Diabetic Digest - July 18, 2018

Readers:

I'm headed out to see my doctor. I'm due for an A1C blood test just to make sure that my blood-sugar is staying where it should and making sure that I'm not headed for any problems.

I'm sure you know by now that I get this taken care of every three months. It's always important to have your A1C blood draw on a regular basis. I'm glad I do and I'm sure you do as well. It's always better to be up on things rather that playing the 'coulda, woulda, shoulda' game.

It's been rather high the last two times I've had it checked so I've got my fingers crossed for some good results this time out. I'll let you know how it went in the next issue.

Regards,
Steve

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Comments? Questions? Email Steve



*-- Diabetic News --*
Study: Older insulin forms as effective as newer type 2 diabetes drugs
Older versions of insulin for type 2 diabetics were just as effective as the newer, costlier generation of therapy in a recent study.

Researchers at the Yale School of Medicine and Kaiser Permanente studied the effects of human insulin and the newer analog drugs based on blood sugar totals and hospital and emergency department visits for hypoglycemia. They published their findings last week in the Journal of the American Medical Association.

Treatment of type 2 diabetes typically begins with a change in lifestyle and metformin, a low-cost pill lowering blood sugar levels. But up to 25 percent of diabetes patients eventually require additional insulin injections to control their blood sugar, the researchers note.

Both versions -- the older Neutral Protamine Hagedorn and the newer Basal Insulin Analogs -- can be prescribed as daily or twice-daily injections to control blood sugar throughout the day.

"For decades, people initiating insulin treatment were prescribed human insulin," Dr. Andrew J. Karter, senior research scientist with the Kaiser Permanente Division of Research, said in a Yale press release. "Then in the 2000s, a new generation of long-acting insulin analogs emerged that were designed to mimic human insulin."

And these new drugs are much costlier.

A vial of insulin analog costs about $200 to $300 compared with a $25 vial of NPH insulin, according to lead author Dr. Kasia J. Lipska, an assistant professor of medicine at Yale School of Medicine .

Analog insulin's cost tripled nationally between 2002 and 2013, Lipska noted.

"We found that for patients with type 2 diabetes in usual practice, the use of the more expensive insulin analogs did not appear to result in better safety -- at least as defined by hospital or emergency visits for hypoglycemia -- or better blood sugar control compared with NPH insulin," Lipska said. "This suggests that many people with type 2 diabetes should consider starting with NPH insulin, instead of insulin analogs, especially if cost is an issue for them."

A retrospective observational study used data from 2006-15 of adults at least 19 years old from Kaiser Permanente of Northern California. In the study, 23,561 people started with NPH insulin and 1,928 began with analog insulin. Patients with type 1 diabetes were excluded.

Within one year of insulin initiation, hemoglobin A1c levels decreased by 1.27 percentage points among patients who started insulin analogs and by 1.43 percentage points among patients who started NPH insulin.

"Some people with type 2 diabetes may find the potential benefits of insulin analogs worth the additional cost," Karter said. "But we found no population-level evidence to suggest that the extra expenditure is warranted for most people with type 2 diabetes, particularly when the high cost could prevent some of them from getting the treatment they need or divert resources away from other, potentially beneficial clinical interventions."

They also said their research showed medications with high out-of-pocket costs are linked to poorer adherence, "which directly affects outcomes for diabetes patients."



*-- Diabetic Recipe --*
CUCUMBER AND DILL PASTA SALAD
2 cups Macaroni or small shells
8 oz carton sour cream
1/2 cup milk
1 Tbs fresh dill, minced
1 Tbs. white vinegar
1/2 tsp. salt
1/2 tsp. freshly ground black pepper
2 cups cucumber, peeled and chopped
1 cup Tomatoes, seeds removed and chopped

DIRECTIONS: Cook pasta in boiling salted water until al dente. Drain, and rinse in cold water. Transfer cooked pasta to a large serving bowl. In a separate bowl, mix together sour cream, milk, dill, vinegar, and salt and pepper. Set dressing aside. Mix cucumbers and tomatoes into the pasta. Pour in dressing, and toss thoroughly to combine. Cover, and refrigerate at least 1 hour, for best results and taste prepare the night before the your together. Stir just before serving.

Categories: Pasta, Salads

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