Diabetes Core Update – Episode Summary

Podcast: Diabetes Core Update
Episode: 1/24/2013
Date: December 19, 2013
Hosts: Dr. Neil Skolnik & Dr. John J. Russell

Overview

This episode of Diabetes Core Update offers clinicians a concise discussion of the most clinically relevant diabetes research published in the American Diabetes Association’s journals. The hosts provide insights into groundbreaking trials and recent studies, exploring their implications in the treatment of diabetes and how emerging data can inform bedside care.

Key Discussion Points & Insights

1. 30-Year DCCT/EDIC Follow-Up: Landmark in Type 1 Diabetes Care

Segment: [00:55]–[08:07]

• Background:
  • The Diabetes Control and Complications Trial (DCCT), launched in 1982, proved that intensive glucose control reduces the risk of complications in type 1 diabetes.
  • Followed by EDIC, an observational long-term extension assessing the durability and long-term impact of initial treatment differences.
• Major Results (DCCT):

  • 99% cohort retention over 6.5 years.

  • Intensive therapy (median A1C 7%) led to a 35–76% reduction in early microvascular disease compared to conventional therapy (average A1C 9%).
  • Notable adverse effects: threefold increase in risk of hypoglycemia and increased weight gain.
• Long-Term Outcomes (EDIC):
  • Intensive therapy group saw 42% lower aggregate cardiovascular risk and 57% fewer major events (myocardial infarction, stroke, cardiovascular death).
  • Kidney Disease: Rates of microalbuminuria were up to 59% lower, and macroalbuminuria up to 84% lower with prior intensive therapy.
  • Retinopathy: 76% reduction in risk of developing new retinopathy; severe vision outcomes/procedures reduced by 50%.
  • Neuropathy: Peripheral reduced by 64%, autonomic by 45%.
  • Significant: The effect of early intensive control persisted even as both groups’ A1Cs converged with time.

Notable Quotes

• Dr. Skolnik [03:05]:
  “It sometimes escapes us that it was only 20 years ago… we actually didn’t know that good glucose control clearly yielded better outcomes.”
• Dr. Russell [08:07]:
  “I think if I was talking with a resident or student… these are the two studies I think you should kind of know about in the history of diabetes: the DCCT trial and the UKPDS trial.”

2. Inpatient Management: Sitagliptin Versus Insulin Regimens

Segment: [08:07]–[11:55]

• Study: Examined safety/efficacy of sitagliptin (alone or with glargine insulin) vs. conventional basal-bolus insulin regimens in hospitalized type 2 patients.
• Findings:
  • Glycemic control improved similarly across all groups with no differences in average daily blood glucose, hypoglycemic events, or length of stay.
  • Sitagliptin groups required fewer insulin doses/injections.
• Practice Implication:
  Newer regimens (sitagliptin) may offer less intensive, more streamlined options for selected inpatients with type 2 diabetes.

3. Updates in Inpatient Blood Glucose Targets

Segment: [11:55]–[13:18]

• Historical Context:
  Early 2000s: Intensive IV insulin protocols praised after an ICU study—subsequent trials (e.g., NICE-SUGAR) could not replicate benefits and reported harm.
• ADA Shift:
  Recommendation to aim for blood sugar <180 mg/dL, not strict normoglycemia, among medical inpatients.

4. Neighborhood Green Space & Diabetes Risk

Segment: [13:18]–[14:21]

• Study: 267,000+ Australians: Does neighborhood green space correlate with lower type 2 diabetes prevalence?
• Results:
  • Neighborhoods with 40%+ green space: ~8% diabetes prevalence.
  • Neighborhoods with <20% green space: 9.1% prevalence.
• Clinical & Public Health Insight:
  Environment matters—community features like parks promote physical activity and influence risk.

Notable Quotes

• Dr. Skolnik [14:21]:
  “It isn’t just individual choices and decisions… it’s also the social milieu in which we live… the lay of the land, how much green space there is, has an effect on decisions… [with] very real impacts on the rate of diabetes among individuals in society.”

5. Omega-3 Fatty Acids and Diabetes Onset

Segment: [14:21]–[17:20]

• Study: Prospective cohort of 2,212 middle-aged men (19.3 years’ follow-up).
• Findings:
  Higher serum omega-3 levels → 33% lower adjusted risk of developing type 2 diabetes.
  • Effect independent of mercury exposure (via fish consumption).
• Context:
  Trials of fish oil supplements (pills) have not shown CVD benefits, but fish-rich diets are associated with lower CVD and diabetes risk.

Notable Quotes

• Dr. Russell [17:20]:
  “When we’re eating fish for dinner, we’re not necessarily eating a hamburger for dinner… The Japanese have far and away the highest fish consumption in the world and they probably have the best metrics for heart disease.”

Memorable Moments

• History Lesson: Dr. Russell likens past attitudes about diabetes management to telling his children cars once had no seatbelts—reinforcing how sea-changing DCCT/EDIC was ([08:07]).
• Big-Picture Takeaway: The panel emphasizes the “legacy effect” of early glycemic control and explains why trials like DCCT and UKPDS are foundational to diabetes care.

Timestamps for Important Segments

• [00:55] – Start of main article discussion: DCCT/EDIC 30-year update
• [08:07] – Historical context, importance of DCCT/UKPDS, legacy effect
• [08:53] – Sitagliptin vs. insulin regimens, inpatient glycemic management
• [11:55] – Modern inpatient glycemic targets and NICE-SUGAR
• [13:18] – Green space, environment, and diabetes risk
• [14:21] – Social determinants and the environment’s role in diabetes
• [14:40] – Omega-3 fatty acids/diet, fish consumption, and diabetes risk

Tone & Language

The hosts use a collegial, teacher-to-clinician tone with a touch of storytelling, emphasizing historical breakthroughs and practical “what to do” takeaways. Their approach is conversational, blending data summaries with clinical pearls and pragmatic advice.

Conclusion

This episode reviews pivotal studies shaping diabetes care—emphasizing the impact of early intensive glucose control, the evolution of inpatient management, lifestyle/environmental determinants, and the nuanced role of nutrition. It’s an essential listen for providers staying current on evidence-based diabetes practices.