NEWSLETTER
MY
Fall 2013 Volume 45
It’s Not Guinea Pig Stuff Anymore!
The Pros and Cons of Becoming a Research Subject Dr. Edelman’s Corner
INSIDE Navigating the Maze of a Food Label Page 3
The Grade Study Page 4
Giving Back
I
n order for the pharmaceutical industry and device companies to get their products approved by the Food and Drug Administration (FDA), they have to perform clinical trials with hundreds and often thousands of people at research sites across the United States and around the world.
Page 5
The Jerry Lund Story, Final Interview Page 6
Ask A Pharmacist Page 8
Question of the Month Page 9
A Pathway to Prevention Page 10
Know Your Numbers Page 11
A typical study evaluating a drug for people with type 2 diabetes will involve a placebo, or dummy pill, as well as the actual drug. These types of studies are referred to as “double blinded.” The research subjects, the investigators, and the nursing staff do not know which (the drug or the placebo) was given to each study participant. This eliminates any potential bias and makes the data more meaningful. Before any clinic or institution starts a clinical trial, an official independent body
called the Human Subjects Committee evaluates the study for safety based on early animal and human laboratory studies. Typically, these are done well before the large studies that you hear about. These committees and boards are very strict and will not allow any further study to be performed without the proper precautions in place and prior data showing its safety. In addition to that, each study has an External Data Safety Monitoring Board that has access to the data as the study proceeds Becoming a Research Subject (continued on page 2)
Becoming a Research Subject (continued from page 1)
Special Acknowledgements Board of Directors Steven V. Edelman, MD Founder and Director, TCOYD Sandra Bourdette Co-Founder and Executive Director, TCOYD S. Wayne Kay s2a Molecular, Inc. Margery Perry Terrance H. Gregg DexCom, Inc. Daniel Spinazzola DRS International Contributing Authors Janice Baker, MBA, RD, CDE Jennifer Braidwood Catherine DeLue Steven Edelman, MD Tiep Ly Candis M. Morello, PharmD, CDE Lorrain Stiehl
TCOYD Team Steven V. Edelman, MD Founder and Director Sandra Bourdette Co-Founder and Executive Director Jill Yapo Director of Operations Michelle Day Director, Meeting Services Michelle K. Feinstein, CPA Director of Finance and Administration Antonio Huerta Director, Latino Programs Jennifer Braidwood Manager, Outreach and Continuing Medical Education Jimm Greer Manager, Multi-Media David Snyder Manager, Exhibit Services Robyn Sembera Associate Manager, CME and Outreach
MyTCOYD Newsletter Editor: Jennifer Braidwood Assistant Editor: Robyn Sembera Design: Hamilton Blake Associates, Inc.
MyTCOYD Newsletter is offered as a paid subscription of Taking Control Of Your Diabetes. All material is reviewed by a medical advisory board. The information offered is not intended to constitute medical advice or function as a substitute for the services of a personal physician. On the contrary, in all matters involving your health, TCOYD urges you to consult your caregiver. ©2013 All rights reserved.
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and they have the authority to stop any clinical trial if they see a safety problem. They can also stop a study if the results are so positive that it is just a waste of time to delay the findings. The entire process is extremely meticulous, decisions are made very carefully, and there is an enormous amount of detailed data analysis. Well…what’s in it for you? Research advances our knowledge of medicine and the potential to have superior drugs and devices for people with type 1 and type 2 diabetes. There are also many personal benefits when it comes to getting involved. • You typically get a free, full history and physical exam as well as an executive type of laboratory workup including: a chemistry panel, lipids, A1C, complete blood count, electrocardiogram, chest X-ray, etc. • Very often you will receive glucose testing supplies if it pertains to the study and access to caregivers who know a lot about diabetes. • Most studies will pay you a stipend for your time and travel expenses. • If you do not have health insurance or good coverage with a large donut hole* (I love donut holes…especially the ones with the sprinkles) getting involved in a clinical study is really awesome. • Often times people improve their A1C merely from the attention they get from the clinical research staff, even the placebo group.
