November 26, 2016 : Issue #861

This Thanksgiving weekend, we’re grateful to our wonderful readers for your participation in the DIC community. For this special holiday issue we’re highlighting the questions and surveys that got your attention in 2016.

Happy Thanksgiving from all of us here at Diabetes In Control!

Many of us are too old to remember how hard tests were when we were in school. In addition, the way learning works now there is always a good chance you can Google the answer. So, the question that begs to be asked is whether it is more important to get the question right, or learn the information from the answer. This week we look back at the top questions and surveys based on your responses over the the past year. I would encourage you to see if you can answer them without using Google, but if you must have a helping hand I will give you a big hint…. All the answers can be found on Diabetes in Control.

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We can make a difference!

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Dave Joffe, Editor-in-chief

• Intarcia Submits New Drug Application (NDA) to FDA for U.S. Marketing Approval of ITCA 650 in Type 2 Diabetes
• FDA Approves 2 new diabetes combo treatments:  GLP-1 inhibitor plus Insulin
  Xultophy, approved in Europe since 2014, combines Novo’s insulin drug Tresiba with its GLP-1 agonist Victoza. Soliqua is a mix of Sanofi’s Lantus and the GLP-1 Lyxumia.

In a year that saw much discussion about new drugs, new devices, and how politics might affect medical care, the surveys you were most interested in were those that touched on the core aspects of care for patients with diabetes. See the five polls that engaged you most.

Why do you respond to DIC survey questions?
1. Because the question is interesting
2. Want to share my opinion
3. Want to see what my colleagues think
4. All of the above
5. I usually don’t respond

You can view the top 5 questions of 2016 in one page here.

In 2016, the TYK questions that received the most interest from our readers were those with a personal touch: questions that gave case-study style descriptions of individual patients and their needs. The 5 most popular questions of the year are featured in this issue. Can you guess which of these 2016 TYK questions was the most popular of all?
A. Question #814, January 2: Unnamed patient
B. Question #817, January 23: Mrs. O’Doole
C. Question #823, March 5: Mrs. Hunter
D. Question #833, May 14: Mrs. Wilson
E. Question #835, May 26: Mr. Fontello

You are reviewing lifestyle modifications with a 42-year-old, relatively sedentary patient who has been newly diagnosed with prediabetes. Your screening for any cardiovascular risk factors was negative, so she has agreed to a 3-month trial of dietary modifications and increased physical activity. Structured exercise interventions and modest weight loss have been shown to lower the risk of developing type 2 diabetes in high-risk populations by an average of: (follow link to answer!)

Mrs. O’Doole is a 34-year-old of Irish descent. She works as a florist and is married with three children. She arrives at your clinic for her annual wellness exam. Her blood pressure is 130/84 mmHg, pulse 65, BMI 24 kg/m2 and her physical exam is notable for acne and mild hirsutism. Her only current medication is oral birth control pills. She recalls starting OCP, 15 years prior, due to irregular menses.

Based upon her medical history and physical, you believe it would be prudent to screen Mrs. O’Doole for type 2 diabetes. You discuss your recommendations with her and she agrees be tested. The lab returns a fasting plasma glucose (FBG) of 112 mg/dL. You share these results with your patient and inform her that, while only mildly elevated, she has impaired fasting glucose.

What is the best choice for initial management of Mrs. O’Doole’s prediabetes? Follow the link to respond.

Mrs. Hunter is a 36-year-old African-American who comes to your office for her annual wellness exam. She is overweight (BMI 27 kg/m2), but is otherwise healthy. She jokes that she “just can’t seem to lose that extra baby weight” after giving birth 3 years ago. However, her daughter recently started preschool, so she has been able to go to her new gym several times per week. In fact, one of the added bonuses of her membership is the free, weekly nutrition and exercise support groups. In addition to her routine labs, you order an A1C, which comes back elevated at 7.1%. This measurement is confirmed several days later.

Based on Mrs. Hunter’s profile, what would a reasonable next step be?

Select one answer:

A. Encourage lifestyle modifications and start metformin with an A1C target of less than 7.0%
B. Encourage lifestyle modifications and start metformin with an A1C target of less than 6.0%
C. Encourage lifestyle modifications and do not initiate drug therapy at this time
D. Encourage lifestyle modifications and start metformin and a sulfonylurea

Are you correct? Follow the link to see!

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!

Mr. Fontello is an overweight, Caucasian 63-year old patient who comes in for a 6-month check-up. He has a 12-year history of type 2 diabetes. He was diagnosed at age 33 with high blood pressure, but had never really done much about it as it was “too much of a hassle” and he felt “just fine.” At the time his diabetes was diagnosed, he was referred to a diabetes education program and was started on metformin, lovastatin, losartan and aspirin. He has an individualized A1C goal of 7%. Four years after diagnosis, pioglitazone was added to Mr. Fontello’s diabetes regimen. Three years ago, he came in for an appointment complaining of polyuria, polydipsia and fatigue with an office A1C of 9.3%. At that time he was started nightly basal insulin detemir. Since that time, he has made concerted efforts to eat a healthy diet and get to the gym. Today, he reports his SBGM fasting plasma glucose levels are on target (FPG below 130mg/dL). He also states that his feet always feel a little bit swollen. BP 128/78, HR 73, RR 19. Physical exam is remarkable for peripheral edema and mildly decreased pedal pulses. Current medications: metformin, pioglitazone, insulin detemir, lovastatin, losartan, aspirin. At today’s visit, his office A1C is 8.1%.

What changes would you recommend for his antihyperglycemic regimen?
Select one answer:
[A] Add a premixed insulin to all three meals of the day
[B] Increase his detemir dose
[C] Add a sulfonylurea to his regimen
[D] Add a rapid-acting insulin analogue to his largest meal of the day

Are you right? Follow the link to find out!

Quote of the Week!

“It’s always too early to quit.”

..Norman Vincent Peale

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Steve and Dave
Diabetes In Control
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USA
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