clinicians intensifying treatment before it is too late?

Initiation of glucagon like peptide-1 agonists may increase risk of gallbladder or bile duct disease and cholecystectomy; no increased risk associated with DPP-4 inhibitor therapy.

In part 1 of this exclusive interview from AACE 2016, Dr. Timothy Garvey discusses the new comprehensive clinical practice guidelines for patients with obesity.

In part 2 of this exclusive interview from AACE 2016, Dr. Garvey discusses the available tools — medication, surgery, lifestyle interventions – to combat obesity, and which strategies are most effective.

Dr. Tim Garvey talks with Diabetes in Control Publisher Steve Freed at the 2016 AACE Meeting in Boston about obesity as a disease and establishment of rational care patterns for patients with obesity.

Quote of the Week!

“Adopting the right attitude can convert a negative stress into a positive one.”

…Hans Selye

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

Christian Gill, URI College of Pharmacy

Emily McDonnell, URI College of Pharmacy

Julie Kelly, URI College of Pharmacy

Iman Aberra, URI College of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
810 Bear Tavern Road Suite 102
Ewing, NJ, 08628
USA
www.diabetesincontrol.com