and the number of visits typically go down over the duration of the trial. • You will need to get your blood drawn in the beginning, at the end, and sometimes in the middle of a typical study. • You may be randomized to taking the placebo and not get the potential benefit of the drug being tested. If this happens you probably will not improve as much as the folks taking the drug being tested. However, if for some reason your diabetes control worsens, there are “rescue” protocols in place that will switch you over to the active, or real drug, or allow you to exit the study. There is also a human subjects bill of rights that allows you to withdraw from any study at any time. All of this is explained to you up front before signing up to be a research volunteer. Now is an excellent time to be a research volunteer. I have been doing clinical research for over 20 years and I have seen so many positive things come out of the research, including advancement in oral medications, designer insulins, devices such as pumps, CGM and HGM, and many grateful subjects. It comes down to being educated about the study, asking questions, showing it to your own provider first, if desired, and weighing the pros and cons of getting involved. It is not guinea pig research anymore.
What is the down side of getting involved in a study? • It is time consuming, especially in the beginning. However, you are paid for every visit * Most Medicare Prescription Drug Plans have a coverage gap (also called the “donut hole”). This means there’s a temporary limit on what the drug plan will cover for prescriptions.
Steven Edelman, MD Founder and Director Taking Control Of Your Diabetes
Fit to Eat
By Janice Baker, RD, CDE
S
hopping for food can be stressful, confusing and certainly not that helpful when it comes to blood sugar control! There are so many claims on food packages these days, such as “made with whole grain,” “lower in sugar,” and “good source of antioxidants.” The real challenge when doing your weekly shopping is to be able to wade through what’s real and what’s totally bogus. False claims can grab your attention, take your money and keep you wondering why your weight or glucose levels are not cooperating! So, what do those food labels tell us?
Serving Size: Tells you the number of servings in the product The information noted on the nutrition facts label is for one serving. Some packages and containers (even those that appear to be a single serving) contain more than one serving. Check this space on the label so you know what you are actually consuming. Calories: Tells you how much energy (calories) is in a serving The calories listed show the amount of calories in one serving of this food item. The label also shows how many calories come from fat. Total Fat, Cholesterol, Sodium and Sugar: These are the types of nutrients that are in the product At the minimum all products must list the amounts of total fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrate, dietary fiber, sugar, protein, vitamin A and C, calcium, and iron that are in one serving. More on Fat: Under total fat, food labels must list saturated and trans fat (consume close to zero grams of trans fats per day). These fats are closely associated with raising bad cholesterol levels and
increasing the risk of heart and blood vessel diseases. Paying attention to the total fat in a food pays off because fat is the most concentrated source of calories (9 calories per gram). Eating too much fat can lead to unwanted weight gain or make it tougher for you to lose weight. More on Sodium: In some people, sodium increases blood pressure because it holds excess fluid in the body, placing an added burden on the heart. If your blood pressure is 120/80 Hg or above, your doctor may recommend a lowsalt diet. The American Diabetes Association recommends 2300mg of sodium or less per day. If you have diabetes and hypertension, you should work with your health care team to see if further reduction of sodium intake is necessary. Food Labeling (continued on page 5)
Taking Control Of Your Diabetes
3
The GRADE Study
Dr. Edelman’s VA San Diego Healthcare System begins recruitment as part of a nation-wide long-term study of diabetes drug efficacy
