November 18, 2017 : Issue #912

• New Information on SGLT-2 Inhibitors
• Next CGMS “Flash” FreeStyle Libre FDA Approved, Available Shortly
• Metformin Improves Vascular Health in Children With Type 1 Diabetes
• Magnesium To Prevent Type 2 Diabetes
• Alzheimer’s Gene Linked to Diabetes
• Exclusive: Mark Huising on Delta Cells

We lost one of our first board members last week when Dr. Keith Campbell, Pharmacist, CDE, Professor of Pharmacy at Washington State, passed away at the age of 76. Keith had recently been bestowed the Lifetime Achievement Award from Washington State University. Keith will be missed by the thousands of diabetes professionals and pharmacists that he personally connected with.

As we look to our latest newsletter issue, there are many of us who have had our DNA analyzed by 23andMe. I happen to be one of those people. The results on my genetic background were what I thought they would be, and although I was secretly looking for some weird variant, the only thing that popped up was 0.1% Native American. I kind of filed this away, but I received some emails from them explaining how they were using the data they had amassed to identify subgroups of patients and possible diseases.

One of these was Alzheimer’s and for an extra fee they would tell you if you had a mutation that might lead to this or other diseases. I looked for some information online as to how they could do this but drew a blank. This week, we have a feature that answers my question.

Our intern, Jessica Quach, Doctor of Pharmacy Candidate 2018, GA-PCOM School of Pharmacy, prepared Item 5 for us to explain how your DNA test might indicate your likelihood of Alzheimer’s, and how you may be able to delay the onset.

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We can make a difference!

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Dave Joffe

Editor-in-chief

See this week’s Did You Know.

See Next CGMS ‘Flash’ FreeStyle Libre FDA Approved, Available Shortly.

Download your Insulin Stability Chart here. (pdf)

In treating your patients with diabetes who have hypertension, elevated blood sugars, and elevated LDL’s, do you treat 1 or 2 of the comorbidities or all 3 at the same time?

Follow the link to share your response.

In this Exclusive Interview, Dr. Mark Huising talks with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California about his work in delta cells, their impact on the body as well as diabetes, and the importance of imparting an understanding about these cells to the diabetes community, patients and medical professionals alike.

A 64-year-old female presents to your office for her 3-month follow-up. She has previously been diagnosed with mild diastolic heart failure, secondary to hypertension. She currently takes an ace-inhibitor and a diuretic with good control of her heart failure symptoms and hypertension. At her last visit, she had a FPG 118 mg/dl. In a subsequent conversation with her, you discussed how she has developed prediabetes and suggested lifestyle modifications. Since her last visit, she has taken up very gentle walking four times/week and has changed her diet to a more healthful one. Despite these positive changes, this visit’s labs return an A1C 7.8%; her remaining labs are within normal limits. Which one of the following antihyperglycemic medication classes would you choose to initiate treatment?

A. Sulfonylureas
B. Biguanides
C. Insulin
D. Thiazolidinediones

Follow the link for the answer.

Tighter blood pressure guidelines mean that those with high blood pressure will go from 72 million to 103 million more people who need to make lifestyle changes, or start taking medication, in order to avoid cardiovascular problems. Americans with blood pressure of 130/80 mm Hg or higher should be treated, down from the previous trigger of 140/90 mm Hg, according to new guidelines. High blood pressure accounts for the second-largest number of preventable heart disease and stroke deaths in the United States, second only to smoking. The guidelines were also endorsed by the American College of Cardiology and 11 other organizations. With 130/80 now considered elevated blood pressure that needs to be treated, a normal reading would be any blood pressure below 120/80 mm Hg and above 90/60 mm Hg.

A large, government-sponsored study of hypertension patients age 50 or older showed in 2015 that death from heart-related causes fell 43% and heart failure rates dropped 38% when their systolic blood pressure was lowered below 120 mm Hg vs those taken to a target of under 140 mm Hg. However, patients in the 120 mm Hg systolic blood pressure group had a higher rate of kidney injury or failure, as well as fainting. Adults with blood pressure of 130/80 mm Hg already have double the risk of heart attack compared to someone in the normal range. — Published online November 13 in the “Journal of the American College of Cardiology.”

Research presented at the American Heart Association provided new insight into  two large diabetes drug trials, CANVAS and EMPA-REG OUTCOME.

CGM will be available at lower price, without fingerstick calibration, and can be worn for 10 days with 12-hour warmup.

HbA1c, daily insulin dose requirement also found to benefit from treatment.

Diet may play a major role in magnesium and its association to type 2 diabetes.

Researchers found that the Alzheimer’s gene ApoE4 could be linked to type 3 diabetes. The Apolipoprotein E (APOE) gene is one of the strongest genetic risk factors for Alzheimer’s disease. Diabetes and impaired insulin signaling in the brain are linked to the development of Alzheimer’s disease. This study shows how apoE4 and insulin resistance can …

Sign up for the next course from American Health Care’s continuing education series! Dr. Claude Lardinois, board certified endocrinologist and medical director of American Health Care, will be discussing a paradigm shift in the treatment approach of type 2 Diabetes Mellitus with established cardiovascular disease.

Please see the Diabetes Webinar Save the Date flyer for more information regarding this presentation.

If you would like to be added to the mailing list and receive an invitation for this course, please contact Yelena Andruh at: 916-960-2755 OR at y.zakharova@americanhealthcare.com.

Quote of the Week!

“Continuous effort – not strength or intelligence – is the key to unlocking our potential.”

…Winston Churchill

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

Graciela Nieto, Doctor of Pharmacy Candidate 2018, LECOM School of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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