5 More Clinical Pearls to Continue Your Diabetes Education

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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