5 More Clinical Pearls to Continue Your Diabetes Education

August 22, 2014

Use these 5 brief summaries of recent developments in the study of diabetes and trends in diabetes care to stay current and optimize care for your patients.

Premixed insulin pros and cons, drugs and renal impairment, thumbs up for eating tree nuts, a new GI microbiome modulator, mental health coaching eases depression and blood sugar level. The 5 summaries below offer research and literature highlights to keep you up-to-date with scientific advances and new diagnosis and treatment options.

1. Premixed insulin: human or analogs?

• Use of a premixed insulin product can help ease anxiety for patients and physicians, but it’s not appropriate for all patients who require insulin.

• Premixed insulin therapy tends to be most successful for patients who lead a relatively routine lifestyle with 3 daily meals taken at regular times and with similar carbohydrate content.

• In a consistent, predictable lifestyle, premixed insulin requires fewer daily injections than multidose insulin therapy and maintains reasonably good glycemic control.

• The premixed product can be human insulin or analog. Human insulin may be associated with more hypoglycemia. Analog insulin offers the convenience of meal-time administration, superior postprandial control, and less nocturnal hypoglycemia.

• The patient needs to be part of the decision-making team about choice of insulin product.

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2. Diabetes drugs account for renal impairment

• Chronic kidney disease can complicate treatment for type 2 DM, especially when available noninsulin therapies are considered.

• Clinicians should be aware of the concerns and consequences when the current type 2 DM therapies are used in patients with renal impairment and consider discontinuation or dose reduction.

• The DPP-4 inhibitors may be a safe and effective alternative in these patients, especially linagliptin.

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3. Tree nuts for type 2 DM: surveys say, go nuts!

• Two recent studies supported recommendations to consume tree nuts alone or as part of heart healthy dietary patterns-such as the Mediterranean, Portfolio, Vegetarian and DASH dietary patterns-to improve glycemic control in patients with type 2 DM.

• Study authors note that results could be explained by an overall shift to a healthier eating pattern in which nuts displace foods high in saturated fat or carbohydrates with a high glycemic index.

• Making healthier choices, and educating your patients on how to do it, at the very least “does not harm.”

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4. A new GI microbiome modulator shows promise for DM

• The modulator improved oral glucose tolerance in patients with prediabetes in a pilot study.

• NM504, the first in a new class of GI microbiome modulators, improved serum glucose levels during an oral glucose tolerance test compared with placebo.

• Insulin levels were similar between groups.

• The drug also decreased the desire to eat and may improve treatment for type 2 DM.

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5. Mental health coaching eases depression and blood sugar levels

• In a pilot study, patients with a new diagnosis of DM were referred to a certified diabetes educator (CDE); patients with depression received mental health coaching.

• Anxiety and depression scores and A1C levels decreased.

• “Those who had mental health coaching said it was life-changing, life-saving, and helped them feel better and happier than they had in a long time,” said Melissa Herman, RD, a certified diabetes educator.

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