March 16, 2019 : Issue #981

• Effects of Metformin Go Beyond the Treatment of Type 2 Diabetes
• Combining High Intensity Exercise And Carb Intake in Type 1 Diabetes
• Diabetes and Chronic Kidney Disease

Metformin was approved in Canada in 1972, but did not receive approval by the FDA for type 2 diabetes until 1994, this because its sister drug phenformin happened to kill people. Although it took us 22 years to get approval we have certainly used enough in the past 25 years to make up for it.

Even with all the new whiz-bang drugs that have been developed, metformin is still the number one choice for patients newly diagnosed with type 2 diabetes. In fact, we even prescribe it for pre-diabetes, and a lower strength dose was actually part of the super pill trilogy (along with lisinopril and lovastatin) that medical researchers and public health officials wanted everyone to take, along with a multivitamin.

This week we have a compilation of research by our LECOM School of Pharmacy Pharm D. Candidate, Ghazal Blair, looking at the extra effects of metformin, especially those that affect the heart. Click here to learn why metformin is the Eveready Bunny of diabetes drugs.

ARB Update: this week the FDA gave provisional approval to a new generic manufacturer of Valsartan because of the increasing shortage of safe non-contaminated active ingredient. Hopefully they did a thorough job of vetting the manufacturer. If you want to learn what is really going on and what to do for your patients, click here.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Zydus Cadila’s sitagliptin and metformin hydrochloride extended-release tablets, a generic version of the diabetes drug Janumet XR, has been tentatively approved by the FDA. The drug will be released in three strengths — 50 mg/500 mg, 50 mg/1,000 mg and 100 mg/1,000 mg.

This calculator from Verywell Fit tells your patients how many calories they are burning according to the type of exercise they are performing and the length of time.

Could it be running, biking, lifting weights, rowing, or maybe elliptical exercises?   The purpose of this study was to explore the long‐term effects of aerobic training (AT), resistance training (RT), and combined training (AT + RT) on the prevention of T2D incidence in patients with prediabetes. When it comes to cutting diabetes risk, the type of exercise a person engages in can matter, a new study says.  In this randomized controlled trial, people with prediabetes were randomly assigned to the control group, AT group, RT group, or AT + RT group. Supervised exercise programs, including AT, RT, and AT + RT, were completed for 60 minutes per day, three non‐consecutive days per week for 24 months. The primary outcome was the incidence of T2D; secondary outcomes were blood glucose and lipid levels, including total cholesterol (TC) and standard 2‐hour oral glucose tolerance (2hPG).  A total of 137 (80%) subjects with a mean age of 59 years (45 men, 92 women) entered the final analysis. After 24 months of intervention, the incidences of T2D adjusted by sex and age were significantly decreased by 74%, 65%, and 72% in the AT + RT, RT, and AT groups compared with the control group. The cumulative T2D incidences were significantly lower in the AT + RT, RT, and AT groups than in the control group (21%, 26%, and 22% vs 69%). The blood glucose and lipid profiles improved more in the AT, RT, and AT + RT groups than in the control group. In conclusion, this study showed that RT and RT plus AT were as effective as isolated AT in preventing overt T2D in patients with prediabetes. The results showed that RT is a viable option for patients seeking to prevent or delay T2D. This finding further expands established paradigms of lifestyle change for preventing T2D and can inform clinician‐patient discussions about delaying disease onset.  This finding further expands established paradigms of lifestyle change for preventing type 2 diabetes and can inform clinician-patient discussions about delaying disease onset. Plus, one of the major benefits of exercise, as has been shown in many studies, is that exercise can extend lifespan and provide a better quality of life. Diabetes/Metabolism Research and Reviews.

Metformin proposes therapeutic benefit for HFpEF treatment.

Carbohydrate ingestion combined with short sprints before a moderate-intensity workout does not negatively affect patients with type 1 diabetes.

Older adults with diabetes and chronic kidney disease (CKD) are at an increased risk of cognitive impairment and dementia, frailty, dysglycemia, and polypharmacy.

Quote of the Week!

“Progress is impossible without change, and those who cannot change their minds cannot change anything.”

…George Bernard Shaw

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

Ghazal Blair, Pharm.D. Candidate 2019, LECOM School of Pharmacy

Dahlia Elimairi, Pharm D Student, UC Denver Skaggs School of Pharmacy

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