January 28, 2017 : Issue #870

• Remission of Prediabetes to Normal Glucose Tolerance in Obese Adults
• Continuous Glucose Monitoring To Improve Diabetes Control
• A New Combination Diabetes Treatment Could Become the Standard Instead of Insulin
• Metformin Not the Only Treatment for Prediabetes
• Metformin Reduces Mortality in CKD, CHF, and CLD
• Fenofibrate with a Statin in Type 2 Patients Reduces Long-Term Cardiovascular Risk

Mary Tyler Moore , TV actress, comedienne, JDRF chairwoman, and diabetes advocate with type 1,  died on January 25 at age 80 from cardiopulmonary arrest following pneumonia. Toward the end of her life, Moore had dealt with many diabetes complications. She underwent surgery in 2011 to remove a benign brain tumor. She was often too weak to stand and, by 2014, she was almost blind.

Moore was diagnosed with type 1 in 1969 at the age of 33, having to manage her condition for many years with less responsive insulin than is found today. She would not have even been able to check her own blood glucose levels for the first 20 years of her diagnosis. Moore regularly shared how she was very careful with what she ate, how she exercised and that she tested her blood sugar regularly.

In 1984, Moore began volunteering for the Juvenile Diabetes Research Foundation,  soon becoming its international chairwoman and raising millions of dollars through various functions. She also appeared numerous times before Congress to lobby for further funding. Although, she sometimes called the disease a  ‘tremendous burden’ that ‘affects you emotionally as well as physically,’ Moore said she was proud of the awareness she had brought.

What percent of your prediabetes patients are on metformin?
1) 0%
2) 10%+
3) 25%+
4) 50%+
5) 75%+

Follow the link to see how you compare!

Let the American Diabetes Association help you answer some of the many questions your patients have at diagnosis. It all starts with a free booklet for you to give your patients with the information they need on day 1. The booklet also offers them the opportunity to enroll in a free, year-long program to get ongoing information, tools, recipes and support to help them manage and live well with diabetes. Help your patients get started. Order your free booklets today.

According to available evidence, which of the following is a treatment strategy for the delay or prevention of macrovascular complications?

1) Antiplatelet therapy
2) Blood pressure management
3) Glycemic control ≤ 7% (individualized for patients)
4) Smoking cessation
5) Lipid management
6) All of the above

Follow the link to see the correct answer!

When patients do not shake there NPH insulin pen before injecting, they will most likely see a wide variation in their insulin levels and blood sugar control, researchers report. NPH insulin comes as an insoluble mixture of crystals and liquid and must be re-suspended before injection. So researchers in Italy wanted to know what difference it would make if patients didn’t re-suspend their NPH insulin by tipping the insulin pen 20 times before injection, and if they didn’t shake it by tipping it back and forth, whether it would matter how they held the needle during the injection. What they found was everything mattered. Dr. Geremia B. Bolli, one of the researchers, was surprised by “the high variability of effects on lowering of blood glucose depending as to whether the NPH pen is properly re-suspended by shaking or not, and (if it’s not re-suspended), even great differences depending on the position of the pen, i.e., horizontal, vertical with tip up or down.” He added that, “The same NPH appears as a different insulin in each of these conditions.”  So, when you compare with re-suspending NPH insulin, not shaking the pen before injecting could result in lower insulin levels in the blood (if you inject with the needle flat or pointing up) or higher insulin levels (if you inject with the needle facing down).  They also detected that your body would also feel the effects of insulin earlier if you injected with the needle down without shaking it first or later if you injected it flat or needle up without shaking it first.  This could result in your blood sugar rising above desired levels sooner (needle flat or pointed up) or later (needle pointed down) when you don’t re-suspend the NPH insulin by shaking the pen first. If not re-suspended, that insulin levels could vary by as much as 23% and blood sugar control could vary by as much as 62% depending on whether NPH insulin is shaken before injecting or not.  So it may seem small, but it is very important that your patients are aware of this problem if they do not shake their NPH insulin. This is also a reason to use long-acting insulin rather than NPH.  So consider this when deciding the best treatment for your patients.  Diabetes Care, online

The use of a high protein diet instead of a high carbohydrate diet to help reverse the progression to diabetes.

Two studies show use of sensor implanted under skin that continuously monitors glucose levels resulted in improved levels in T1 patients who inject insulin multiple times a day.

Study shows significant improvement in diabetes control with a 1 point drop in A1c with less hypoglycemia.

Pioglitazone in people with insulin resistance, prediabetes or diabetes is associated with a decreased risk for major adverse cardiovascular events, study data shows.

FDA label update will increase drug use in persons with historical contraindications or precautions.

Using fibrates to treat hypertriglyceridemia has not shown significant benefit in cardiovascular mortality in previous studies.

Quote of the Week!

“Investing in health will produce enormous benefits.”

…Gro Harlem Brundtland

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