December 1, 2018 : Issue #966

• Reversal of Prediabetes with Medication in High-Risk Populations
• Biomarkers for Diabetes May Differ Based on Childhood Experiences
• Comparison of Cognitive Benefit Between SGLT-2 Inhibitors and Incretins
• Effects of Intensive Control on Quality of Life in Type 2 Diabetes
• Diuretics and Risk of Lower Limb Amputation in People Who Have Type 2 Diabetes
• Updated Federal Physical Activity Guidelines: Do They Apply to People with Diabetes?
  • By Sheri R. Colberg, PhD, FACSM

For the last two years, my wife has been controlling her diabetes with long-acting insulin, a GLP-1 analog, and an SGLT-2 Inhibitor. After she was diagnosed two and a half years ago, she lost over 80 lbs and her A1c went from 13.7 to 7.2. Over the past four months, she had seen her SMBG readings increase by 40 to 50 mg/dl, even though she was still watching her carbs, increasing her long-acting insulin and riding her bike 12 to 15 miles a day.

A recent bout with mild food poisoning sent her to the hospital with severe nausea and vomiting, dehydration and, you guessed it, DKA. After three days in the hospital, she was discharged and we started her on mealtime insulin with a correction factor and carb ratio.

At first, she felt like her condition was getting worse because of the addition of the mealtime insulin, but after we discussed it, she realized that she actually had more control over her health and that this would likely be a better method for care.

This kind of thinking goes along with a study of over 1,600 patients in the Fremantle Diabetes Study Phase 2, looking at the patient perception of health and quality of life issues. Click here to see how their findings correlate with my wife’s opinion.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Do you consider ethnicity when determining the best treatment options for your patients? Follow the link to see how you and your colleagues compare.

GliControl allows you to keep a daily log for diabetes. View a list of glucose records/carbohydrates/insulin, insulin assistant, analysis. reports. medications with alerts, and much more.

Which of the following is a recognized strategy when considering diet and exercise in the management of hypertriglyceridemia?

A. Individuals should consume 45% of calories as fat, with saturated fat reduced to approximately 20% of calories.
B. Restricting simple carbohydrates and increasing dietary fiber are ineffective for lowering triglycerides.
C. Exercise has minimal impact on lowering triglyceride levels.
D. Progressive aerobic and toning exercise, weight loss, and dietary management can significantly lower triglyceride levels.

Follow the link for the answer.

More and more, we are seeing that ethnicity and genetic background can play a role in how patients react to specific treatments. When it comes to determining the best treatment for certain diseases, we are becoming more aware of the fact that some treatments work better or worse for patients with certain genetic and ethnic backgrounds. In a recent study of adults with type 2 diabetes, those of black Caribbean ethnicity who are prescribed insulin are at increased risk for hypoglycemia as are those of black Caribbean, black African or Bangladeshi ethnicity who are prescribed a sulfonylurea, compared with adults of white British ethnicity, according to findings published in Diabetic Medicine. Additionally, researchers found a lower risk for hypoglycemia among adults with type 2 who are of Indian and Bangladeshi ethnicity when taking insulin vs. sulfonylurea in comparison with other populations. We are just beginning to look at ethnicity and genetic backgrounds before we determine the best treatments for the individual patient, called “personalized medical treatment.” A current study used data from electronic health records of 19,771 adults with type 2 diabetes who were patients at 128 general practices. The patients were prescribed insulin or a sulfonylurea 6 months before January 2013 (mean age, 66.2 years; 46.5% women). The study spanned from 2013 to 2015. Study participants were divided into two cohorts based on whether they were prescribed insulin (n = 7,269) or sulfonylurea (n = 12,502). Nine ethnic groups were examined, with those of white British ethnicity (17.3%) used as reference for comparison: Bangladeshi (26%), Indian (10.8%), black Caribbean (9.7%), black African (8.5%), other white (7%), Pakistani (6.7%), other South Asian (3.8%), other black ethnicities (3.5%) and the rest “other” or not recorded. Among the insulin cohort, hypoglycemic incident rates were highest for adults of black Caribbean ethnicity compared with adults with white British ethnicity. Adults of Bangladeshi ethnicity had the lowest incidence rate of any of the nine ethnicities in the study.

Among the sulfonylurea cohort, adults of black Caribbean, black African, Indian, and other South Asian ethnicities were at a higher risk for hypoglycemia than those of white British ethnicity. “The higher risk of hypoglycemia found among black African/Caribbean ethnic groups may be partly explained by relatively intensive glycemia targets in these ethnic groups. Black African/Caribbean and South Asian ethnic groups tend to have higher HbA1c levels at a given blood glucose than their white European counterparts,” the researchers wrote. “Consequently, these individuals may be at greater risk of hypoglycemia than white European populations when lowering HbA1c to national and international glycemic targets.”  The researchers also found that insulin use by adults of Indian and Bangladeshi ethnicity had a decreased hypoglycemic risk compared with sulfonylurea risk.

Medical researchers are now paying increasing attention to findings of racial or ethnic differences in quality and access to care, health outcomes, risk factors, genetic markers, and therapeutic response. However, this attention has been met with growing controversy and debate. Society’s history of discrimination, racism, and eugenics, and continued disparities in access and quality of care make this a particularly sensitive issue and an important one for the future of research.

Diabetes Care 2003 Jul; 26(7): 2189-2193.https://doi.org/10.2337/diacare.26.7.2189

New study shows treating prediabetes risk for developing diabetes could reverse the disease before it starts.

MIDUS study looks at individual adverse childhood experiences and their impacts on future diabetes.

Which antihyperglycemic agent will provide the greater cognitive benefit in patients who are elderly and have diabetes?

Will perceived quality of life be affected by increasing antidiabetes medication burden on the patient?

New study shows diuresis, canagliflozin use nearly doubled risk of complications.

In mid-November 2018, the U.S. Department of Health and Human Services finally released new physical activity guidelines (as a 2nd edition) to update their previous set from a decade before. Various activity guidelines for adults with diabetes have been updated several times in the interim, including a 2010 position statement on exercising with type 2 diabetes published jointly by the American College of Sports Medicine and the American Diabetes Association; a 2016 ADA position statement on exercise and physical activity for all types of diabetes; and a consensus statement on being active with type 1 diabetes published in The Lancet in 2017.

Quote of the Week!

“It is amazing what you can accomplish if you do not care who gets the credit.”

….Harry S. Truman

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

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

Arsalan Hashmi, PharmD. Candidate, LECOM College of Pharmacy

Michael Zaccaro, Pharm. D. Candidate 2019, LECOM School of Pharmacy

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