October 7, 2017 : Issue #906

• Carbohydrate Timing Affects Glucose and Insulin Excursions
• Heart Failure Warning Added to the DPP-4 Inhibitor Class of Drugs
• Two New Treatments Offer Type 1 Patients Greater Weight Loss and A1c Reduction
• Increasing Incidence of Type 1 Diabetes In Children
• Efficacy and Safety of Diacerein With Inadequately Controlled Type 2 Diabetes
• What Do We Really Know About Exercising with Complications?
  • By Sheri R. Colberg, PhD
• Exclusive: Mark Molitch on the Modern Diabetes Treatment Landscape

I first got my CDE back in 2004. Before that I was the proud holder of a certificate from the Lifescan Pharmacist Diabetes education program that they were offering to us in Milpitas, CA. After I became a CDE, I desperately wanted to become a pump trainer. I talked to every company, but the idea of a pharmacist doing pump trainings was rarely ever done. Finally, a sales person from Disetronic gave me a chance and that began my career of training patients. My logic for doing this was based on the idea that the “pharmacist is the drug expert.” Over the years, I trained for Disetronic as well as Medtronic, Animas, Omnipod, Deltec.

I always loved the Deltec pump for its ease of use and the way cool infusion sets that they had. Business was good, but it appeared to me that Smiths, their parent company, was more interested in developing airport security systems than diabetes products, and although business was increasing, in 2009 they decided to exit the market.

Now eight years later, another major pump company has thrown in the towel. Animas announced that they were closing down their insulin pump business and it appears that Medtronic will reap the benefits. Please check out the special press release to learn about the shut down.

Of special note to any of our readers in the Anchorage, Alaska, area, our Publisher, Steve Freed, will be presenting to over 200 medical professionals on Tuesday Oct. 10^th on new drugs and technology that is changing the way we manage and treat diabetes and prediabetes, at the 33^rd Annual Alaska Native Diabetes Conference.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Animas Corporation intends to exit the insulin pump business and discontinue the manufacturing and sale of Animas® Vibe® and OneTouch Ping® insulin pumps. This decision was extremely difficult and comes following an extensive exploration of all viable other options for the Animas business.

The Humalog® Junior KwikPen®  [insulin lispro injection 100 units/mL] is now available by prescription for the treatment of diabetes in the U.S. Humalog Junior KwikPen is the only prefilled, disposable half-unit insulin pen.  Humalog Junior KwikPen, which is lighter and shorter than other half-unit insulin pens, provides an option for people who prefer a prefilled pen and need the precision of half-unit dosing, such as those with insulin sensitivity and some older adults for whom rounding to the nearest whole-unit dose is not adequate.

For a 2nd add-on drug to prescribe to those with type 2 diabetes and who are not meeting either an A1c goal of 6% or less, or an A1c of 7.5% with no complications, which might you prefer to add on to metformin to reach the goal of 6%?

1. DPP-4 Inhibitor
2. SGLT-2 Inhibitor
3. TZD
4. Sulfonylurea
5. Dopamine receptor agonist
6. GLP-1 Agonists

Follow the link to share your response.

By: Medtroninc, Inc. Price: Free Description: This on-the-go support tool is perfect for anyone who uses a Medtronic insulin pump and continuous glucose monitor. With myMedtronic Connect, you can order supplies and accessories, access helpful tips and explanations, set reminders, and prepare for travel. Details: Medtronic, Inc. Released: August 2, 2011. Requirements: Compatible with iPhone, …

Dr. Mark Molitch is the Martha Leland Sherwin Professor of Medicine at Northwestern in the Division of Endocrinology, Metabolism and Molecular Medicine. Dr. Molitch has been active in clinical research in diabetes, focusing on diabetic nephropathy, and other areas of endocrinology.

One of your patients is currently taking metformin, glyburide, and an evening basal dose of insulin. After discussing how best to achieve better glycemic control, he has agreed to add a pre-meal insulin dose. Which modification should be made with the addition of the prandial dose?

A. Discontinue the glyburide
B. Discontinue the metformin
C. No modifications should be made
D. Discontinue the metformin, glyburide, and evening insulin

Follow the link for the correct answer.

In the 50’s, we discovered that saturated fat was clogging our arteries, so we assumed too much fat was not good and we ate more carbs. Now, with the results of the PURE study, we see that getting energy from carbs may not be good and the fat we avoided may not be as bad as we thought.

The Prospective Urban Rural Epidemiology (PURE) study looked at 135,335 individuals from18 socioeconomically diverse countries. They were followed for a median of 7.4 years to evaluate the association between the intake of fruits, vegetables, and legumes, and the risk of cardiovascular disease and death. There was an inverse association between higher fruit, vegetable, and legume intake and major cardiovascular disease, myocardial infarction, cardiovascular mortality, noncardiovascular mortality, and total mortality. The hazard ratio for total mortality was 0.78 for individuals having three to four servings per day compared with the control population, and there was no further decrease in risk seen with increased consumption. The study also showed a protective effect from all types of fat. Too much sugar is associated with elevated triglycerides, which are made by the liver to store unused carbs, and is the main cause of fatty liver. From the results of the study, it was concluded that increased consumption of fruit, vegetables, and legumes was associated with a lower risk of mortality, and the optimal number of servings appears to be three to four per day. This is equivalent to 375 to 500 grams per day.

Dehghan M, Mente A, Zhang X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study [published online August 28, 2016]. Lancet. doi: 10.1016/S0140-6736(17)322523 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/fulltext

Meal sequencing may decrease glucose levels and insulin utilization.

Increased cardio risk of Saxagliptin found during trial prompts FDA decision.

Trial results promising, but DKA still a concern with use of new once-daily pills.

Philadelphia youth see rise in diagnosis; especially for African Americans, by 70%.

Common osteoarthritis treatment may be beneficial in lowering HbA1c.

By Featured Writer Sheri R. Colberg, PhD. As a clinical exercise researcher, I frequently have found it difficult to study exercise effects in people with health complications, even though this is critical information to know in order to make appropriate exercise guidelines. Try convincing your university Institutional Research Board, or IRB, that it is advisable to exercise people with eye issues like unstable proliferative retinopathy to find out if breath-holding, jumping, jarring, or head-down activities cause them to experience retinal hemorrhages. Understandably, that is not going to happen, nor should it.

Quote of the Week!

“Health is the vital principle of bliss, and exercise, of health.”

…James Thomson

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

Jessica Lambert, Doctor of Pharmacy Candidate; USF College of Pharmacy

Kay Lynn Tran, Doctor of Pharmacy Candidate: Class of 2018; LECOM College of Pharmacy

Fabio Rodriguez, Doctor of Pharmacy Candidate: Class of 2018; LECOM College of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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