Diabetes Core Update – September 2014 Episode Summary

Hosts:

• Dr. Neal Skolnik
• Dr. John J. Russell

Publishing Date: August 24, 2014
Podcast Length: Approximately 15 minutes

Episode Overview

This episode delivers a concise, clinically focused discussion on the latest research featured in the American Diabetes Association's journals. Dr. Skolnik and Dr. Russell present six recent articles centered on diabetes management and its broader implications—from the safety of DPP4 inhibitors and the cost benefit of lifestyle interventions, to the cognitive impacts of diabetes and macroeconomic consequences of the disease. The conversation maintains a practical emphasis, offering actionable insights for frontline healthcare professionals.

Key Discussion Points & Insights

1. Safety of DPP4 Inhibitor Saxagliptin: Pancreatic Cancer and Pancreatitis

(Diabetes Care – SAVIR TIMI Trial) | [00:55–03:05]

• A randomized, multicenter study (16,000+ patients with type 2 diabetes, 2+ years follow-up) compared saxagliptin to placebo.
• Incidence of pancreatitis: 35 events in each arm (HR 1.09; not significant).
• Pancreatic cancer: 5 cases (saxagliptin) vs. 12 (placebo); difference not significant.
• No notable differences in time to onset, risk factors, or severity.
• Key Insight: The findings suggest no increased risk of pancreatitis or pancreatic cancer with saxagliptin over two years.

Memorable Quote:
"The concerns about disorders of the pancreas have been kind of one of these things that's been talked about in whispered undertones… I think this should be a reassuring safety study that we can use these medicines."
—Dr. John Russell [03:05]

2. Intensive Lifestyle Intervention: Healthcare Cost Savings

(Diabetes Care – Look AHEAD Trial) | [03:05–05:29]

• 5,000+ adults with type 2 diabetes randomized to intensive lifestyle intervention (ILI) or standard support.
• Over 10 years:
  • 11% reduction in annual hospitalizations
  • 15% fewer hospital days
  • 6% fewer medication prescriptions
  • Healthcare cost reduction: mean per person 10-year savings > $5,000 (not observed in patients with prior CVD).
• Key Takeaway: Lifestyle changes yield significant real-world cost savings and health improvements.

Memorable Quote:
"If we had a medicine that could do this, everyone would run out, pay whatever they needed to have that medicine. And yet we have the power in our hands…"
—Dr. Neal Skolnik [05:29]

3. Metformin and Cancer Risk: No Protective or Adverse Association

(Diabetes Care – UK Cohort Study) | [05:29–08:26]

• Retrospective cohort (UK): 95,000 patients followed ~5 years post-initiating metformin or sulfonylureas.
• No significant difference in incidence of overall or site-specific cancers between groups.
• Caveat: Duration may be too short to assess long-term cancer risk or benefit.

Memorable Quote:
"Over one year, it certainly does not increase anyone's cancer risk, and at this point I would probably say over the first year it does not decrease anyone's cancer risk."
—Dr. John Russell [08:26]

4. Diabetes Nutrition Therapy: Efficacy and Recommendations

(Diabetes Spectrum – Review Article) | [08:26–11:55]

• Review of 10 years’ research supports nutrition therapy as effective for glycemic and metabolic control.
• A1C reductions:
  • Type 1 diabetes: 0.3–1%
  • Type 2 diabetes: 0.5–2% (greatest effect in those newly diagnosed with higher baseline A1C)
• Key guidelines:
  • Individualized nutrition therapy (A rating) advised, preferably by a registered dietitian.
  • Intensive insulin education/carb counting (A rating).
  • Consistent carb intake benefits (B rating).
  • Portion control/simple plans effective for some populations (C rating).
• Notable Point: Benefits of optimized diet can match those of adding a new medication.

Memorable Quote:
"The benefits of diabetes nutrition therapy… were around the same as adding an additional drug… It's once again a reminder to go back to fundamentals."
—Dr. Neal Skolnik [11:55]

5. Lifetime Cost of Diabetes: Importance of Prevention

(Diabetes Care – Economic Analysis) | [13:19–14:31]

• National survey modeling: Excess medical costs for newly diagnosed diabetes ranges from $124,000 (diagnosed at 40) to $35,000 (diagnosed at 65).
• Implication: Earlier onset leads to far greater lifetime costs; primary prevention is critical.

Memorable Quote:
"We have to have a system where the cost of preventing diabetes costs less than the cost of treating diabetes.”
—Dr. John Russell [14:31]

6. Cognitive Decline and Brain Activity Patterns in Type 2 Diabetes

(Diabetes – fMRI Study) | [14:31–16:31]

• Small fMRI study (22 T2D vs. 29 controls): Cognitive challenge revealed brain activity changes in patients with higher A1C, mirroring those seen in early Alzheimer's.
• Prior studies: Higher dementia rates in diabetes; intensive glucose control does not always lower this risk.
• Takeaway: Early glucose control may influence risk or delay of cognitive decline; underscores diabetes' multifaceted complications.

Memorable Quote:
"What this study suggests though is that at least early changes are related to glucose control… it's another study that reminds us that diabetes has multiple adverse outcomes, one of which is increased incidence of dementia."
—Dr. Neal Skolnik [16:31]

Final Thoughts

• The episode emphasizes the broad reach of diabetes—impacting the pancreas, economics, mental acuity, and more—and highlights the importance of fundamental interventions like lifestyle modification and nutrition therapy, alongside medication safety and surveillance.
• The discussion is practical, with advice directly relevant to clinical decision-making.

References & Further Resources

• All articles discussed are accessible at www.diabetesjournals.org.

For practicing clinicians, this episode is a reminder to stay current on the evidence, revisit the basics of diabetes care, and weigh both medication advances and time-honored interventions in everyday practice.