The Research Rundown! A summary of recent research findings that impact the Type 1 Diabetes community.
A recent study in Sweden lends additional weight to the continuing evidence to suggest that long term complication risk of organ damage such as retinopathy and nephropathy is maximized with an A1C between 6.5 and 7.
This study again showed no long term complication risk benefit to maintaining an A1C below 6.5.
Professor Johnny Ludvigsson who led the research also added with regard to A1C targets for children “Attaining a low HbA1c value may, in some cases, require children to be woken up several times a night, plus extra glucose monitoring and strict attention to diet and physical activity day after day, which can be extremely burdensome”
Following the abundant evidence for best practices, at IDS we recommend our patients aim for an A1C of 6.5 and then assess whether further A1C reduction is appropriate and safe based on instances of hypoglycemia, stress, nutritional and activity needs etc since more and more evidence is showing that the “lower is better” approach to A1C targets have not been supported by the longterm outcomes. (this may differ for women planning pregnancy or for adults with increased hypoglycemia risks that may benefit form higher or lower targets, whether temporary of long term)
Speaking of organ damage we continue to see encouraging data on SGLT2 inhibiting medication use.
These medications, which trigger the body to release additional glucose in the urine, even beyond the typical 160 mg.dl Blood glucose threshold, have been avoided by many with diabetes due to concerns about the impact on kidney function. However analysis of recent trials indicates that SGLT2 use actually reduces the risk of kidney failure in patients with diabetes by 33% (risk of transplant, dialysis or death due to kidney disease) when compared to placebo.
The mechanism of this apparent protective effect is unknown at this time. It may be possible that the improved glycemic profile of patients using these medications is responsible for some of the reduced risk, but reduced risk of kidney disease appears to supersede A1C reduction.
SGLT2 inhibitors continue to be contraindicated for patients with exhisting renal impairment and ongoing renal function monitoring is imperative for all persons with diabetes. However, when combined with evidence of reduction of cardiovascular event risk in persons with diabetes, the Pros of SGLT2 use are shifting to outweigh the cons.
(For more information: https://www.mdmag.com/medical-news/sglt2-inhibitors-protect-against-kidney-failure-in-diabetics)
Along side SGLT2i news comes more news on the benefits of GLP-1 analogues. In a recent liraglutide study the impacts on time in range for people with Type 2 diabetes who are also on MDI (multiple daily injections) showed increased time in range and reduced time at elevated range without an increase in hypoglycemia.
We continue to encourage patients who are struggling with postprandial control, over all control, as well as weight management to speak with their prescribers about whether adjunctive therapy would benefit them. These medications alone, and together can reduce post prandial spikes by, slowing digestion speed allowing insulin timing to more closely match blood sugar rise, and reduce the release of post meal glucagon. While insulin secretion stimulation may not be particularly beneficial for people with Type 1 diabetes (Though we often do still make a small amount of our own insulin) the benefits remain.
The most common side effect of both SGLT2 and GLP1 medications for people with type 1 are GI side effects like nausea, but titrated appropriately these symptoms can typically be minimized and go away after a couple weeks at a steady dose.
The FDA has still not approved these medications for use by persons with type 1 diabetes, but the benefits are many and with proper monitoring and education, current literature shows that the risks are few.
Studies continue to flood journals and other outlets demonstrating that modern Americans simply are not sleeping well. Likely due to the increase in the use of screens and devices that are following us into bed at night and the increases of stresses since the economic down turn some years ago. This was confirmed in a recent study that determined that American workers are getting less sleep than we did 10 years ago. 35.6% of us report getting less than 7 hours of sleep on average. That is up 5% since 2010. This is a big deal because sleep is a critical time to our over all health and our diabetes management! Decreased sleep leads to increased inflammation and increase cortisol levels which directly raise blood sugars and increase blood sugar variability. Not to mention that supporting healthy habits like making good food choices, exercising, and taking medications suffers when we are fatigued. We also don’t think as well so we make fewer and less accurate decisions about carb counts, insulin doses etc. Not to mention that fatigue also sends us reaching for more snacks and caffeine through the day which can push blood sugars up too!. The data shows what you do for a living may have the biggest impact on your sleep time
“In 2018, half of people working in the police and military said they slept fewer than seven hours a night, as did 45 percent of people in health care professions and 41 percent of people working in transportation and material moving, such as truck drivers”
We spend a lot of time managing diabetes, but a significant time is your sleep time!! So protect that time. Turn off screens sooner, get regular exercise earlier in the day to improve sleep quality, and those working shift work should do what they can to achieve 7+ consecutive hours of sleep (3 hours here and 4 hours there does NOT equal 7 hours total when it comes to sleep health)