May 13, 2017 : Issue #885

• New AACE Lipid Guidelines Establish ‘Extreme’ CVD Risk Category (LDL <55mg/dL)
• The Future For Insulin Pumps
  • Guest Post by David Kliff
• AACE: Complete Reversal of Type 2 Diabetes With GLP-1 Agonist
• Sulfonylureas No More!
• Are We Providing the Best Care to Our Mothers-to-Be with Diabetes?
• Back to Biking to Reduce Cardiovascular, Diabetes, and Cancer Risks

This week, the Giro d’Italia started. This professional bike race stretches from the island of Sicily to the Alps and covers 2,250 miles of pedaling over 21 days. This Sunday, the Amgen Tour of California, America’s premier cycling event, begins and Team Novo Nordisk joins with 16 other professional teams to ride 579 miles over 7 days, finishing with a monster climb up  Mt. Baldy.

The kind of endurance and physical conditioning that is required for those races will escape even the most avid non-professional rider. However, this week, we are featuring an article on the value of commuting to work and how pedaling to the job can reduce the risk of cardiovascular disease, cancer, and diabetes, and can even lower the chance of premature death over five years. Our office building just put in 4 free-to-ride bikes, and many cities have bikes to rent or use at no charge. Maybe you could mention this to your patients or even try it yourself.

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We can make a difference!

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Dave Joffe

Editor-in-chief

As a medical professional, what would you like your A1c to be, regardless of your health?
1) 7%
2) 6%
3) 5%
4) 4%
5) 3%

Follow the link to see how your response compares to your colleagues’!

The ADA issued a statement on May 12 stating: “On behalf of the nearly 30 million Americans living with diabetes, the ADA is extremely disappointed by the misinformed statement of Mick Mulvaney, budget director, as reported by The Washington Examiner. His comments perpetuate the stigma that one chooses to have diabetes based on his/her lifestyle. We are also deeply troubled by his assertion that access to health care should be rationed or denied to anyone. All of the scientific evidence indicates that diabetes develops from a diverse set of risk factors, genetics being a primary cause.. Nobody should be denied coverage or charged more based on their health status.”

This system is a smart insulin pen that provides the benefits of an insulin pump to pen and syringe users, including a dose calculator, dose alarms, and an electronic logbook.   The InPen insulin injector pen is an easy-to-use pen that not only helps calculate doses, but also keeps track of injection data.

When paired via Bluetooth® with the smartphone app, the InPen delivery system keeps tabs on how many units received at last injection, when taken, and other helpful information.

InPen was designed for insulin-dependent individuals 12 year old and older undergoing multiple daily subcutaneous injections. It can deliver 0.5 to 30 units of insulin, dialed in half-unit increments. Dial too many units? Not a problem. InPen allos dose correction without wasting insulin.

The InPen injector pen is compatible with Lilly Humalog® and Novo Nordisk Novolog® U-100 3.0 mL insulin cartridges and single-use detachable and disposable needles (not included). InPen is as easy to maintain as it is to use. The InPen lasts for one year – no recharging needed. And with options in blue, grey, and pink, patients can even add a bit of color to their management plan. Coming this year, 2017. — InPen

According to the American Diabetes Association’s (ADA’s) guidelines, how often should you intensify therapy for patients with diabetes who have not reached their A1C goal?
A. Every month
B. Every 3 months
C. Every 6 months
D. Every 9 months
E. Every 12 months
Follow the link to see the correct answer!

Although air pollution containing fine dust particles is gaining attention worldwide, little is known about the effects of such pollutants on diabetic wounds. Air pollutants from diesel exhaust particles (DEPs) cause inflammation, resulting in an increased expression of pro-inflammatory cytokines and chemokines, which attract monocytes and T cells to the sites of inflammation. The authors evaluated the effects of air pollutants on diabetic wounds. According to researchers, exhaust particles from diesel fuel can trigger inflammatory responses from cytokines known to slow wound healing, especially for patients with diabetic ulcers. It has been shown that pollution can delay wound healing, especially for those with diabetes.  Air-polluting diesel exhaust particles, already linked to cardiovascular and respiratory diseases, also can delay diabetic wound healing. The team examined the effect of such pollutants on rats, measuring levels of post-exposure inflammation in normal and diabetic fibroblasts, critical collagen-producing cells found in connective tissue. One of the cytokines, cyclooxygenase-2, is normally undetectable but can be induced with pro-inflammatory stimuli. In this study, exposure to diesel exhaust particles increased cyclooxygenase-2, already implicated in processes related to diabetic neuropathy. The resulting inflammation can be particularly dangerous for patients with diabetic ulcers. “Wound healing requires complex cellular and molecular events that can lead to either accelerated or delayed healing, the latter of which can result in chronic wounds,” researchers wrote. — Wounds March 2017;29(3):65–70. Epub 2016 December 29

In a departure from recommendations by cardiology societies, two endocrine groups issue new lipid-management guidelines that bring back LDL-cholesterol targets.

Guest writer David Kliff of Diabetic Investor explains why he doesn’t expect any closed-loop systems to expand the overall insulin pump market by any significant amount.

Retrospective analysis presentation shows liraglutide (LIRA) improved glycemic parameters, reduced body weight, BMI, and waist circumference in new T2 patients.

Cheapest treatment associated with increased risks of cardiovascular events and death.

One recent study examines how we’re doing.

A new study found riding a bike to work associated with reduction in risk of cardiovascular disease, cancer risk, diabetes, and premature death over five years.

Quote of the Week!

“Health is the greatest gift, contentment the greatest wealth, faithfulness the best relationship.”

…Buddha

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

Mark T. Lawrence, University of Colorado-Denver, School of Pharmacy NTPD

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