March 11, 2017 : Issue #876

• American Diabetes Association Updates on Diabetic Retinopathy
• 2017 ADA Position Statement on Diabetic Retinopathy
  • by Dr. Paul Chous
• Metformin in Gestational Diabetes
• Acceptance of Advanced Technologies & Treatments for Diabetes
• Recommendations for Insulin Using Patients When Fasting
• Reducing Metabolic Risk Factors By Temporary Fasting

For the first time in many years, the ADA has updated their guidelines on retinopathy. These new guidelines take into account the improvements that have been made in diagnosis and both medical and physical treatments.

Most of our colleagues at other medical news outlets either paraphrased the guidelines or printed the entire thing outright.

We took the time to dig deeper as we had our resident eye expert, Dr. Paul Chous, share his ideas on these new rules of care and what he felt were the important takeaways, and how to put these guidelines into practice.

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We can make a difference!

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Dave Joffe

Editor-in-chief

See items 1 and 2.

Now that a new combination drug of a GLP-1 plus DPP-4 is approved, will you:
1. Recommend it for current patients
2. Wait until we have further information on its use
3. Not sure

Follow the link to respond and see what your colleagues think.

Developed by diabetics for diabetics. DiabetesPlus lets you administer your readings on your device and saves time by enabling you to send the data directly to your doctor.

When asked in a survey, 77% got it wrong! In head-to-head trials of dipeptidyl peptidase 4 (DPP-4) inhibitors vs glucagon-like peptide 1 (GLP-1) receptor agonists, GLP-1 receptor agonists showed more favorable outcomes in all of the following areas except which one?

A. Greater glycemic control
B. Greater tolerability
C. Greater weight loss
D. Greater improvement in beta-cell function
E. Greater reduction in postprandial triglycerides

Were you able to get it right? Follow the link to find out!

Every month we learn of another disease that people with diabetes are at risk for. We need to let our patients know that too much glucose can reduce their immune system and put them at risk for most diseases, including Alzheimer’s, cardiovascular disease, senility, hepatitis B, and everything and anything from cancer to athlete’s foot. This can damage their quality of life. An online survey, sponsored by pharmaceutical company Merck, involved over 1,000 U.S. adults age 18 and older with either type 1 or type 2 diabetes. Respondents were twice as likely to identify an increased risk of kidney disease and heart disease, which are common diabetes complications, compared with serious infection diseases such as pneumonia, meningitis or pneumococcal disease, which is the most common cause of lung infection.

Robert E. Ratner, M.D., Chief Scientific & Medical Officer at the American Diabetes Association stated in a news conference that, “These data illustrate that patients with diabetes are not fully aware of their risk of other serious illnesses, and that there is a critical communication gap between patients and their healthcare providers about the risks for serious illness, including pneumococcal pneumonia or pneumococcal disease, flu and hepatitis B for adults with diabetes.”  Adults with diabetes are roughly three times more likely to develop pneumococcal disease compared to healthy adults, but only one in three respondents were aware of this.  Less than half of those surveyed had discussed the risk factors for pneumococcal disease and other serious illness with their healthcare provider. Ratner added that healthcare professionals should initiate discussions with patients to “bridge the information gap” and ensure that risks relating to their diabetes are made clear, enabling greater preventative measures to be taken.  ADA Feb, 2017 News Release

Improvements in assessment and treatment of diabetic retinopathy position statement

This represents the first such update by the American Diabetes Association since 2002, and is notable for inclusion of the latest evidence and recommendations with respect to appropriate eye examination intervals, referral criteria, prevention of incidence and progression of diabetic retinopathy (DR), and treatment strategies.

Should metformin or glyburide, or a combination of both drugs, be the first-line treatment for gestational diabetes?

Is innovative telemedicine the answer to preventing and treating diabetes?

Can patients who use insulin safely fast?

To fast or not to fast.