Type 2 diabetes can be prevented yet the journey of prevention is challenging. Making changes to our nutritional habits and physical activity are two keys for type 2 diabetes prevention. When it comes to physical activity, cardiovascular exercises such as walking, running, bike riding are often emphasized more than resistance training. Well as it turns out muscle strength should also be considered. In a prospective health outcomes study, moderate muscle strength was actually associated with 32% reduction in incidence of type 2 diabetes when compared to those with lower muscle strength. These findings sure motivate me to rise early in the morning to head to gym for my usual Wednesday morning workout which happens to include weights. To learn about about this study, please click below.
Fariba Ahmadizar, PhD, of the department of epidemiology at Erasmus University Medical Centre, Rotterdam, the Netherlands, published a prospective, population based study showed risk of risk of type 2 diabetes with statin use. As it turns out in this study, the association between statin use and development of type 2 diabetes was strongest among those who were overweight or obese. So should everyone stop taking their statin? Certainly not. For those who are overweight or obese, reducing risk of type 2 diabetes through lifestyle changes and reducing insulin resistance is key. The major limitations to this study were lack of family history of type 2 diabetes, no hemoglobin A1 value or dose of statin. While this study is helpful, it certainly is limited in applying the results to general population. To learn more, please click below.
Let me begin by stating that I firmly believe the pricing of analog insulins must be addressed as this is vital issue affecting people living with diabetes. On to an interesting summary of a couple of studies on the use of human insulin in type 2 diabetes. A nice summary piece on a couple of recent studies published in JAMA on switching from analog to human insulin, and comparison of groups started on human versus basal analog insulin in persons with type 2 diabetes. The outcomes from these studies were positive for human insulin. To read this excellent summary, please click below.
Dapagliflozin (Farxiga, Xigduo) has an important label update – it can now be used in setting of moderate renal impairment (eGFR 45-59 mL/min/1.73 m2). This allows dapagliflozin to be used in a greater number of patients which is especially important in light of its cardiovascular benefit. The link below further describes this label update.
Another important label update is insulin glargine and lixisenatide injection (Soliqua 100/33) now having an indication for persons who had not achieved glycemic target on oral diabetes medication. Remember, Soliqua is a great alternative to basal bolus insulin regimen for persons with Type 2 diabetes. More details are provided in the link below.
In practice, I often find it helpful to use glucagon-like )GLP-1) receptor agonist in combination with sodium glucose cotransporter-2 (SGLT-2) inhibitor for type 2 diabetes as they tackle type 2 diabetes from different avenues. Using these two drug classes together creates synergy. Findings from a recent study of semaglutide, GLP-1 agonist, being added to SGLT-2 inhibitor (either alone or in combination with metformin or sulfonylurea) in persons with Type 2 diabetes who have inadequately controlled glucose improved glycemic control. Greater A1c and weight reduction were positive outcomes. Please click below to read this trial summary.
The International Diabetes Center has produced a great resource breaking down the ambulatory glucose profile for self monitoring of blood glucose (SMBG), continuous glucose monitoring (CGM), insulin pump and CGM, and closed loop pump and CGM. Below are a list of components of this profile.
Glucose statistics: average tests per day (SMBG ), percent time CGM active, average glucose (mean), GMI (glucose management indicator), CV (coefficient of variation), SD (standard deviation)
Time in range: time in target, low/very low, high/very high
Glucose profile: 24 hour picture of glucose; orange, blue and green zones
Daily glucose profile (SMBG and CGM): single day’s glucose pattern is represented in a box
Bolus insulin graph (pump and CGM, and closed loop pump and CGM): one graph of 24 hour insulin bolus doses
Insulin profile graph ( pump and CGM, and closed loop pump and CGM): shows basal insulin pump settings over 24 hour period
Below is a link with more detailed look at the AGP.
Following the ADA’s release of 2019 Standards of Care in Diabetes back in December 2018, AACE and ACE have now released their 2019 Consensus Statement on Comprehensive Type 2 Diabetes Management. This is a must read as much as ADA Standards of Care in Diabetes. Grab a cup of coffee or tie and sit in your favorite chair for a good read. The link is below.
There seems to be an app for everything these days in the diabetes world. So what makes FDA’s approval of an insulin phone app from Hygieia unique? This particular phone app is able to titrate individualized doses for all types of insulin regimens with the recommendations being delivered directly to the patient. This app with connect with any glucose meter and share data with the cloud. Hygieia currently has d-Nav insulin guidance service. Sounds interesting but I am sure that it has its pros and cons like all technologies. To learn more please click below.
Have every compared your finger stick glucose to your CGM glucose only to find s significant difference between the two values? So why? A physiologic time lag of glucose transport from the vascular to the interstitial space. Therefore, interstitial glucose readings (aka CGM readings) tend to lag finger stick glucose values by 5 – 10 minutes. It is even longer if glucose readings are changing rapidly. To learn more, click the link below to watch a short video.