October 14, 2017 : Issue #907

• Diabetes Treatment Failure May Actually Be Nonadherence
• The Effects Of Dietary Carbohydrate Restriction On Glucose-Lowering Effect In T2DM
• Dapagliflozin Added To Insulin For People with Type 1
• Hyperkalemia Associated With Poor Outcomes For Diabetes Patients
• Early Childhood Infections May Be Related to Development of Type 1 Diabetes
• An Overview of EASD 2017
  • By Guest Writer David Kliff, Diabetic Investor
• Exclusive: Dickinson & Guzman on the Language of Diabetes

When I made the move from retail pharmacist to diabetes educator I had the opportunity to spend more time with patients and clinicians. Often the prescribers would express their frustration because they would constantly add on more medications with no improvement in results. Whenever I heard this frustration I would immediately call the pharmacy and ask when was the last time the patient filled their current medication. Most often I heard that it had been at least double the amount of time the medication should have lasted, and in many cases the first fill had never been picked up.

These prescribers got in the habit of having their staff call the pharmacy to check, and it was always a lot of fun to listen to a patient tell you how adherent they were to a medication they had never picked up.

Now that I manage a pharmacy program for a Pharma company I am laser focused on adherence, and this week our LECOM PharmD candidate Fabio Rodriguez put together a great article on just how this lack of adherence makes a difference. My professional advice on this problem is to try to get your patients to use an independent pharmacy as adherence is typically much higher.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Please click here to read a National Alert Network (NAN) release regarding the incorrect use of insulin pens at home. As explained in the alert, ISMP has received reports of several insulin dependent patients who failed to remove the inner cover from a standard insulin pen needle prior to administering the insulin. In the most recent case, the patient developed diabetic ketoacidosis and later died. Please share this alert with your staff and colleagues. If you are having trouble opening the link, copy and paste the following address into your web browser. https://www.ismp.org/NAN/files/NAN-20171012.pdf

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’!

Download this chart to help you choose the right treatment therapy for your patients. Drug comparisons 2017 (.pdf)

Jane Dickinson and Susan Guzman discuss the language of diabetes: why the way we talk to and about patients, and the way we listen to them, matters so much for effective disease management.

A 41-year-old patient with a BMI of 39 kg/m2 returns for a follow-up visit 3 months after initiating metformin. She is highly sensitive to her weight and has tried to implement lifestyle modifications, but is finding it difficult to make any meaningful changes in her diet or exercise routines. Her current A1C is 7.7%, with a target goal A1C<7%. In addition to discussing consideration of bariatric surgery, which drug class might you add? A. Thiazolidinedione B. Sulfonylurea C. DDP-4 inhibitor D. GLP-1 receptor agonist Follow the link to see the correct answer.

Repeated use of over-the-counter (OTC) mouthwash was linked to a higher risk of developing prediabetes and diabetes in a study of more than 1,000 adults who have excess weight or obesity. For many individuals, use of OTC mouthwash is part of their regular oral hygiene care. The potential adverse effects of long-term daily use, however, have not been investigated. Study authors explained that using antibacterial mouthwash can eradicate oral microbes needed for nitric oxide formation and place the user at risk for metabolic disorders. The study found that adults who used mouthwash at least twice daily had a significantly increased risk of developing prediabetes or diabetes, compared with less frequent users or those who never used mouthwash. Researchers analyzed data for 1,206 adults who have excess weight or obesity, and without diabetes or major cardiovascular disease, ages 40 to 65. Patients were followed for 3 years. Patients had no diabetes or major cardiovascular disease; 945 patients had complete follow-up data for analyses. The data showed that 43% of patients used mouthwash at least once a day and 22% used mouthwash at least twice a day. Adults who used mouthwash at least twice a day at baseline showed a significantly increased risk of prediabetes/diabetes vs. those who used it less frequently (HR 1.67, 95% CI: 1.24–2.26) or never used mouthwash (HR 1.65, 95% CI: 1.19–2.28). The size of the effects we’re consistent after factoring in income, education, oral hygiene, oral conditions, sleep breathing disorders, diet, medications, HOMA-IR, fasting glucose, 2-hour post-load glucose, or C-reactive protein to the multivariate models.  From the results it was concluded that, participants who used mouthwash less than twice a day did not demonstrate a risk, suggesting that the effect starts at a threshold of use of twice a day or more.–Published in Nitric Oxide, Available online 20 September 2017

Second-line treatment is often initiated without evidence of recommended use of first-line treatment.

Recent meta-analysis conducted to address ideal amount of dietary carbohydrates in the management of T2DM.

Trial shows HbA1c reduced, hypoglycemia and DKA similar across study participants.

Increased risk for cardiac events, hospitalization clear predictors of death.

High frequency of infections associated with islet cell autoimmunity and disease progression.

By Guest Writer David Kliff, Diabetic Investor: As we were getting ready to disembark the plane when it arrived in Lisbon I asked a long-term consultant to the diabetes industry why he comes to EASD. “I like to come here because what they have here will show up in our country in two years” was his response. Given what we witnessed at EASD there isn’t much to look forward to in 2019.

Quote of the Week!

“Healing is a matter of time, but it is sometimes also a matter of opportunity.”

…Hippocrates

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
810 Bear Tavern Road Suite 102
Ewing, NJ, 08628
USA
www.diabetesincontrol.com