Participants will have their diabetes medications managed free of charge By Catherine DeLue and Jennifer Braidwood through the study, including at least four medical visits per year. What differentiates GRADE from previous studies is that it will ave you been diagnosed with type 2 diabetes within the perform a head-to-head comprehensive last five years? You might be interested in enrolling in the comparison of the most commonly Glycemia Reduction Approaches in Diabetes: A Comparative used drugs over a long period of Effectiveness (GRADE) Study. This randomized clinical trial time,” said David M. Nathan, M.D., is a multicenter trial that is currently being conducted at 36 of Massachusetts General Hospital, clinical sites around the country. The study plans to enroll 5,000 Boston. Nathan and John Lachin, participants in order to compare the long-term benefits and risks of four widely used diabetes drugs in combination with metformin, Sc.D., of The George Washington University, Washington, D.C., are the most common first-line medication for treating type 2 diabetes. co-principal investigators. “In addition to determining which If metformin is not enough to help quality of life over an average medications control blood glucose of nearly five years. Potential manage type 2 diabetes, a person’s levels most effectively over time, we participants may be on metformin, doctor may add one of several other hope to examine individual factors but not on any other diabetes drugs to lower glucose (blood sugar). that are associated with better or worse medications. During the study, all But while short-term studies have response to the different medications,” participants will take metformin, shown the efficacy of different drugs Nathan said. “This should provide when used with metformin, there have along with a second medication randomly assigned from among four understanding of how to personalize been no long-term studies of which combination works best and has fewer classes of medications, all approved the treatment of diabetes.” GRADE (ClinicalTrials.gov for use with metformin by the U.S. side effects. number: NCT01794143) is supported Food and Drug Administration. “GRADE is a novel and exciting under NIH grant U01DK098246. Three of the classes of study which has the potential of Additional support in the form of medications increase insulin levels. changing the future of therapy and donation of supplies comes from the They are: sulfonylurea, which management of type 2 diabetes,” said National Diabetes Education Program, increases insulin levels directly; Robert Henry, MD, local principal Sanofi-Aventis, Bristol-Myers Squibb, DPP-4 inhibitor, which indirectly investigator, chief of Endocrinology, increases insulin levels by increasing Novo Nordisk, Merck, BD Medical Metabolism & Diabetes at VA San and Roche Diagnostics. the effect of a naturally occurring Diego Healthcare System. Also, intestinal hormone; and GLP-1 working closely with Dr. Henry is agonist, which increases Dr. Steven Edelman, Founder and the amount of insulin Director of Taking Control Of Learn more about the study and how to become released in response to Your Diabetes. a participant visit: https://grade.bsc.gwu.edu . nutrients. The fourth The study will compare drug VA San Diego Healthcare System GRADE study contacts: type of medication is effects on glucose levels, adverse Catherine DeLue (858) 552-8585 ext. 6740 a long-acting insulin. effects, diabetes complications and Erik Castro (858) 552-8585 ext. 6449
H
4 My TCOYD Newsletter, Vol.33 Vol. 45
% Daily Value: Tells you how much you are (continued from page 3) consuming based on a More on Sugar: specific daily percentage The sugars on the The % daily value is a label include naturally guide to the nutrients in occurring sugars, such one serving of the product. as sucrose in fruit and For example, if the label lactose in milk, as lists 15% for calcium, well as added sugars— it means that one serving provides those added to products during 15% of the calcium you need each day. manufacturing. The percent daily values are As opposed to outdated advice based on a 2,000 calorie-a-day diet that all sugar is “forbidden,” you don’t for healthy adults. need to omit all sugars from your meal plan. Naturally occurring sugars found Footnote: Reminds you that the in fruit and dairy products are part of Percent Daily Value is based on a 2,000 calorie a day diet a well-balanced diet.
“We Keep Coming Back”
The footnote contains a statement saying that nutrient values vary by a person’s particular caloric needs. If there is enough space on the package, the footnote includes a list of selected nutrient values for both 2,000 and 2,500 calorie-a-day diets. Keep in mind that many people, including women and older adults, or those trying to lose weight, may need less than 2,000 calories, while others may need 2,500 calories or more. So think of 2,000 calories a day as a general reference point. Now get your shopping list ready and use this information to make wiser and healthier food choices this month!
