December 8, 2018 : Issue #967

• ADA’s Position on the Evaluation and Management of Type 2 Diabetes in Youth
• Potential Risks of Cannabis Use in People with Type 1
• The Delayed Effect of Dietary Change on Insulin Sensitivity in Children with a Family History of Obesity
• Liraglutide Lowers Risk of Cardiovascular Events In Type 2 Diabetes
• Stricter Treatment Targets for Gestational Diabetes Leads to Earlier Births, No Difference in Birth Weight
• Genetic Risk Score for Type 1 Diabetes Predicts Progression of Disease

It has always been thought that if you use marijuana, you will get the munchies, and we had a whole generation of pot users who just couldn’t get enough to eat. Back in the 70’s and 80’s, we were just beginning to be concerned with type 2 diabetes care and we really didn’t care about those pot smoking “hippies” with diabetes.

Now that marijuana, THC, and CBD use is legal in many states, there is a concern that patients would be more likely to end up in the hospital with DKA either from the effects of cannabis consumption and use, or increased food consumption. When we asked our intern, Michael Zaccaro, Pharm. D. Candidate 2019, LECOM School of Pharmacy, to investigate this, he was able to find one study that had some interesting and unexpected findings. Click here to read what he found out.

*****************************

We can make a difference!

*****************************

Dave Joffe

Editor-in-chief

With all the new insulin pump technology, do you feel that more patients, with either type 1 or type 2 using insulin, will move towards the smart pump rather than an insulin pump? Follow the link to see how you compare to your colleagues.

For some people living with diabetes, it can be difficult to afford care. Lilly is offering a new program that may help. For your patients who use insulin, Lilly announces long-term savings for those with the greatest need, including point-of-sale savings, counsel on accessing insulin through free clinics, and support for immediate needs. Have your patients contact the Lilly Diabetes Solution Center at 1-833-808-1234, Monday-Friday 9AM-8PM ET.

John S. is a 63-year-old white man with significant abdominal obesity, type 2 diabetes, hypertension, and dyslipidemia as well. On the basis of an exercise stress test, John was recently diagnosed with silent ischemia. John’s current medications include metformin, a DPP-4 inhibitor, an ACE inhibitor/HCTZ agent, a calcium channel blocker, a high-dose statin, and ezetimibe. John’s relevant physical exam and laboratory findings are as follows:

BMI: 34.8 kg/m2
Blood pressure: 140/86 mm Hg
HbA1C: 7.2%
Total cholesterol: 150 mg/dL
LDL-C: 79 mg/dL
HDL-C: 42 mg/dL
Triglycerides: 145 mg/dL
non-HDL-C: 118 mg/dL
eGFR: 65 mL/min/1.73 m2
ACR: 100 mg albumin/g creatinine

Which statement best describes the evidence supporting cardiovascular benefits of the antihyperglycemic agents available to treat John’s type 2 diabetes?

A. Further glucose reduction using any available agent should have similar cardiovascular disease benefit.
B. Thiazolidinediones increase the risk of heart failure and myocardial infarction in patients with type 2 diabetes.
C. Two approved GLP-1 receptor agonists have been shown to reduce mortality in patients with type 2 diabetes and cardiovascular disease.
D. Both GLP-1 receptor agonists and SGLT2 inhibitors affect cardiovascular risk through the same physiologic mechanisms.

Follow the link for the answer.

If you drink coffee, you already know that coffee is considered a superfood. Coffee is loaded with essential nutrients and antioxidants, and studies show that coffee raises your metabolism and makes you smarter.  According to a meta-analysis of 30 studies and nearly 1.2 million participants, drinking three to four cups of coffee a day reduces the risk of type 2 diabetes. Both decaf and full-strength coffee are said to be beneficial, according to a meta-analysis published in Nutrition Reviews. They found in the study that there was a reduction in the risk of type 2 diabetes from daily coffee consumption and that drinking 3 to 4 cups of coffee per day is associated with 25% lower risk of developing type 2 diabetes. The conclusion was that coffee’s benefits primarily come from its natural compounds, not the caffeine content. However, the risk reduction was slightly higher in caffeinated coffee. Of course, correlation doesn’t equal causation. It’s possible that people who were less likely to get diabetes simply happened to drink more coffee. Also, coffee contains cafestol and kahweol —  potent anti-inflammatories. Studies show that chronic inflammation is linked to metabolic disorders like type 2 diabetes, as well as cardiovascular disorders. That means drinking coffee helps curb inflammation, which reduces the risk of chronic disease. A couple of other reasons for the benefits of coffee is that it: increases metabolism, reduces oxidative stress, fights inflammation, feeds good gut bacteria, and may even help to regulate blood sugar.

Specific treatment recommendations outlined for this growing patient population.

Study assesses the prevalence of complications following regular use of cannabis.

Variations in certain macronutrients may be correlated to change in insulin sensitivity/resistance.

GLP-1 treatment benefits patients on statins and with varying LDL levels.

New study shows implementing tighter treatment goals for GDM does not improve birth weight in neonates, but may increase risk for earlier birth and clinician intervention.

Study focuses on score accuracy to improve prediction models for the better.

Quote of the Week!

“Sometimes things aren’t clear right away. That’s where you need to be patient and persevere and see where things lead.”

….Mary Pierce

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

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

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