May 11, 2019 : Issue #989

TOP STORIES — Diabetes News and Research

Misdiagnosis of Type 1 Diabetes 38% Of The Time

Fractures and Type 2 Diabetes

Liquid Meal Replacements To Treat Diabetes

When my wife was first diagnosed with diabetes at the age of 63 her A1c was 14.3 and she had lost weight. Her primary allowed me to start her on long acting insulin the first day. As we progressed she was at 6.8 with a regimen of Toujeo, Trulicity and Farxiga. This kept her A1c levels at about 6.7- 7.0 for the next 2 years. As her levels started to climb we added Novolog with a correction factor and carb ratio and had been able to control it for about 8 months. Since she wanted a Dexcom CGM we had to visit an Endo and he did an antibody test to verify what we already knew, she was truly a type one. 

When I relate this story to others they are always amazed that we started so aggressively, and her current Endo considers this aggressive treatment very successful. The question comes up, what if she didn’t have a CDE for a husband, and would anyone have identified and treated her type 1 diabetes so soon?

This week we have a special feature on this misdiagnosis of type 1, and how often even the consideration of an older patient having type 1 is overlooked and simple tests are not done.

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We can make a difference!

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Dave Joffe

Editor-in-chief

The FDA approved a once-daily, extended-release combination of the SGLT2 inhibitor dapagliflozin, the DPP-IV inhibitor saxagliptin, and metformin.  The oral combination therapy (Qternmet XR) is approved in two fixed doses (dapagliflozin/saxagliptin/metformin 5mg/5mg/1000mg and 10 mg/5 mg/2,000 mg) and is intended for adults with type 2 diabetes as an adjunct to diet and exercise.

Half of those misdiagnosed were still being treated as though they had type 2 diabetes 13 years later.

Type 2 diabetes doubles short-term fracture risk for older women.

Do they work for people with type 2 diabetes and obesity?

Metformin has been available for more than 25 years in the U.S., and we continue to learn more. For most diets, we know that it is difficult for patients with diabetes to not only lose weight, but to maintain the weight loss over time. Identifying reliable predictors of long-term weight loss (LTWL) could lead to improved weight management. The DPP (Diabetes Prevention Program) was a randomized controlled trial that compared weight loss with metformin, intensive lifestyle intervention (ILS), or placebo. Its Outcomes Study (DPPOS) observed patients after the masked treatment phase ended. One of the outcomes was a surprise to investigators, and that was the ability for those on metformin to continue to maintain weight loss of 15 years. Of the 3,234 randomly assigned participants, 1,066 lost at least 5% of baseline weight in the first year and were followed for 15 years. After 1 year, 289 (28.5%) participants in the metformin group, 640 (62.6%) in the ILS group, and 137 (13.4%) in the placebo group had lost at least 5% of their weight. After the masked treatment phase ended, the mean weight loss relative to baseline that was maintained between years 6 and 15 was 6.2%  in the metformin group, 3.7% in the ILS group, and 2.8% in the placebo group. Independent predictors of LTWL included greater weight loss in the first year in all groups, older age and continued metformin use in the metformin group, older age and absence of either diabetes or a family history of diabetes in the ILS group, and higher fasting plasma glucose levels at baseline in the placebo group. From the results it was concluded that, among persons with weight loss of at least 5% after 1 year, those originally randomly assigned to metformin had the greatest loss during years 6 to 15. Older age and the amount of weight initially lost were the most consistent predictors of LTWL maintenance. — Annals of Internal Medicine April 23, 2019

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