Giving Back
By Jennifer Braidwood
W
alter and Carol McCauley attended their first TCOYD Honolulu conference in 2003. “A friend of ours, who volunteers at the TCOYD conferences in Honolulu, approached us and convinced us that we needed to attend the next time TCOYD was in town,” said Walter McCauley, a Maui resident, who has had type 2 diabetes for many years. Walter and his wife Carol have attended a total of five TCOYD conferences since 2003. “We keep coming back because the conferences help us keep up with the current developments within the field of diabetes. It’s always a good refresher when it comes to diabetes management and keeping up with the best care strategies.” Walter and Carol have generously donated to
TCOYD many times throughout the years. “We donate because it’s a very worthwhile cause. The staff at TCOYD are extremely dedicated. It’s a small organization, so I know my donations have made, and will continue to make a big difference.” Because of people like Walter and Carol, TCOYD is able to continue our mission of educating and empowering individuals with diabetes. “People should donate to TCOYD because of the simple fact that it’s a great organization and like I said before, it’s a great cause. There are good people at TCOYD and they are really making a difference in the lives of people with diabetes.” TCOYD sends a generous thank you to Walter and Carol for their many years of dedication and continued support of our work. If you would like to make a donation to TCOYD please visit our website at tcoyd.org and click on the “Giving” tab.
Taking Control Of Your Diabetes
5
A TCOYD Extreme Diabetes Makeover:
‘‘ I
’ve put back on seven pounds.” It was the first thing Jerry Lund said into the tape recorder on August 9, 2013 when Sandra Bourdette, Executive Director for TCOYD, sat down with him for his sixth interview. The vibrant, bold, and unstoppable Jerry that we have all gotten to know through his Extreme Diabetes Makeover these last 11 months has been dangerously slipping back into his old ways.
“It’s been a rough two months. My last interview was in May after my trip to China, when I fell off the wagon and since then, it’s been so hard to get back on. I was having so much success and the success kept By Jennifer Braidwood coming and coming. I remember thinking, ‘Man, this is great and so easy!’ You know what? I lost focus. I thought I could eat more and snack more. I thought I didn’t have to keep this rigid diet anymore. I was convinced that my metabolism had changed because of exercise and I was fooling myself. I got to a place where I was comfortable and, well, I just stopped doing the things I knew I Interview #6 needed to do. Now, I’m going August 9, 2013 back the other way.” Current Weight: 202 For the last 11 months, BP: 122/72 Jerry has proudly been A1C: 5.9 advertising his weight loss Total Cholesterol: 155 to friends, family, TCOYD, LDL: 91 his co-workers and, most importantly, to anyone that reads our newsletter each quarter. “I’ve stopped telling people. I’m not going to tell anyone I gained a pound or I’ve gained two pounds. So I’ve shut it all off for the last two months,” said Jerry. In reality, it’s not just a pound or two, it’s a whopping seven pounds, and that’s a lot in two months. “Sorry all you people out
The Jerry Lund Story - Final Interview
6 My TCOYD Newsletter, Vol. 45
there who thought this was so easy. Even though I thought it was different this time, it’s exactly the same as all the other times I’ve lost weight. I’m falling back into my old ways.” Our Executive Director quickly realized that this interview was going to be vastly different from the five she had done previously. For the first time, Jerry needed some serious help getting back on track and reigniting his motivation. She offered him this bit of advice, “a secret to success is realizing that you are going to fall off the wagon periodically, but, the key is to get back on track quickly. The next time you fall off, find a way to get back on sooner. Things happen, life happens! It’s human nature.” There was silence and then she continued, “it wouldn’t be a bad idea to put those same things in place that you did at the beginning of all of this. Checking in with me every day, calling or texting your doctor on a regular basis. Having the same system in place that really worked.” It’s important to remember that not every diet and exercise plan is going to be perfect and easy day in and day out. There are going to be days where you don’t follow all the rules, so to speak. The first couple of months are usually the easiest because you’re motivated and excited, but soon enough, like most things in life,
