October 13, 2018 : Issue #959

• Delaying the Progression of Type 1 Diabetes
• Aspirin No Longer Preventative Drug for Cardiovascular Disease
• Omega-3 Supplementation Fails to Prevent Heart Disease
• How Ethnicity Can Influence the Risk of Type 1 Diabetes
• Lack of Sleep Slows Wound Healing in Patients with Type 2 Diabetes
• Empagliflozin as First Line in Patients with Type 2 and Fatty Liver Disease

If you have ever had to deliver the message to the parent of a newly diagnosed type 1 patient, you likely have had to explain why we don’t manage to perfection from day 1. Sometimes these adults can not grasp the concept of a honeymoon period where the pancreas starts producing insulin again. In addition, they often see the honeymoon period and decide that their child is “cured” or that your diagnosis was wrong.

For most of these younger patients physical activity is not a problem, but as we find that the age of diagnosis seems to now reach more often into adulthood, getting these patients to exercise is often more difficult.

This week we have a new study from “Diabetic Medicine” that our PharmD Intern, Angela Reyes, reviewed, that delivers strong evidence that the honeymoon period could last 5 times longer in newly diagnosed type 1 patients if they were physically active.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Do you think that having your patients who have type 2 and are not on insulin wear a CGM can improve their numbers? Follow the link to see if you and your colleagues agree.

Download this helpful chart comparing GLP-1 agonists by evaluating how they can reduce cardiovascular disease. GLP-1 Comparison with CVD (pdf)

SugarBEAT® is a non-invasive, affordable, and flexible Continuous Glucose Monitor (CGM) developed by Nemaura Medical Inc. and designed to provide persons with diabetes and prediabetes with an Ambulatory Glucose Profile (AGP) as a superior metric to better manage their glucose levels as compared to an HbA1c reading. People who take insulin can adjunctively use sugarBEAT when calibrated with a finger-stick glucose reading. SugarBEAT is expected to launch in the United Kingdom in 2018.

Hypertriglyceridemia, a condition in which triglyceride levels are elevated, is a common disorder in the United States. It is often caused or exacerbated by untreated diabetes mellitus, obesity, and sedentary habits, and is a risk factor for coronary artery disease. Additional risk factors for hypertriglyceridemia include diet, stress, physical inactivity, and smoking. More than 25% of US adults have elevated triglycerides.

Which of the following is true regarding the epidemiology of hypertriglyceridemia?

A. Triglyceride levels increase gradually in women until about age 50 years and then decline slightly.
B. Triglyceride levels in men continue to increase with age.
C. Mild hypertriglyceridemia (triglyceride level > 150 mg/dL) is slightly more prevalent in women beginning at age 30 years and in men starting at age 60 years.
D. People who are African American often have lower triglyceride levels than people who are Caucasian.

Follow the link for the answer.

The results of the InTandem study were presented at the 54th Annual Meeting of the European Association for the Study of Diabetes. Sotagliflozin is currently under investigation for the treatment of type 1 diabetes. It is the first drug to combine both SGLT-1 inhibitor and SGLT-2 inhibitor-2 effects. These agents work primarily by inhibiting absorption of glucose by the kidneys. Sotagliflozin has an additional SGLT-1 inhibitor effect, which acts primarily on the gut, delaying and blunting absorption of glucose and galactose. More than two-thirds of patients [with type 1 diabetes] do not achieve target HbA1s, and more than two-thirds of patients in the U.S. have excessive weight or obesity. This drug does not require insulin for its action, which differentiates it from the other antidiabetes drugs that have been unsuccessfully tried for use as adjunctive therapy in type 1 diabetes. These include metformin, GLP-1 receptor agonists, and DPP-4 inhibitors. For this double-blind, 52-week trial, 793 adults with type 1 diabetes who were being treated with multiple daily insulin injections (40%) or an insulin pump (60%) were randomized to placebo (n = 268), sotagliflozin 200 mg (n=263), or sotagliflozin 400 mg (n=262) once daily.  At week 52, patients taking sotagliflozin had significantly reduced HbA1c, weight, bolus insulin, fasting plasma glucose, and patient distress, compared to placebo. Among patients with systolic blood pressure > 130 mm Hg at baseline, blood pressure also dropped significantly. The proportion of patients who experienced a net clinical benefit was 26.2% with the 200 mg dose of sotagliflozin and 32.4% with the 400 mg dose compared with 19.0% among patients in the placebo group (P < .05 for each comparison with placebo). For weight loss, -3.14 kg ± 0.34; P< .001 for the 200 mg dose and -4.32 kg ± 0.35; P< .001, for the 400 mg dose. — 2018 EASD

Exercise can lengthen remission after being diagnosed with type 1 diabetes.

Increased risk of hemorrhage with no significant lowering of cardiovascular risk means low-dose aspirin recommendations are in peril.

No significant statistical differences found between patients with diabetes using supplement versus placebo.

Obesity found as additional impact in patients with multiple autoantibody positivity.

Study shows mice with obesity and type 2 have significantly slower healing of wounds compared to those with undisturbed sleep.

Multiple studies find drug to be first diabetes medication to show significant reduction of liver fat.

Quote of the Week!

“The two most powerful warriors are patience and time.”

…Leo Tolstoy

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

Angela Reyes, Pharm.D. Candidate, LECOM College of Pharmacy

Your Friends in Diabetes Care
Steve, Dave, and Joy
Diabetes In Control
810 Bear Tavern Road Suite 102
Ewing, NJ, 08628
USA
www.diabetesincontrol.com