James Keck, MD, set out to find if adult patients at an academic family medicine clinic, who were actively screened for prediabetes, received a referral to the Diabetes Prevention Program.

The research team evaluated the electronic health records of 5,360 adult patients at an academic family medicine clinic to determine whether they received pre-diabetes screening, diagnosis and treatment.

They found that:

• 4,068 (76%) patients received a hemoglobin A1c test.
• 1,437 (35%) of these patients had a result in the prediabetes range.
  • Of these, only 729 (51%) had a diagnosis of prediabetes their EHR

Even though 35% of patients met the diagnostic cut off for prediabetes, not one of them was referred to a Diabetes Prevention Program.

Keck and colleagues also reviewed 31 surveys from clinicians from the same clinic about their pre-diabetes attitudes, knowledge and practices. Keck noted that even when clinicians are aware of the program, insurance coverage for such programs is low even though more and more insurers are recognizing the wisdom in these prevention programs.

James Keck, a physician at the University of Kentucky, believes this is due to a lack of awareness about the Diabetes Prevention Program in general.

The lack of electronic or streamlined referrals to these programs is another notable barrier, besides perceptions of the clinician and individual of whether the program will be effective.

What can be done about this?

Raising awareness about the National Diabetes Prevention Program is the first step, as well as raising awareness of private insurance and Medicare which now covers such programs. Finally, increasing relationships between clinics and places offering these programs (or encouraging clinics to start up their own programs) is a great step towards removing barriers.

Read more on the full survey results and recommendations on Healio.

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Whether it’s the candy, the turkey, stuffing, or the desserts, the holidays are a difficult time for anyone to eat healthy and avoid weight gain. Experts suggest that the holidays are not the best time to set weight loss goals. Instead, a more realistic approach is to focus on enjoying special events and weight maintenance coupled with lots of good self-care.

Weight watchers, most dietitians, and health bloggers suggest several strategies to make healthier choices when tempted by holiday fare:

• There is no need to eat to be polite – save calories or points for favorite foods. If there is lots of pressure, have 1-3 bites of whatever family or friends are suggesting.
• Be prepared for extra calories: maintain regular eating routine for the whole week leading up to the big meal. On the day of, make sure to have breakfast, and if the big meal is in the afternoon, have a small lunch or snack to avoid over-eating at the party.
• Drink calorie free beverages and choose vegetables or other low calorie options first before digging into the richer food choices.

Some interesting, alternative strategies that people are reporting success with:

• Plating up with a smaller plate: it tricks our brains into thinking we are eating more, and on average this strategy decreases intake by 40% or more.
• Wear something fitted and fabulous: boost self-confidence with an outfit that makes the wearer feel great about how they look, but also keeps them aware of quantity of food consumed.
• Take a walk after the meal instead of sinking into a recliner or couch to burn a few calories and keep metabolism revved up a bit longer.

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Continuous Glucose Monitoring – The key to improving BG?

A three-year long study showed real time continuous glucose monitoring (rtCGM) was associated with lower A1c levels in people with type 1 diabetes, whether the participants used pumps or multiple daily injections.

In the study, participants checked glucose levels using CGM or fingersticks four times per day.

Only the real time CGM group had improvements in time-in-range and reduced time below range, regardless of whether they used an insulin pump or injections.

Also, fewer participants using real time CGM experienced severe hypoglycemia.

This three-year study came from the Comparison of Different Treatment Modalities for Type 1 Diabetes Including Sensor-Augmented Insulin Regimens (COMISAIR). The group still advocates for individualization of treatment, but emphasizes what an important difference incorporating real time CGM makes.

Jan Soupal presented the study findings at the European Association for the Study of Diabetes 2019 Annual Meeting in the Czech Republic. Soupal noted that CGM can be coupled with multiple daily injections for those who prefer to only have one device on their body or worry about accessibility and affordability.

Read the full study details here.

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Want more valuable CGM info for the test?

Check out our Technology Toolkit! Two fantastic courses included for a total of 3 CEs:

• Tech 101 – Pumps and Sensors Update and Overview and 
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Adverse Childhood Experiences (ACE) such as neglect, abuse, household dysfunction, etc. have been found to have a profound impact on health and disease throughout life.

Here is the the link to the ACE Screening Tools and more information.

The higher the ACE Score, the higher the risk of diabetes, cardiovascular disease, mental health issues, earlier mortality and more.

Nadine Burke Harris, MD and California’s newly appointed Surgeon General, pushed for ACE scores to be more seriously considered and to increase routine screening, early detection, and early intervention.

Funding has been put forward to reimburse providers for screenings, and towards after school education and safety programs in preschool, early learning, and childcare.

Dr. Harris corrects the assumption that every person who scores positive for ACE needs mental health services: “most patients don’t” she says, and it’s important to know proper next-steps after a positive screening.