a year after he started his Extreme Diabetes Makeover with TCOYD he is realizing that he is now embarking on an entirely different journey, a journey that will be much harder than his initial quest to take control of his diabetes, his weight and his life. “The challenge is over. I’m not climbing that mountain anymore trying to reach the top. I’ve reached it.” The daunting question that Jerry faces is, now what? And, the answer to that question is something Jerry is still trying to figure out. “Losing 70 pounds, that’s exciting. Having your blood sugar go from 180 to 90 and having your blood pressure drop from 160/110 to 120/70, that’s exciting. It was easier to stay focused. The results were great and that added more to Interview #7 my focus, but now it’s completely September 17, 2013 different. It’s more about the longCurrent Weight: 201 term process, about maintenance.” BP: 122/72 Let’s be honest, maintenance isn’t A1C: 5.9 very exciting and, as Jerry is figuring Total Cholesterol: 155 out, can be difficult. But, it is an LDL: 91 absolute necessity when it comes to lasting weight loss and good health. “I need to completely buy “It’s kind of like meeting someone into good eating and exercising and and falling in love. You are so understand that it’s not just about excited at first, everything is new, then eventually you just get used to losing 70 pounds, following a plan for eight months and then stopping each other and the novelty wears off,” said Jerry Lund during his final and gaining it all back. I’ve done that interview. Jerry’s love affair with his plenty of times in the last 40 years. I’m not going to do it this time.” revolutionized lifestyle of healthy During the interview, our eating and working-out has officially lost its luster. It’s a very real fact that Executive Director shared her own Jerry’s journey with diet and exercise thoughts with Jerry about the yearlong process they went through is no longer intensified by massive together. “We are ending this with drops in weight, waist size, blood lots of questions, things to ponder sugar and blood pressure. Almost the novelty wears thin. There is an important lesson we can all learn from Jerry: diet, exercise and living a healthy lifestyle, is a journey with no end, with no stopping point. “I have to keep moving on and pushing forward. The ultimate goal is to stay on the journey and keep getting healthier. There was a starting point, September 26, 2012, but there is no ending point. It’s not the results, it’s the process and maybe I was focusing too much on the results. Reestablishing a plan and acting on it is what I need to do. I’ll tell you what, when I’m done with this interview I’m going straight to the grocery store do to my weekly shopping.”
and a sense of uncertainty as to what exactly the next steps are. We aren’t going to have a tidy little ending to this story because the story doesn’t end. This is the beginning of something new.” Jerry and Sandy continued to talk about the importance of identifying self-sabotaging behaviors and how pivotal it is to be aware of those behaviors that could potentially lead Jerry back to the person he was before his Extreme Diabetes Makeover. “I do know one thing about myself for sure and that is that I am a closet eater. I’ll only eat a donut when no one else is around. I’ll have a cheeseburger on my way home from work when I’m by myself. Eating bad food when I’m alone is my biggest problem.” The fact that Jerry is able to identify this behavior is a very good thing and will help him continue to have the awareness he needs to recognize these behaviors and not give in as he continues into the next year of his life. “In a year from now, if I am in the shape that I am in now, that would be a very good thing,” Jerry said at the close of his final interview. “I did make a promise to myself that I would never wear elastic shorts again and remember, I sold all my fat clothes!” Everyone at TCOYD would like to wish Jerry Lund much luck as he embarks on the next year of his life, a new man, who’s a lot lighter and much healthier than he was a year ago. We send lots of encouragement your way and thank you for letting us be so involved in your incredible journey!
Taking Control Of Your Diabetes
7
Ask a Pharmacist
Urinating Down Your A1C By Candis M. Morello, PharmD, CDE, FASHP and Tiep Ly
P
eople with type 2 diabetes just got a brand new oral medication option for treating diabetes that does not cause weight gain or hypoglycemia (low blood glucose). In March 2013, the FDA approved Invokana (canagliflozin). Along with improved glucose control, Invokana offers the benefits of weight loss and blood pressure reduction.
fact, most patients taking Invokana reported clinically significant weight loss. Second, through its unique mechanism of action, Invokana can also help reduce blood pressure. The idea for treating diabetes with an SGLT-2 inhibitor came by studying individuals with a defective SGLT-2 gene. These individuals with non-functional SGLT-2 transporters had higher levels of glucose in urine, but experienced no long-term consequences. The lack of long-term consequences was the basis for developing Invokana.
