October 6, 2018 : Issue #958

• WHO Guidelines Recommend Treatment Intensifications in Type 2 Diabetes
• Poor Glycemic Management Equals Risk of Dementia
• Poor Understanding of Diabetes Therapy Leads to Increased Hba1c In Type 2 Diabetes
• Semaglutide May Foster Significant Weight Loss in Patients with Obesity
• GLP-1 Agonists Do Not Increase Risk for Diabetic Retinopathy
• Can Exercise Overcome Environmental Impacts like Pollution on Diabetes Risk?
  • by Sheri R. Colberg, PhD, FACSM

Last Saturday I did a CE presentation to the Florida Consultant Pharmacy Association. They are the pharmacists that take care of our older patients who are in assisted living and nursing home facilities. The CE was part of morning of Dementia and Alzheimer’s education. My program Diabetes Care and Dementia, Alzheimers, and Memory Loss, looked at the relationship between diabetes and dementia, and how these two somewhat distinct diseases actually had a lot in common, and how each of these diseases had a negative effect on each other.

In the CE I presented 10 well respected studies on the relationship of diabetes to dementia, and this week our LECOM Pharm D. Candidate, Clark Powell, shares another one looking at the effect of poorly managed A!c levels in Type 1 patients and increased risk of developing dementia.

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We can make a difference!

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Dave Joffe

Editor-in-chief

In your experience, what have most studies about CGM demonstrated?

– HbA1c is lower in CGM users regardless of age or type of insulin delivery.
– Patients using MDI + CGM have greater reductions in HbA1c than those using CSII + CGM.
– Reductions in glycemic variability and time spent in hypoglycemia are not significantly different between SAP and MDI/RT-CGM therapy groups.
– All of the above

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

The DOJ announced on September 26, 2018 that they had entered into a settlement with KinderCare regarding administering insulin via pen or syringe to children with type 1 diabetes. Under the agreement, KinderCare is obligated to take critical steps toward improving access for children with Type 1 diabetes, including revising its policies and procedures, revising its training, and performing initial and ongoing assessments of the need for reasonable accommodations. Click here for more information.

iFORA – Diabetes Manager app designed to make busy lives easier to manage. iFORA comes with advanced mobile technology, sleek interface design, detailed and yet careful data management tools to assist you in better diabetes management. The easy-to-use tools can help you better understand how your blood glucose level interlinks with a positive self-monitoring process through recording, tracking, seeing your diabetes information in statistic trend graphs, target pie charts and exporting data to Fora TeleHealth solution to share with your doctor.

Which is not a side effect of SGLT-2 Inhibitors?

A. Kidney failure
B. Hyperkalemia
C. Ketoacidosis
D. Hypertension
E. Increased cholesterol levels
F. Serious urinary tract infections
G. Increased bladder cancer risk
H. Serious allergic reactions

Follow the link for the answer.

The study in The Journal of Nutrition also saw a reduction risk for women by 7%. Danish researchers analyzed data from the Danish Diet, Cancer and Health study for 55,465 adults. Cecilie Kyrø, MSc, PhD, from the Danish Cancer Society Research Center, Copenhagen, Denmark, and colleagues wrote, “Whole grains and cereal fiber may offer protective effects on type 2 diabetes risk.” They analyzed data from the Danish Diet, Cancer and Health cohort to examine how whole grain intake affects the risk of type 2 diabetes. A total of 55,465 adults ages 50 and 65 years were included in the study and completed a food-frequency questionnaire on total whole grain intake, including different cereal products and types. The researchers found that each whole grain serving of 16 g per day lowered the risk for type 2 diabetes by 11% among men (HR = 0.89; 95% CI, 0.87-0.91) and by 7% among women (HR = 0.93; 95% CI, 0.91-0.96). The highest consumption of whole grains (50.8 g or more per day) was associated with a 34% lower risk for type 2 diabetes among men and a 22% lower risk among women, compared with the lowest whole grain consumption. The final result of the study showed that there are consistent associations between high whole-grain intake and lower risk of type 2 diabetes, plus an association was found for all different cereals and whole-grain products that were tested. — Journal of Nutrition July 17, 2018

Medications suggested for second- and third-line treatments for diabetes management following treatment failure with metformin and sulfonylureas.

Patients with type 1 diabetes and prolonged increased HbA1c were found to be at two-times greater risk for dementia than those with well-managed HbA1c values.

Thorough knowledge of anti-diabetes medications found to lead to better management, adherence.

When combined with diet and exercise, GLP-1 medication showed significant weight loss compared to liraglutide and placebo, a new study finds.

New findings compare treatment with patients taking two or more glucose-lowering agents.

By Sheri R. Colberg, PhD, FACSM
It’s known that lack of exercise, poor eating habits, genetics, and lifestyle factors can all contribute to the onset of prediabetes and type 2 diabetes. I have spent many years touting the benefits of lifestyle change to prevent and manage these health conditions—and in some cases reverse them. Exercise is a particularly important lifestyle management tool because of its ability to lower inflammation (the underlying cause of insulin resistance) naturally.

Quote of the Week!

“It is not ignorance but knowledge which is the mother of wonder.”

…Joseph Wood Krutch

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

Melissa Bailey, Pharm.D. Candidate, USF College of Pharmacy

Clarke Powell, Pharm.D. Candidate 2019, LECOM School of Pharmacy

Your Friends in Diabetes Care
Steve, Dave, and Joy
Diabetes In Control
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