The best thing health care providers can do after a positive screening is to educate individuals on which symptoms could be related to a history of adversity, and give them tools they can use to manage and improve outcomes. These are tools like sleep, exercise, nutrition, mindfulness, mental health, and healthy relationships. Most of these tools don’t require a lot of extra resources as some health care professionals may fear.

Read Dr. Harris’ full interview on the Chronicle of Social Change.

For more info, here is the link to an excellent ACE Resource Page

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A panel of experts found that what children drink has a big impact on overall health and development.

Kids should drink breast milk, infant formula, water and milk in early childhood – and limit their fruit juice as much as possible.

Although the type of milk varies (breast milk, skim, infant formula, etc.) the experts agree most of what children need from 0-5 years is just milk and water.

Experts recommend no more than half a cup of juice a day (whole fruit is preferred) for children between 1-5 years old, and no juice for children under 12 months.

The recommendations, released Wednesday, broke down what children through age five should drink by age:

• 0-6 Months: Breast milk or infant formula.
• 6-12 Months: Breast milk or infant formula; small amounts of plain drinking water introduced once solid foods become part of diet.
• 12-24 Months: Whole milk and plain drinking water.
• 2-5 Years: Skim or low-fat milk and plain drinking water.

These evidence-based recommendations were crafted after careful review of existing domestic and international policy statements by experts from the Academy of Nutrition and Dietetics, the America Academy of Pediatrics, the American Academy of Pediatric Dentistry, and the American Heart Association.

Read more recommendations and panelist discussion in the full news story on U.S. News.

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Canagliflozin (Invokana), an SGLT-2 Inhibitor, just received a new Food and Drug Administration (FDA) indication.

Adults with type 2 diabetes and diabetes kidney disease who take canagliflozin (Invokana) experience a reduction of:

• end-stage renal disease
• worsening kidney function
• cardiovascular death
• hospitalization for heart failure
  

This new indication is based on the results of the CREDENCE Trial, which was designed to see if canagliflozin had a renal vascular protective effect.

The trial enrolled over 4, 400 people with type 2 diabetes and GFRs between 30 and 90. The results clearly indicated several benefits.

Researchers observed a 32% risk reduction of end stage renal disease among patients who took canagliflozin (HR = 0.68), as well as a 28% risk reduction for starting dialysis, having a kidney transplant or experiencing renal death.

In a sub-group of the CREDENCE Trial, cardiovascular death for type 2 diabetes dropped by over 30% and in the CANVAS Study, there was a 33% drop in risk of hospitalization for heart failure.

Please see Oral Meds Pocketcard for side effects and precautions of canagliflozin and SGLT-2 Medications. In the most recent ADA Standards, two SGLT-2 Inhibitors, empagliflozin and canagliflozin are indicated for individuals with heart failure, chronic kidney disease and an elevated CV risk profile.

The use of these SGLT-2 Inhibitors offer hope and a new strategy to protect renal function and decrease heart disease risk in those living with diabetes.

For more information see this Helio Article on the new FDA indication for Canagliflozin.

Please see our GLP-1 Receptor Agonists and Injectibles Pocketcard for new oral GLP-1 tablet.

Get Your Updated PocketCards Here!

Download FREE Medication PocketCards on our website.

Purchase PocketCards – Updated physical PocketCards will ship out no later than October 18, 2019.

Download our FREE CDCES Coach App

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The Journal of General Internal Medicine recently surveyed nearly 300 physicians, and the findings were alarming.

Their research suggests approximately 25% of all physicians misdiagnose people who have diabetes with prediabetes instead.

Additionally, the average provider didn’t know 33% of the risk factors for prediabetes, were unfamiliar with prevention or management of the condition, and generally under-screened for it.

Only 42% of the physicians knew the correct fasting A1c to diagnose prediabetes.

Researchers from John Hopkins University recommend providing physicians with better knowledge on diabetes prevention and for insurance to cover plans that help better diagnose and treat prediabetes.

The hope is these two strategies will help with more accurate screening and earlier intervention to avoid development and progression of type 2 which can lead to kidney failure, heart disease, or stroke. Read the full study and statistics here.

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October Newsletter Now Available!

Our October Newsletter is brimming with medication updates! From Oral GLP-1 to Semaglutide and pre-filled Glucagon, we’re keeping you up to date AND updating our PocketCards. Did you know you can hire Coach Beverly to come speak in your hometown? Read this month’s Newsletter to find out how to request her time. 

October News Topics Include:

• Oral GLP-1: Easier to Stomach than Injectables?
• Canagliflozin Slows Kidney Disease and Protects the Heart
• Diabetes & Breast Cancer
• 25% Off Live Webinars
• Updated DiaBingo
• 7 Strategies to Survive Halloween

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