overall blood glucose. In addition, blood pressure is lowered because glucose draws water with it into the urine. This reduces blood volume and leads to a decrease in blood pressure. What is Invokana? A common concern might Invokana is the be that glucose in urine damages first drug in a new class the kidneys; this, however, is a of diabetes drugs called misconception. High blood glucose SGLT-2 inhibitors. It damages blood vessels and capillaries, helps rid your body’s including those in the kidneys. excess blood glucose When the kidneys don’t receive How Does Invokana through urination. enough oxygen, the cells die and Work? Invokana has been holes are formed, which can cause When urine first forms diabetic nephropathy (kidney shown to be more in your kidneys, it is filled damage from diabetes). effective at lowering with glucose. As urine AIC than older drugs How Is Invokana Used? travels through your kidneys, this like glimepiride and even new ones Invokana is an oral diabetes extra glucose is pumped back into like Januvia (sitagliptin). Clinical medication used with a healthy diet the blood by a transporter called trials showed its A1C lowering SGLT-2. Invokana works by blocking and exercise. Ivonkana comes as a abilities to be 0.9-1.2% when used 100mg and 300mg tablet and should the action of this transporter. By alone, or an additional 0.7-0.9% be taken before the first meal of the when added on to other medications, doing so, it allows the glucose to day. Usually people start with 100mg be urinated out and decreases the such as metformin. Because of its novel mechanism, Invokana provides Table 1. Tips for Preventing Yeast Infections two benefits over other diabetes Personal • Clean genital area daily using a mild, unscented soap and water. medications. First, Invokana does Hygiene • Use toilet paper by wiping from front to back (away from the genital area). not work by increasing your body’s Clothing • Don’t wear tight fitting clothing. insulin levels, so weight gain and • Use cotton underwear since it breathes better and won’t hold in moisture. risk for hypoglycemia are very low • Change out of wet clothing or bathing suit immediately. compared to other diabetes drugs. In
8 My TCOYD Newsletter, Vol. 45
Question of the Month
daily then increase to 300mg daily if a further A1C reduction is needed. Is Invokana Right for Me? Currently, Invokana is FDA approved for patients with type 2 diabetes only. People who are likely candidates are those taking more than one oral diabetes medication. Based on clinical trials, Invokana appears to be equally or more effective than old drugs like glimepiride and new ones like Januvia. Patients on these drugs can consider talking to their doctors about switching. Those concerned about weight and blood pressure may also benefit from Invokana’s weight loss and blood pressure lowering effects. Clinical trials showed the drug reduced body weight by 2-3% and blood pressure reduction of about 4mmHg over a six month time period. Before starting Invokana, have your health care provider do tests on your kidney function and potassium levels. Invokana is not to be used in those with severe renal failure or those with high levels of potassium in their blood, a condition called hyperkalemia. While Invokana provides many benefits, there are some side effects. The two most common were increased risk for urinary tract infections (UTIs)—especially in those with a history of UTIs—and increased urination. With more glucose exposed to the genital area, some patients, mainly women, may experience yeast (fungal) infections. Urination Down Your A1C (continued on page 12)
By Steven Edelman, MD
I
am a 28-year-old female with type 1 diabetes that was diagnosed 10 years ago. I was recently informed of a study where I would get Victoza (Note: also called liraglutide, an injectable incretin currently approved for people with type 2 diabetes) or a placebo injection for three months. If I were to become a study participant, I would have access to a continuous glucose monitor as well as all the test strips and I really need a new glucose meter. My A1c is 7.6% and I am 10 pounds overweight but, otherwise, I’m pretty healthy. I do have a general doctor and rarely get to see a diabetes specialist. How do I know if this study is right for me? Answer: There have already been a few studies using Victoza in folks with type 1 diabetes. Those study results have shown improved A1C, reduced variability of glucose values measured by a CGM device, weight loss and reduced insulin requirements. This has prompted NovoNordisk, the makers of Victoza, to conduct more studies in hopes of an official FDA approval to move forward with the use of Victoza in people with type 1 diabetes. If you get selected for the placebo group and not the actual drug, you probably will not see any major improvements in your diabetes, however, you will get the same free evaluation and supplies as all the other research volunteers. I would suggest looking at the protocol, number of visits, and the safety concerns. Discuss any concerns with the staff and with your own doctor if you want another medical opinion. Once you get all the information you can make an informed decision. A special thanks to all of our Facebook fans who sent in questions for Dr. Edelman!
