July 22, 2017 : Issue #895

• Even More Protection for the Kidneys With An SGLT-2 Inhibitor (with exclusive  comment from George Bakris, MD)
• The Link Between Depression and Gestational Diabetes
• Diabetes and Its Association with Dementia
• How Carbohydrate Consumption Impacts Glycemic Control Among Pregnant Women With Type 1 Diabetes
• Ramadan Fasting and Type 2 Diabetes
• Current Interview: George Bakris, MD, on kidney disease as it relates to diabetes

It seems every week the SGLT-2 inhibitors are in the news, one time good and one time bad. Now there is a new study that shows that these products may have the ability to protect the kidneys in patients with type 2 diabetes.

Since we have had so many articles on both sides of the aisle, we decided to go to one of our board members and one of the foremost kidney experts, Dr. George Bakris, and get his feedback on this new indication for SGLT-2 inhibitors.

When Steve and Joy sat down with him, he wanted to cover more than just the kidney protective study, and we have a set of interviews for you covering almost everything related to diabetes, cardiovascular issues and kidney disease.

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We can make a difference!

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Dave Joffe

Editor-in-chief

As of 2015, 9.4% of the US population, or 30.3 million people, have diabetes, while 84.1 million have prediabetes, according to the CDC’s 2017 National Diabetes Statistics Report. Researchers also found increased rates of diagnosed diabetes with age, with 25.5% of adults ages at least 65 having diabetes, compared with 4% of those ages 18 to 44. —Source

Do you agree with the statement: Doing a monthly A1c test could act as a way to motivate patients to better care?
Follow the link to share your response and see what your colleagues think!

This is a complete list that includes:

• Drugs that May Cause Hyperglycemia
• Drugs That May Cause Hypoglycemia
• Drugs that May Cause Hyper – or Hypoglycemia
• Drugs that Mask Hypoglycemia

Download 390 Drugs That Can Affect Blood Sugars here.

Dr. George Bakris, MD, is a referral nephrologist, board-certified hypertension specialist, and professor of medicine and director of ASH Comprehensive Hypertension Center at The University of Chicago. He specializes in kidney disease as it relates to diabetes and blood pressure issues. In this interview, Dr. Bakris shares his excitement for the results of some important diabetes trials.

All the following are true about smoking and heart disease EXCEPT:
A. Compared with nonsmokers, the incidence of myocardial infarction (MI) is increased 6-fold in women who smoke approximately 20 cigarettes per day.
B. Male smokers are 25% more likely to develop coronary heart disease than female smokers.
C. Smoking cessation rapidly increases high-density lipoprotein (HDL) cholesterol.
D. Smokers who take a thrombolytic agent for an acute MI have better outcomes than nonsmokers.
E. All of these statements are true.

Do you have the right answer? Follow the link to see.

We know that type 1 and type 2 diabetes affects our brains, and it can increase the risk for dementia. Now, new research finds an even greater risk for all-cause dementia by 2 to 2.5 times higher when you have diabetes.

Dr. Jeffrey Klingman, chief of neurology at Kaiser Permanente, says that the higher chance of developing cognitive impairment and dementia is often linked to microvascular damage – damage to small blood vessels – which is directly related to diabetes. Studies show that in addition to loss of nerve cells, there is also a change in the way brain cells work when someone has diabetes. The higher the blood sugars are, on average, the higher the risk. Plus, repeated low blood sugar, or hypoglycemia, is also associated with cognitive decline. We know that the risk of cognitive decline increases with age, as does the risk for diabetes. That’s another reason why these problems may go hand in hand. Obesity and sleep are also associated with brain issues, but there are very few studies that tease apart these different factors that relate to brain decline.  Diabetes and its complications can accelerate cognitive decline, making patients especially vulnerable to mental impairment and dementia as they age. Diabetes detrimentally affects brain structure and function. Its effects on cognition are due at least in part to macrovascular disease, microvascular changes, hyperlipidemia, alterations in insulin homeostasis, and inflammation. And the relationship between hypoglycemia and dementia may be bidirectional.

Kloppenborg RP, van den Berg E, Kappelle LJ, et al. Diabetes and other vascular risk factors for dementia: which factor matters most? A systematic review. Eur J Pharmacol. 2008;585:97-108.; Strachan MW. R D Lawrence Lecture 2010. The brain as a target organ in type 2 diabetes: exploring the links with cognitive impairment and dementia. Diabet Med. 2011;28:141-147.

New data from the EMPA-REG-OUTCOME study provide more evidence of the renoprotective effects of empagliflozin in patients with type 2 and cardiovascular disease.

Study finds increased risk during and after pregnancy

Individuals with diabetes who experience hypoglycemia at increased risk for developing cognitive dysfunction and dementia.

Study focuses on quality and quantity of carb consumption during pregnancy.

Fasting found to lead to deterioration of glycemic control in people with type 2 diabetes.

Quote of the Week!

“A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses.”

….Hippocrates

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

Nuha Awad, Doctor of Pharmacy Candidate: Class of 2018; LECOM 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