November 4, 2017 : Issue #910

• Awareness of Type 3C Diabetes and Why It Is Misdiagnosed
• More Acute Renal Failure Adverse Events With SGLT-2
• Increased Quality of Life in Obesity and Prediabetes seen with Liraglutide
• Insulin Pump Interruptions Reduce Hypoglycemia
• Nocturnal Hypoglycemia Occurs Frequently In Children And Adults With Type 1 Diabetes
• Are My Joint Issues Due to Being Active, Normal Aging, or Diabetes?
  • By Sheri R. Colberg, PhD
• Exclusive: Sheri Colberg on Exercising with Diabetes

Over the years we have heard that there are more than two types of diabetes. In fact we have carried articles in the past stating that Alzheimer’s is really a form of diabetes. These monikers often disappear in a short time period and are forgotten.

This week we bring you a compelling discussion making a claim for diabetes type 3c, a disease associated with diagnosed and undiagnosed pancreatitis, and what you can do to identify which patients may have this designation in your practice.

We also have news of DIC Advisory Board member R. Keith Campbell being honored with a Lifetime Achievement Award. Be sure to check it out and see why Keith is an inspiration for so many pharmacists and nurses.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Pharmacy innovator Keith Campbell, B.Pharm, MBA, CDE, who sits on our board of advisors at Diabetes in Control, is one of the first pharmacists to become a certified diabetes educator and the inspiration for hundreds of other pharmacists and nurses who since followed in his footsteps, received the Lifetime Achievement Award on Friday, Oct. 20, 2017 at the Washington State University College of Pharmacy Crimson Gala.

Intarcia Therapeutics, Inc. a privately held biopharmaceutical company announced that the Food and Drug Administration (FDA) has issued a Complete Response Letter (CRL) for ITCA 650 (exenatide implant) for the treatment of type 2 diabetes. The FDA is requesting that they resubmit with simplified procedures this Feb. 2018. The company looks forward to meeting with the FDA and working closely together on next steps. Intarcia does not anticipate the need to conduct new pivotal trials or any long lead-time CMC activities in order to satisfy the requirements of the FDA.

OptiScanner is the first-of-its-kind bedside blood monitoring platform that provides plasma-based, automated monitoring of ICU patients’ glucose levels. The OptiScanner 5000 directly measures plasma glucose levels using an integrated blood centrifuge and spectrometer to help avoid dangerous glycemic variations and assist clinicians in achieving the right level of glucose control.

Are you open to recommending an SGLT-2 inhibitor as a second drug for a patient with type 2 diabetes who is overweight and has not met their goal? Follow the link to see how you compare to your colleagues.

Sheri R. Colberg, PhD, FACSM is Professor Emerita of Exercise Science from Old Dominion University and an internationally recognized authority on diabetes and exercise. She is the author of 11 books, 24 book chapters, and over 300 articles. The author of “Exercise and Diabetes: A Clinician’s Guide to Prescribing Physical Activity,” published by ADA in 2013, she is also the lead author on a new ADA position statement on physical activity and diabetes published last fall. In 2016, she received the ADA Outstanding Educator in Diabetes Award.

A 62-year-old Asian-American female arrives at your office for a new patient appointment. Her current medications are metformin, pioglitazone, enalapril, lovastatin, alendronate, calcium supplements and vitamin D. Her A1C is on target at 6.9%, however you decide to replace her pioglitazone with a different antihyperglycemic medication. Why would you make this decision?

A. Pioglitazone increases the risk of hypertriglyceridemia
B. Pioglitazone increases the risk for cardiovascular events
C. Pioglitazone increases the risk for fractures
D. Pioglitazone increases the risk for hypoglycemia

Follow the link to see the right answer.

Previous studies identify gestational diabetes (GD) as a risk factor for intermediate markers of cardiovascular disease (CVD) risk; however, few are prospective, evaluate hard CVD end points, or account for shared risk factors, including body weight and lifestyle. The Nurses’ Health Study II (NHS II) is an observational cohort study of US female nurses. 89,479 women were included who reported at least one pregnancy and were free of CVD and cancer at baseline. Follow-up through May 31, 2015 was complete for more than 90% of eligible participants. In this study, to prospectively evaluate history of GD in relation to incident CVD risk with follow-up of nearly 90,000 US women older than 26 years, women with a history of gestational diabetes had 43% greater risk of CVD (myocardial infarction or stroke) compared with women without prior gestational diabetes, although absolute rates in this cohort were low. Adhering to healthy lifestyle factors over follow-up mitigated this modestly elevated risk.  Participants had a mean age of 34.9 (4.7) years. Adjusting for age, prepregnancy body mass index, and other covariates, GD vs no GD was associated with subsequent CVD. Additional adjustment for weight gain since pregnancy and updated lifestyle factors attenuated the association. Classifying GD by progression to T2D in relation to CVD risk indicated a positive association for GD with progression to T2D vs no GD or T2D, and an attenuated relationship for GD only. Gestational diabetes was positively associated with CVD later in life, although the absolute rate of CVD in this younger cohort of predominantly white women was low. This relationship is possibly mediated in part by subsequent weight gain and lack of healthy lifestyle. 1,161 incident self-reported nonfatal or fatal myocardial infarction or stroke, confirmed via medical records.

JAMA Intern Med; 2017 Oct 16; EPub Ahead of Print; DK Tobias, JJ Stuart, S Li, et al

Diabetes has long been divided into type 1 and type 2. But a third type has entered the mix — and we aren’t diagnosing it correctly.

SGLT-2 inhibitors were associated with more acute renal failure reports than other diabetes medications.

New study suggests improvement in quality of life and obesity seen with liraglutide compared with placebo.

Sensor-augmented therapy can diminish hypoglycemia with the low-glucose suspend feature.

Study uses continuous glucose monitoring (CGM) systems to assess blood glucose levels during sleep.

Living with diabetes often leads me to wonder if what I’m experiencing—particularly when it’s an irritated joint or an overuse injury—is a consequence of being a regularly physically active person, getting older, or having diabetes, or some combination of those. Which one of these is causing my joint issues? Is it possible to know? I will attempt to answer these questions based on my deeper dive into the published research.

Quote of the Week!

“The only disability in life is a bad attitude.”

…Scott Hamilton

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

Jessica Quach, Doctor of Pharmacy Candidate; GA-PCOM School of Pharmacy

Kay Lynn Tran, 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