February 2, 2019 : Issue #975

• Insulin Pump Use and Exercise Strategies
  • By Sheri R. Colberg, PhD, FACSM
• Albuminuria Change and Risk of End-Stage Kidney Disease
• The Best Time To Exercise for Type 2 Diabetes
• Omega 3 Fatty Acid Supplementation in Type 2 Diabetes
• Reducing Risk of Macrovascular Disease With Bariatric Surgery
• Your Help Needed! New Diabetes in Control Features

It was about 22 years ago that I first hooked up with our publisher, Steve Freed. I had gotten involved with a nutritional multilevel company that had a soluble fiber product with two patents for lower serum cholesterol, and could level blood sugars.

As you know, in an MLM company, you recruit others to join your team and I figured why not pharmacists? I found Steve on an old pharmacy bulletin board, and went to work recruiting him. I found out he was a diabetes educator and so I tried to stress the value of the product for diabetes. Steve called my bluff and said if I learned about diabetes, he would partner in the nutritional business with me. I was just gullible enough to take him up on the offer and that is what led us to start Diabetes in Control.

Fourteen years ago, we convinced the manufacturer of that original product to fund a study on our website using the product, and we saw great results in both lipid and glucose control. Most everyone had a different explanation for the results, but this week in our “Did You Know” item the ADA in their recent edition of Diabetes Care listed the multitude of reasons why a viscous soluble fiber product is so good.

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

We can make a difference!

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

Dave Joffe

Editor-in-chief

Do you tell your patients with type 2 the best time to exercise? Follow the link to see how you and your colleagues compare.

The FDA has announced that the implanted Senseonics Eversense CGM Sensor no longer needs to be removed when having an MRI.

The Glucophage XR and Glucophage brand name products have been discontinued. The metformin (generic brands) will remain available.

Electronic health records (EHRs), electronic prescribing (e-prescribing), and other health information technology (HIT)-related tools are a mainstay in healthcare, and their introduction has brought about significant changes in how medications are prescribed, dispensed, and administered. If the conventions used to communicate medication information electronically are not carefully considered, these technologies may contribute to medication errors rather than mitigate risks. To address this concern, ISMP has developed the ISMP Guidelines for Safe Electronic Communication of Medication Information, with input from clinicians, government and standards-setting agencies, professional organizations, and electronic pharmacy information, health information, and prescribing system vendors. The scope of the guidelines is narrow and covers only issues that deal with how information about medications is communicated in electronic formats, including EHRs, pharmacy computer systems, e-prescribing systems, and other displays of electronic health information when using medication administration records, barcode scanning systems, smart infusion pumps, and automated dispensing cabinets. The guidelines recommend strategies to present drug information safely in various electronic formats and suggests specific HIT-associated design features intended to mitigate the risk of medication errors. Visit www.ismp.org/MERP to report a medication error. Download the Guidelines for Prevention of ePrescribing Errors(pdf).

Which of the following items would you be interested in seeing added to DIC?

Which is more efficacious in improving glucose levels in individuals with type 2 diabetes — morning, afternoon, or evening exercise? Or does it matter? Follow the link to see.

In a review of 28 trials with a total of 1,400 patients, researchers discovered that recommending a viscous fiber supplement can help to reduce HbA1c and improve fasting blood glucose and insulin resistance in patients with type 2 diabetes. Evidence from randomized controlled trials (RCTs) suggests that viscous dietary fiber can offer beneficial effects on glycemic control and, thus, an improved cardiovascular disease risk profile. Viscous fiber at a median dose of ∼13.1 g/day significantly reduced HbA1c fasting blood glucose compared with control and in addition to standard of care. The certainty of evidence was graded moderate for HbA1c, fasting glucose, fasting insulin, and HOMA-IR and low for fructosamine. From the results, it was concluded that viscous fiber supplements improve conventional markers of glycemic management beyond usual care and should be considered in the management of type 2 diabetes. — Diabetes Care 2019 Jan; dc181126. https://doi.org/10.2337/dc18-1126

By Sheri R. Colberg, PhD, FACSM

Whether you have type 1 or type 2 diabetes, if you use insulin, you may choose to use a specialized insulin pump for both your basal and bolus insulin delivery. Pumps have a small catheter placed under your skin and are programmed to cover your basal insulin needs by delivering small doses of fast-acting insulin to mimic normal insulin release by the pancreas. Insulin pumps are programmed to deliver small, basal doses of fast-acting insulin to mimic normal insulin release by the pancreas throughout the day. These pumps are not ideal for everyone, and the choice to use one should be an individual one.

Change in albuminuria as a surrogate endpoint for progression of chronic kidney disease strongly supported by biological plausibility, but empirical evidence to support validity in epidemiological studies still lacking.

Study aims to determine whether exercise training at two distinct times of day would have differing effects on 24-hour glucose levels in men with type 2 diabetes.

Trial assesses cardiovascular benefit in patients with diabetes.

Patients with severe obesity and type 2 diabetes and without bariatric surgery are assessed to determine comparative incidence of macrovascular disease.

Quote of the Week!

“Eagles come in all shapes and sizes, but you will recognize them chiefly by their attitudes.”

….E. F. Schumacher

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

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

Annahita Forghan, Pharm.D. Candidate 2019, 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