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Risk Of Diabetic Ketoacidosis After Initiation Of An SGLT2 Inhibitor

Risk of Diabetic Ketoacidosis after Initiation of an SGLT2 Inhibitor

Risk of Diabetic Ketoacidosis after Initiation of an SGLT2 Inhibitor

To the Editor:
Inhibitors of sodium–glucose cotransporter 2 (SGLT2) decrease plasma glucose by blocking the reabsorption of glucose at the proximal tubule.1,2 Case reports have suggested that SGLT2 inhibitors may be associated with an increased risk of diabetic ketoacidosis, which led to a warning from the Food and Drug Administration (FDA) in May 2015.3,4 The objective of our study was to assess the risk of diabetic ketoacidosis after the initiation of an SGLT2 inhibitor.
Using a large claims database of commercially insured patients in the United States (Truven MarketScan), we identified a cohort of adult patients (≥18 years of age) who had newly started treatment with either an SGLT2 inhibitor or a dipeptidyl peptidase-4 (DPP4) inhibitor between April 1, 2013, and December 31, 2014 (before the FDA warning). DPP4 inhibitors were chosen as the comparator medication because they are similarly used as a second-line treatment for diabetes but have no known association with diabetic ketoacidosis. We excluded patients with human immunodeficiency virus infection, end-stage renal disease, cancer, type 1 diabetes, or past diabetic ketoacidosis. Our primary outcome was hospitalization for diabetic ketoacidosis (using the primary position code of the International Classification of Diseases, Ninth Revision) within 180 days after the initiation of an SGLT2 inhibitor or a DPP4 inhibitor. We censored data for patients at the time that they discontinued the initial medication, had the outcome, lost insurance coverage, or died.
We used 1:1 propensity-score matching to balance 46 char Continue reading

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New diabetes research takes a page from the past with a drug from the 1950s | Miami Herald

New diabetes research takes a page from the past with a drug from the 1950s | Miami Herald

Prior to Daniel Dyner having open-heart surgery four years ago, he appeared to be in great health.
He had just moved to Key Biscayne from Venezuela, where he spent his time sailing around the world on solo trips to places like Trinidad, the Mediterranean and the coast of Africa. He swam nearly a mile every day and kept a strict diet.
The 69-year-old Dyner was on the first lap of his daily swim in May 2013 when he “suddenly felt funny.”
He immediately went to see Dr. Gervasio Lamas, his cardiologist at Mount Sinai Medical Center in Miami Beach.
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“I remember this so distinctly,” said Dyner, now 73. “The guy said ‘stop’ and he ran over with two doctors. They said I had 24 hours to live.”
Dyner
Jose A. Iglesias [email protected]uevoherald.com
The next morning, Dyner underwent open-heart surgery. After that, his sugar levels went “completely crazy.”
Now, Dyner is part of Lamas’ clinical trial at Mount Sinai, where Type 2 diabetics with a history of cardiac arrest might find a solution to their complications. The key? A drug developed in the 1950s.
To treat diabetes in new ways, South Florida physicians and researchers like Lamas and Dr. Camillo Ricordi, director of the Diabetes Research Institute at the University of Miami’s Miller School of Medicine, are looking to the past for answers.
Both are testing alternative techniques in hopes of bringing unconventional diabetes treatments into the mainstream.
In Type 1 diabetes, which affects about 5 percen Continue reading

New Diabetes treatment available in Palm Beach Gardens

New Diabetes treatment available in Palm Beach Gardens

PALM BEACH GARDENS, Fla. —
A new diabetes treatment is being offered at the Nicklaus Children’s Palm Beach Gardens Outpatient Center.
“With the new pump there’s a lot of consistency and peace of mind and it just helps me live normally,” said Colton Smith, a 16-year-old high school football player who has Type 1 diabetes and started treatment a few months ago.
The Medtronic MiniMed 670G system works by automatically measuring blood sugar, predicting when a rise or fall is going to occur, and continuously delivering precise doses of insulin. Eight patients at the center in Palm Beach Gardens are currently using it but medical staff said they’d like to add more.
“When our kids were growing up we had to go to Orlando or Miami and now they can do things here,” said legendary golfer Jack Nicklaus. He and his wife Barbara said they are just happy to have the means to be able to help. Continue reading

Diabetes educator role boundaries in Australia: a documentary analysis

Diabetes educator role boundaries in Australia: a documentary analysis

Abstract
Background
Diabetes educators provide self-management education for people living with diabetes to promote optimal health and wellbeing. Their national association is the Australian Diabetes Educators Association (ADEA), established in 1981. In Australia the diabetes educator workforce is a diverse, interdisciplinary entity, with nurses, podiatrists, dietitians and several other health professional groups recognised by ADEA as providers of diabetes education. Historically nurses have filled the diabetes educator role and anecdotally, nurses are perceived to have wider scope of practice when undertaking the diabetes educator role than the other professions eligible to practise diabetes education. The nature of the interprofessional role boundaries and differing scopes of practice of diabetes educators of various primary disciplines are poorly understood. Informed by a documentary analysis, this historical review explores the interprofessional evolution of the diabetes educator workforce in Australia and describes the major drivers shaping the role boundaries of diabetes educators from 1981 until 2017.
This documentary analysis was undertaken in the form of a literature review. STARLITE framework guided the searches for grey and peer reviewed literature. A timeline featuring the key events and changes in the diabetes educator workforce was developed. The timeline was analysed and emerging themes were identified as the major drivers of change within this faction of the health workforce.
This historical review illustrates that there have been drivers at the macro, meso Continue reading

Taking blood pressure drugs at night wards off diabetes, study finds

Taking blood pressure drugs at night wards off diabetes, study finds

(Mike Derer / Associated Press)
Sometimes, disease-prevention really is this simple: Adults with high blood pressure who take all of their hypertension medications before they go to bed, rather than in the morning, are less likely to develop Type 2 diabetes, new research has found.
The new findings are in line with other insights gleaned by the same investigators: that hypertension patients who are most at risk of developing diabetes -- and cardiovascular disease -- are those whose blood pressure fails to show a substantial dip during sleep.
It stood to reason, then, that a medication regimen that more tightly controls a hypertensive's blood pressure while he or she sleeps might help to at least forestall the development of Type 2 diabetes.
In a large clinical trial conducted in Spain and published Wednesday in the journal Diabetologia, that hypothesis turned out to be true. And effecting such tight nighttime blood-pressure control turned out to be as simple as having subjects take their hypertension drugs -- whether ACE inhibitors, angiotensin-receptor blockers or beta blockers -- before they turned in for the night.
A drop in blood pressure is normal while sleeping. But not all people see such a dip while they sleep, and some see more shallow dips.
A second trial, also published in Diabetologia on Wednesday and conducted by the same group of Spanish researchers, found that subjects whose blood pressure did not dip, and those whose readings dipped more briefly or shallowly, were more likely to develop Type 2 diabetes than those whose sleep-time blood pressure saw a deep an Continue reading

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