March 31, 2018 : Issue #931

• New Way to Screen for Diabetes and Prediabetes
• Study Evaluates Best Way to Diagnose Prediabetes
• Intensive Versus Standard Blood Pressure Control in Type 2 Diabetes
• Impact of Weight Gain on Cardiovascular Outcomes in Type 1 Diabetes
• Behind Empagliflozin’s Reduction in Cardiovascular Mortality
• The Reason to Urge Your Patients to Follow Proper Oral Care Routine

In the past when we worked with type one patients, we typically have had no issues with weight gain and obesity. Most of them seem to have the opposite problem and couldn’t retain weight. In addition, they are often concerned about hyperglycemia and so they usually don’t eat enough carbs to gain weight.

This seems to have changed over the past 10-12 years as we have gotten better insulins and monitoring devices so that patients could easily cover all the carbs they wanted with insulin without the fear of hypo- or hyperglycemia.

This week, our LECOM Pharm D. Candidate Vidhi Patel has looked into how this excess weight that our newer type one patients are presenting with can increase cardiovascular risk and greater hypertensive control issues.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Sanofi, in collaboration with Lexicon Pharmaceuticals, has submitted a New Drug Application (NDA) to the Food and Drug Administration (FDA) for sotagliflozin, an investigational dual sodium-glucose co-transporter types 1 and 2 (SGLT1, SGLT2) inhibitor, intended for use with insulin to improve glycemic control in adults with type 1 diabetes. Sotagliflozin works by inhibiting the two proteins responsible for glucose regulation: SGLT1 (responsible for glucose absorption in the GI tract) and SGLT2 (responsible for glucose reabsorption by the kidney).

Would you vote for Medicare for All? Follow the link to share your opinion.

According to the briefing document for the Eversense Implanted 90-day CGM, by Senseonics, 87% of readings with the system were within 15 mg/dL or 15% of reference while accuracy was within 8.5% from the 15,753 readings. Learn more about the Eversense System.

BD plans to enter the estimated $1 billion market for insulin patch pumps for patients with type 2 diabetes. Last year, BD announced its intention to dive into the emerging market for insulin patch pumps for patients with type 2 diabetes, with an expected product launch sometime in 2019. Unlike traditional insulin pumps, patch pumps adhere directly to a user’s skin and require no tubing. BD said last year that its patch pump will feature adjustable basal and bolus insulin rates and will be small enough to fit in the palm of your hand. The device is initially expected to launch in the United States, Western Europe, and Canada.

Mrs. O’Doole is a 34 year-old of Irish descent. She works as a florist and is married with three children. She arrives at your clinic for her annual wellness exam. Her blood pressure is 130/84 mmHg, pulse 65, BMI 24 kg/m2 and her physical exam is notable for acne and mild hirsutism. Her only current medication is oral birth control pills. She recalls starting OCP, 15 years prior, due to irregular menses. Based upon her medical history and physical, you believe it would be prudent to screen Mrs. O’Doole for type 2 diabetes. The lab returns a fasting plasma glucose (FPG) of 112 mg/dL. You share these results with your patient and inform her that while only mildly elevated, she has impaired fasting glucose. You recommend that she see a diabetes educator to help her modify her diet and exercise to lose some weight.

At a follow-up appointment 6 months later, Mrs. O’Doole tells you despite good intentions, she has not been able to adhere to any meaningful lifestyle changes. In fact, she has gained 5 pounds. At this time, her repeat fasting plasma glucose shows FPG 138 mg/dL. After discussing management options with her, you decide the best management would be:

A. lifestyle modifications only
B. metformin only
C. metformin + continue with lifestyle modifications
D. repaglinide only

Follow the link for the answer.

According to the findings from an observational study, looking at the impact of aspirin for primary prevention in patients with type 2 diabetes and heart failure, Abi Khalil and colleagues identified 12,534 patients in The Health Improvement Network (THIN) database of patients seen in primary care in the United Kingdom. Patients were 55 years of age or older with no previous MI, stroke, peripheral artery disease, or atrial fibrillation. Just over half (6,567 patients) were not taking aspirin, and of the others who were taking aspirin, most were taking low-dose (75 mg/day) aspirin. Only 137 patients were taking higher dose aspirin (≥100 mg/day). During a mean follow-up of 5.2 years and up to 16.7 years, the primary outcome — a composite of all-cause mortality with or without hospitalization for HF — was 10% less likely in the patients who were taking aspirin (hazard ratio, 0.89; 95% CI, 0.84 – 0.94), after multivariable adjustment.  However, patients who were taking aspirin had a 50% increased risk for nonfatal MI or stroke, but without any significant difference in risk for major bleeding. So, the final results found those taking aspirin for primary prevention had a lower mortality, specifically all-cause mortality with or without HF hospitalization over a 5-year follow-up, but were paradoxically more likely to have a nonfatal myocardial infarction (MI) or stroke. The findings will be presented March 11 at the American College of Cardiology at the American College of Cardiology (ACC) 2018 Scientific Sessions.

Dental exams may be earlier predictor of disease than even blood tests.

Researchers compare fasting BG, HbA1c and 2-hour plasma glucose test.

Trials find intensive control reduced cardiovascular events in high-risk, diagnosed patients.

Excessive weight gain due to intensive therapy can lead to increased cardiovascular risk factors.

Post-hoc analysis of the breakthrough EMPA-REG Outcome trial demonstrated reduction in composite cardiovascular outcomes that can be seen with empagliflozin therapy.

Study shows that good periodontal health is necessary to achieve a favorable glycemic status.

Quote of the Week!

“He who has courage and faith will never perish in misery!”

…Anne Frank

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

Lamija Zimic, PharmD(c), University of South Florida College of Pharmacy

Vidhi Patel, Pharm. D. 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