Taking Control Of Your Diabetes
9
TCOYD in Motion
A Pathway to
Prevention
By Lorraine Stiehl
TrialNet will invite them to have further blood testing at a study center. These tests will tell TrialNet if they can join a prevention study. TrialNet’s Pathway to Prevention If your relatives are found to be at risk for developing type 1 diabetes, a number of prevention studies are in progress.
Oral Insulin Prevention Trial— ot only is TCOYD individuals who have For Individuals at Moderate Risk TrialNet is repeating an earlier study focused on improving these autoantibodies. using oral insulin (taken by mouth, not the lives of everyone with Relatives of diabetes through educational individuals with type 1 diabetes by injection). The prior study (completed and motivational conferences and have approximately 15 times greater by the Diabetes Prevention Trial-Type 1) continued support, we are committed risk for developing the disease than suggested that oral insulin may help delay type 1 diabetes for four or more years in to bringing new medical advances individuals with no family history. individuals with higher levels of insulin to patients with diabetes and to TrialNet offers the screening blood autoantibodies. Volunteers who join this help prevent this disease in future test at no cost to family members study will take one capsule each day for generations. of individuals with type 1 diabetes. a limited time, visit a study site for blood TCOYD is pleased to be partnering Your relatives may be screened tests every six months, and return at with the National Institutes of Health- if they are: other times as needed. funded Type 1 Diabetes TrialNet, • 1 to 45 years old and have a www.diabetestrialnet.org. TrialNet is brother, sister, child, or parent CTLA-4 Ig (Abatacept) Prevention a network of 18 clinical centers working with type 1 diabetes (first Trial—For Individuals at Moderate Risk with more than 200 screening sites degree relative) Abatacept (also known as Orencia) around the world. This network is OR is currently approved by the US Food dedicated to the study, prevention, • 1 to 20 years old and have a and Drug Administration (FDA) for and early treatment of type 1 diabetes. cousin, aunt, uncle, niece, treatment of rheumatoid arthritis which nephew, half-brother, half-sister, is an autoimmune disease like type 1 Delay or Prevent Type 1 Diabetes or grandparent with type 1 diabetes. In a prior TrialNet study, for Individuals At-Risk diabetes (second degree relative). subjects with newly diagnosed type 1 Type 1 diabetes is an autoimmune diabetes who received Abatacept kept disease in which the immune system Your relatives will learn the producing their own insulin longer than attacks and destroys the cells in the results of their blood test in four people in the study who did not receive body that produce insulin. Proteins to six weeks. Abatacept. Volunteers who qualify and called autoantibodies are markers of Only 5 out of every 100 people the destruction. TrialNet offers a tested will have autoantibodies and are enrolled will receive 14 doses of Abatacept or placebo over the course screening test that can detect these children under 18 years of age who of 12 months. The drug will be given autoantibodies in the blood up to 10 do not have autoantibodies may be through a vein (IV infusion) over 30 years before someone is diagnosed with retested every year to see if their type 1 diabetes. A major goal of TrialNet risk has changed. If their blood tests minutes. All volunteers will be monitored is to delay or prevent diabetes in show that they have autoantibodies, one to five years after the treatment
N
10 My TCOYD Newsletter, Vol. 45
Know Your Numbers
period to assess their overall health and to determine the effects of the treatment to their immune system and beta cells. AntiCD3 (Teplizumab) Prevention Trial – For Individuals at High Risk Teplizumab is a medication that has shown promise in preserving insulin secretion in people with newly diagnosed type 1 diabetes. This study is testing whether Teplizumab can help to delay or prevent the onset of diabetes in individuals at high risk. Volunteers who join the study will visit a TrialNet site to receive the twoweek study treatment. They will return for follow-up tests and monitoring approximately every six months. All study volunteers may be eligible for reimbursement for time, effort and travel expenses. TCOYD National Conference Screening Opportunities TCOYD has arranged for TrialNet to screen at all of our upcoming TCOYD National Conferences. If you have family members who are not within driving distance of one of our TCOYD National Conferences, TrialNet screening locations may be found at www.DiabetesTrialNet.org/locations New! Online Screening Opportunities Family members may now conveniently participate in free screening online. After completing a consent form online, a kit will be sent to the family member’s home. This kit can be taken to any Quest lab to facilitate the blood draw needed to screen for autoantibodies.
