January 27, 2018 : Issue #922

• Trade Offs — Clinical Decision Making for Patients with Type 2 Diabetes
  • Part 3 of a special 4 part series, How To Overcome The Complexities of Treatment Decisions For Your Patients with Type 2 Diabetes
• Fasting Glucose and Mortality
• Adverse Effects of Short-Term Corticosteroid Use in Diabetes Mellitus
• Study Shows Advantage of SGLT2’s Over DPP-4’s
• Correlation of Depression and Severe Dysglycemia in T1DM
• Exclusive: Robert Rapaport on Pediatric Diabetes & Transitioning Patients to Adult Care

The CDC and NIH are saying that this year is one of the worst ever for the flu. Patients often try OTC’s to treat the symptoms, but a lot of times respiratory problems drive them to their prescriber, and often a short course of tapering corticosteroid therapy is prescribed. This works well for most patients. However, our patients with diabetes often have consistently elevated glucose levels during the treatment phase and these levels will often last ’til the drug levels are very low.

This week, our current PharmD candidate Adrianna Jackson from LECOM College of Pharmacy shares information (Item 3) on how this use in diabetes patients can increase their chances of VTE, fracture and sepsis. There are some nice tidbits on what you can do to lower the risk.

*****************************

We can make a difference!

*****************************

Dave Joffe

Editor-in-chief

Would you consider using a diabetes software program that can determine the best treatment for type 2 and provide you 3 possible solutions that fit into the patient’s budget using their insurance?

Follow the link to see how you and your colleagues compare.

For the complete list of our featured interviews with international diabetes experts from the
2017 AACE meeting held in Austin, Texas and the 2017 AADE Scientific Sessions held in San Diego , CA, download here.

Robert Rapaport, MD is Professor of Pediatrics, Chief of the Division of Pediatric Endocrinology and Diabetes and the Emma Elizabeth Sullivan Professor of Pediatric Endocrinology and Diabetes at Icahn School of Medicine at Mount Sinai, New York. He directs an annual Pediatric Endocrinology/Diabetes Symposium. He has been a long time active member of the Pediatric Endocrine Society serving in many capacities during membership. He was elected member of the American Pediatric Society.

A 39-year-old, overweight (BMI 27 kg/m2) patient comes into your office for his annual wellness examination. Routine labs show random plasma glucose of 176 mg/dL, so you ask him to return for a fasting plasma glucose and A1C. The results show a FPG 139 mg/dL and A1C of 7.7%. He is resistant to the idea of starting medication and is very keen on pursuing a trial period of dietary modifications and an exercise program, especially after you tell him about the benefits of moderate exercise on diabetes. Which of the following statements about exercise is true?

A. Exercise reduces basal insulin levels only when paired with proper diet
B. Exercise can lead to weight loss, but rarely reduces A1C levels
C. Exercise can reduce all-cause mortality by up to 38%
D. Exercise must be rigorous and regular to lead to greatest reduction in mortality

Follow the link for the answer.

In a recent study, researchers found that men who report greater rather than less satisfaction with life are less likely to have type 2 diabetes, but the relationship does not hold for women. In Munich, Germany, at the Helmholtz, Research Centre for Environmental Health, they evaluated data from two population-based surveys (MONICA and KORA) conducted from 1989 to 1995 from 7,107 adults (51.5%; mean age, 47.8 years) to determine associations between life satisfaction and incident type 2 diabetes. Participants were followed until 2009. At baseline, 26.9% of men and 25.3% of women reported a high-level of life satisfaction. They were followed for 14 years and 568 patients with type 2 diabetes were identified. The risk for type 2 diabetes was 22% lower in men with high life satisfaction compared with men with medium or low life satisfaction (HR = 0.78; 95% CI, 0.6-1). The risk was further reduced (28% lower) in men with high life satisfaction compared with men with medium or low life satisfaction after adjustment for age, survey, parental history of diabetes, smoking status, alcohol intake, physical activity, BMI, hypertension and dyslipidemia; however, after adjustment for depressed mood, the association was no longer significant. No significant associations were observed between high life satisfaction and incident type 2 diabetes in women. “The findings suggest that life satisfaction has a protective role in the development of type 2 diabetes, independently of common risk factors, and call for increased consideration of psychological well-being,” researchers said. It was concluded that the assessment of life satisfaction may be considered in the prediction of type 2 diabetes risk in men, and positive psychological well-being interventions may be targeted in individuals at high-risk as preventive measures. — Piciu AM, et al. Diabet Med. 2017;doi:10.1111/dme.13574.

Part 3: Trade Offs — Clinical Decision Making for Patients with Type 2 Diabetes: In the previous series of articles, we discussed the complexity of clinical decision making and the role the cost plays into that decision. Cost is only one dimension of the complex process of deciding the appropriate next steps in the treatment of type 2 diabetes. In this article, we will discuss the other aspects of clinical decision making, and how clinicians can think about the trade-offs involved in making medication choices.

Study to examine the association between fasting glucose and mortality by age in patients with diabetes.

Is preventive medication the key to reducing risk of fractures, VTEs, and sepsis?

Systematic review and meta-analysis show lead in HbA1c reduction, weight loss, and favorable fasting blood glucose levels.

Patients with type 1 diagnosed with depression said to be in danger of experiencing more severe episodes of hypoglycemia and hyperglycemia.

Quote of the Week!

“To keep the body in good health is a duty… otherwise we shall not be able to keep our mind strong and clear.”

…Buddha

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

Lamija Zimic, Doctor of Pharmacy Candidate 2018, USF College of Pharmacy

Adrianna Jackson, Doctor of Pharmacy Candidate 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