April 21, 2018 : Issue #934

• Everything You Need To Know To Prescribe An SGLT-2 Inhibitor (Part 1)
• Cardiovascular Disease and Mortality in Prediabetes
• The Reason to Urge Your Patients to Follow Proper Oral Care Routine
• Estrogen Treatment Helps To Prevent Type 2 Diabetes
• High Risk and Mortality in Patients With Atrial Fibrillation and Diabetes
• An SGLT-2 inhibitor Shows Renoprotective Benefits

I have been a fan of Indigogo and Kickstarter for the last couple of years and have invested in some good products and some not-so-good products. I have a Twicycle (https://twicycle.com) and Ice Plate – The DIY At Home Ice Cream Roll Maker on its way. They also have a lot of devices to help you do things better, like a self-making bed.  Two things recently caught my eye, an automatic toothbrush and teeth whitener and a Tooth Shower for oral care while you are showering. I am considering the automatic toothbrush / teeth whitener. 

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We can make a difference!

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Dave Joffe

Editor-in-chief

The American College of Physicians (ACP) has issued a new recommendation that type 2 patients should not have a target A1C level below 8 percent for any patient population and should not have any A1C targets for older adults (e.g., age 80 and older) or younger individuals with limited life expectancy because of other serious diseases and illnesses.

Do you agree with the American College of Physicians’ new A1C target recommendations?

Follow the link to share your opinion.

Finger-prick tests for blood glucose monitoring may soon be a thing of the past, due to an adhesive skin patch that measures glucose levels every 10–15 minutes, without pricking the skin. It still needs to go through all the testing before it becomes available. Created by researchers from the University of Bath in the United Kingdom, the novel patch has proven to be a feasible noninvasive strategy for glucose monitoring in tests of both pig and human skin. — Reported in the journal Nature Nanotechnology

Mr. Hernandez’ lab results are A1C 7.5%, FPG 137 mg/dL, LDL 190 mg/dL, HDL 38 mg/DL and triglycerides 232 mg/dL. He is started on metformin, lifestyle modifications, an ACE inhibitor, and a statin. He was asked to return in 3 months’ time to evaluate how everything is going. However, he fails to keep his appointment. He returns 1 year after his initial diagnosis for a recurrent yeast infection. His A1C is currently 7.7%. Upon questioning, he admits that while he has been good about taking his “heart meds,” he has not taken the “sugar pill” because he didn’t like it. What side effect did the patient most likely find intolerable?

A. Diarrhea and abdominal cramping
B. Paresthesias
C. Increased appetite
D. Insomnia

Follow the link for the answer.

This is a subject that many patients will ask you about. There have been mixed messages in the medical literature ever since the GISSI-Prevenzione and JELIS trials were published almost 20 and 10 years ago respectively, which showed the benefit of fish oil supplements.

This current analysis, done by a very experienced group with a track record of prior meta-analyses in lipid-lowering therapy, evaluated over 77,000 patients in 10 randomized trials of patients with either known ASCVD or at high risk for CV events randomized to omega-3 fatty acids vs control for at least 1 year. The mean daily dose in the studies for EPA/DHA was 735 mg/540 mg. MACE (major adverse cardiac events) were not reduced in the treatment population compared with control. There was no relation between dose and MACE reduction, nor was there a relationship to the presence of diabetes, lipid levels, or statin use. The 2016 European Society of Cardiology and European Atherosclerosis Society guidelines for prevention of cardiovascular disease indicated that it is debatable whether omega-3 FAs may exert a protective effect, and the 2016 guidelines on the management of dyslipidemia indicated that more evidence on the efficacy of omega-3 FA supplements for prevention of clinical outcomes is needed to justify their prescription. In contrast, the American Heart Association recommended that the use of omega-3 FAs for prevention of CHD is probably justified in individuals with prior CHD and those with heart failure and reduced ejection fractions. However, the results of the present meta-analysis provide no support for the recommendations to use approximately 1 g/d of omega-3 FAs in individuals with a history of CHD for the prevention of fatal CHD, nonfatal MI, or any other vascular events.

This meta-analysis demonstrated that omega-3 fatty acids had no significant association with fatal or nonfatal coronary heart disease or any major vascular events. It provides no support for current recommendations for the use of such supplements in people with a history of coronary heart disease. The results of the ongoing trials are needed to assess if higher doses of omega-3 FAs (3-4 g/d) may have significant effects on the risk of major vascular events.

JAMA Cardiol. 2018;3(3):225-234. doi:10.1001/jamacardio.2017.5205

Why and when to use this therapy to treat patients who have type 2 diabetes.

Method to identify prediabetes found to impact risk of heart disease or death.

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

New research shows how estrogen treatment helps to control blood sugar levels after menopause.

Risk for stroke significantly increased, but exceeded by heart failure

Subanalysis of CANVAS program shows slower progression of kidney disease, reduction in weight, reduction in A1c and even drop in blood pressure.

Quote of the Week!

“All you need is the plan, the road map, and the courage to press on to your destination.”

…Earl Nightingale

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