By Steven Edelman, MD
A
15-year-old boy who has had type 1 diabetes since the age of six is treated with Lantus at bedtime. Additionally, he carefully and accurately figures out how much Novolog he needs to take before each meal by counting the carbohydrates in that meal. His CHO:insulin ratio is 1:10. By taking a look at his logbook you can see that his post-breakfast numbers are through the roof almost every day (commonly above 300 mg/Dl).
SAT SUN MON TUES WED THUR FRI
Breakfast Before After 121 362 97 410 116 299 159 351 126 320 84 281 162 427
Lunch Before 186 159
After
Dinner Before 161 212 113 149 225 261 144
After 179 187
118 145 197
After a thorough dietary history, it was discovered that his typical breakfast consisted of orange juice (8 oz), a bowl of cold cereal (his favorites are Trix and Captain Crunch) with 1% milk, and two pieces of toast with diet jelly. Potential solutions for bringing down his post-breakfast numbers are: • More protein in the meal and less refined carbohydrates • Change the CHO:insulin ratio • Add Symlin before breakfast and, potentially, his other meals, too
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Taking Control Of Your Diabetes
11
TCOYD Conferences & Health Fairs 2014 Schedule
Pala, California
March 8 Sacramento, California
April 12 Honolulu, Hawaii
May 17 Raleigh, North Carolina
Tel: (800) 998-2693 (858) 755-5683 Fax: (858) 755-6854 Nonprofit Organization U.S. Postage
February 8 Native American,
Taking Control Of Your Diabetes 1110 Camino Del Mar, Suite “B” Del Mar, CA 92014 | www.tcoyd.org
PAID
San Diego, CA Permit No 1
June 7 Washington, DC September 6 Missoula, Montana
September 27 Des Moines, Iowa
October 18 Amarillo, Texas November 8 San Diego, California
For schedules, bios, trailers and more, visit www.tcoyd.org
TCOYD is a not-for-profit 501(c)3 charitable educational organization.
Urinating Down Your A1C (continued from page 9)
See Table 1 for tips to prevent yeast infections. Be sure to contact your medical provider should you experience genital itching, redness, or skin flaking, since you will need treatment with an anti-fungal agent. Similar to blood pressure medications, Invokana can cause dizziness and lightheadedness due to the reduced blood pressure effect it has. This might be an important consideration for senior patients who already have adequate blood pressure control. Finally, those
12 My TCOYD Newsletter, Vol. 45
with very high levels of cholesterol should note that Invokana has been shown to increase both your LDL (bad cholesterol) and HDL (good cholesterol). Bottom Line Invokana is a great new drug for those with type 2 diabetes and shows much promise. By allowing urination of excess glucose, it provides a three-prong attack on the important health concerns of most diabetic patients. This includes
lowering blood glucose, weight, and blood pressure. While it’s not a cure for diabetes, when coupled with a healthy diet and exercise, Invokana appears to provide a formidable new weapon in the fight against diabetes. Submitted by:
Candis M. Morello, PharmD, CDE, FASHP; Associate Professor of Clinical Pharmacy and Associate Dean for Student Affairs at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences and Clinical Pharmacist at VASDHS Tiep Ly, 3rd Year Student Pharmacist at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences.