Diabetes Core Update – March 2016 Episode Summary

Podcast: Diabetes Core Update
Hosts: Dr. Neil Skolnik & Dr. John Russell
Release Date: February 24, 2016
Length: ~15 minutes

Episode Overview

This episode features Dr. Neil Skolnik and Dr. John Russell discussing key research articles from the American Diabetes Association journals, summarizing recent findings pertinent to diabetes care and their practical implications for clinical practice. The topics covered range from hypoglycemia incidence, vitamin D supplementation, dietary risks, early obesity mechanisms, global diabetes trends, and novel combination therapies.

Key Discussion Points & Insights

1. Severe Hypoglycemia in Type 2 Diabetes

[00:55–03:09]

• Study: Observational cohort (2005–2011) with >900,000 US adults with diabetes.
• Findings:
  • Incidence: Severe hypoglycemia ranged from 1.4 to 1.6 events per 100 person-years.
  • Risk Factors: Older age, chronic kidney disease, heart failure, cardiovascular disease, depression, higher A1C, use of insulin/insulin secretagogues, and beta blockers.
• Notable Insight: Hypoglycemia risks are not solely due to tight glucose control; even those with higher A1Cs exhibited higher rates.

Notable Quote:

• “I was also a little surprised that the hypoglycemic events were higher in folks that had higher A1Cs, which didn’t make a whole lot of sense.” – Dr. John Russell [03:09]
• “Every time that we're looking at a med list with our patients, I think we need to assess are they at risk for hypoglycemia and reevaluate continuosol.” – Dr. John Russell [03:09]

2. High-Dose Vitamin D and Glucose Control

[03:09–05:47]

• Study: Double-blind RCT, 44 subjects with abnormal glucose tolerance, 8 weeks of 30,000 IU/week vitamin D3 vs. placebo.
• Findings: No improvement in insulin secretion, insulin sensitivity, or glycemic control with vitamin D supplementation—even in those with low baseline vitamin D.
• Clinical Application: Vitamin D supplementation does not improve blood sugar control in pre-diabetes or diabetes, despite epidemiological associations.

Notable Quote:

• “So I think at this point we can say very clearly that while low vitamin D levels may be associated with diabetes, that association is not causal.” – Dr. Neal Skolnik [05:47]
• “There's no value of supplementing vitamin D with the goal of improving blood glucose control.” – Dr. Neal Skolnik [06:40]

3. Potato Consumption and Type 2 Diabetes Risk

[05:47–09:22]

• Study: Prospective analysis, >200,000 participants (Nurses' Health Studies, Health Professionals Follow-up Study).
• Findings:
  • Potatoes/French Fries: Higher consumption linked with increased type 2 diabetes risk (up to 33% for >7 servings/week; 19% higher risk for French fries per 3 servings/week).
  • Substitution: Replacing potatoes with whole grains reduced diabetes risk by 12%.
• Discussion: The preparation method (e.g., frying, added fats) may influence risk, but even unadorned potatoes cause high postprandial glucose spikes.

Notable Quote:

• “Potatoes can cause as much excursion in our blood sugar as drinking a can of Coca-Cola or having a handful of jellybeans.” – Dr. John Russell [09:01]

4. Maternal Obesity and Offspring Stem Cell Differentiation

[09:22–12:33]

• Study: Examined umbilical-cord-derived mesenchymal stem cells from infants born to obese (BMI 34.6) and normal-weight (BMI 21) mothers.
• Findings: Offspring of obese mothers had stem cells more prone to become fat cells (adipogenesis), mirroring their body fat content.
• Clinical Implication: There's a physiological, not just environmental, mechanism linking maternal obesity to childhood and adult obesity.

Notable Quote:

• “I think the main importance of this is recognizing that it’s not just environmental…but there actually is a physiologic mechanism...that create more adipocytes than muscle mass.” – Dr. Neal Skolnik [12:33]

5. Diabetes Trends in Asia and the Pacific

[12:33–15:57]

• Epidemiology: Over 60% of global diabetes cases are in Asia; China alone has ~113 million adults with diabetes and ~500 million with prediabetes.
• Contributing Factors: Rapid urbanization, westernized diets, less activity, increased obesity, and genetic predispositions. Large-scale lifestyle intervention studies in China/Asia show similar success as in the West.
• Public Health Message: Diabetes prevention strategies should be tailored globally, recognizing local dietary practices and genetic susceptibilities.

Notable Quote:

• “As the westernization happens in Asia...populations that once upon a time walked and biked everywhere suddenly have access to automobiles...and we’re seeing fast food in populations that had never seen fast food before.” – Dr. John Russell [15:57]

6. Combination Therapy: Canagliflozin & Metformin for Type 2 Diabetes

[15:57–19:32]

• Trial: 26-week, double-blind Phase 3 in treatment-naive type 2 diabetics.
• Findings: Canagliflozin (an SGLT2 inhibitor) plus metformin achieved better A1C reduction (1.77–1.78% drop) and more weight loss (3 kg vs. 1.9 kg) compared to either alone. More patients met A1C <7% goal with combination therapy.
• Practice Implication: Early combination therapy may improve both glycemic outcomes and medication adherence, mirroring long-standing hypertension management approaches.

Notable Quote:

• “With diabetes we're really moving toward a lot more patients getting combination therapy in a way that is easy to adhere to.” – Dr. Neal Skolnik [19:32]
• “The best data out there on adherence suggests that patients with diabetes only take about 50 to 75% of the medicines...so the advent of combination therapy...makes it easier for patients to adhere to.” – Dr. Neal Skolnik [19:55]

Memorable Moments & Quotes

• Beta Blockers & Hypoglycemia: “Maybe we should be a little bit smarter, especially in our elderly patients [when prescribing beta blockers].” – Dr. John Russell [03:09]
• Vitamin D Skepticism: “Everyone gets excited about the idea of a natural substance, a vitamin, helping disease…[but] no value of supplementing vitamin D with the goal of improving blood glucose control.” – Dr. Neil Skolnik [05:47, 06:40]
• Potato Popularity: “The average American eats about 126 pounds of potatoes a year. So that's an awful lot of potatoes.” – Dr. John Russell [09:22]
• Transgenerational Obesity: “It's another thing that we can discuss with young adults as to why they should exercise and eat in a healthy way...and also to pass on to their children healthy genes.” – Dr. Neal Skolnik [12:54]

Timestamps for Important Segments

| Topic | Start Time | |-------|------------| | Severe Hypoglycemia Study | 00:55 | | Vitamin D Trial | 03:09 | | Potato Consumption & T2D Risk | 05:47 | | Maternal Obesity/Stem Cells | 09:22 | | Diabetes in Asia/Pacific | 12:33 | | Canagliflozin + Metformin Combo | 15:57 |

Conclusion

This content-rich episode delivers a blend of clinical pearls and evidence-based guidance, urging practitioners to:

• Continually assess hypoglycemia risk, especially in older, comorbid patients.
• Reconsider vitamin D for glycemic control.
• Counsel patients on the real glycemic impact of potatoes and dietary choices worldwide.
• Understand the hereditary and physiological roots of childhood obesity.
• Recognize global variations in diabetes trends and preventions.
• Embrace practical combination therapies for improved diabetes management and patient adherence.

For further reading, visit: www.diabetesjournals.org