April 14, 2018 : Issue #933

• Prediabetes a Pathway to Heart and Kidney Disease
• A1c Crucial Prior to Any Surgery
• Effect of Fenofibrate on Cardiovascular Risk in Type 2 Diabetes
• Empagliflozin Reduces Cardiovascular Mortality
• Incident Diabetes And Diabetes Treatment in Postmenopausal Women
• The Joint is Jumping: CGMS, AI and Wearables
  • Guest Post by David Kliff, Editor, Diabetic Investor

A couple of days ago we sent out our latest therapy update on SGLT-2 Inhibitors. This class of drugs shows multiple ways to decrease A1c values with a small risk of hypoglycemia. This means that individual glucose levels often are not of concern. This is not true with our insulin-using patients and many of them don’t maximize therapy in order to avoid low glucose readings.

This week, our good friend from Diabetic Investor, David Kliff, gives us an update on what is happening with CGMS, Insulin Pumps, Smart Pens and Software, and what the future holds for managing tighter control.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Do you prescribe sulfonylureas?

Millions of people worldwide are prisoners of their medication. With LifeinaBox, the world’s smallest intelligent fridge, your patients can travel anywhere, any time, with their medication. Keeping medication cool has never been so easy. It can be taken any place, any time, keeping medication at the right temperature.  It can be connected to the Lifeina App to follow the temperature of the patient’s medication and to better manage medication schedules. Suitable for insulin, adrenaline, growth hormones, anti-TNF, or any other medication that needs to be kept cool. By the end of 2019, they hope to have a pen-tube and also a pocket cooler. Product not yet available in the U.S. — https://www.lifeina.com/

Mr. Hernandez’s labs are notable for A1C 7.5, FPG 137 mg/dL, LDL-cholesterol 190 mg/dL, HDL-cholesterol 38 mg/dL, and triglycerides 232 mg/dL. You discuss his lab results, his diagnosis, and how to manage diabetes, then you make referrals to the appropriate diabetes team clinicians. You start Mr. Hernandez on metformin, lifestyle modifications, an ACE inhibitor, and a statin.

What clinical parameters are you looking to achieve?

A. A1C less than 7%, BP less than 130/80 mmHg, LDL less than 100 mg/dL
B. A1C less than 7%, BP less than 130/90 mmHg, LDL less than 100 mg/dL
C. A1C less than 7%, BP less than 140/80 mmHg, LDL less than 100 mg/dL
D. A1C less than 7%, BP less than 140/90 mmHg, LDL less than 150 mg/dL

Follow the link for the answer.

This expanded indication allows for use in adults with type 2 diabetes whose blood sugar is uncontrolled on one or more therapies with diet and exercise, as adjunctive to metformin or without metformin. The injectable suspension GLP-1 receptor agonist works by aiding in insulin production in response to a rise in glucose, as well as a reduction in glucagon production and slowing of gastric emptying in order to reduce hyperglycemia. The new approval is based on findings from the 28-week DURATION-7 study, which reported positive outcomes compared with placebo for both weight loss and HbA1c improvement. When exenatide extended-release was added on to insulin glargine, mean HbA1c was lowered by 0.9% versus 0.2% in placebo, without a significant increase in hypoglycemia risk. In addition to A1c reduction, the study also reported significant improvements in weight loss with the combination GLP-1RA treatment. — Frias J. et al. “Efficacy and safety of exenatide QW versus placebo added to insulin glargine in uncontrolled basal-insulin treated type 2 diabetes: DURATION-7 trial.”

Individuals with undiagnosed diabetes, prediabetes found to have high incidence of unrecognized chronic kidney disease.

Study finds higher hospital admissions, complications, and mortality rates among patients with increased A1c.

Studies find greater risk reduction following treatment of patients with dyslipidemia.

Most important mediator due to changes in markers of plasma volume.

Secondary analysis evaluates effect of Women’s Health Initiative dietary intervention.

Guest Post by David Kliff, Editor, Diabetic Investor
Senseonics has taken their Eversense implantable CGM before an FDA panel, and Bigfoot has announced they have closed their series B $55 million financing round. The FDA has approved Dexcom’s G6 system, pushing shares in the company higher in early trading. And while they didn’t announce anything recently, our friends at Tandem are feeling the love as shares continue to surge higher in anticipation of their new system, which has low glucose suspend.

Quote of the Week!

“Keep your face always toward the sunshine – and shadows will fall behind you.”

…Walt Whitman

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

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