Laurie Scudder, DNP, NP

Disclosures

June 17, 2016

Editor's Note:
Choosing among posters presented at the American Diabetes Association 76th Annual Scientific Sessions is equivalent to sending a child into a grocery store–sized candy shop with instructions to pick out just five pieces. Topics ranged from high-science examinations of intracellular differences between obese and nonobese knockout mice, to qualitative studies of efficacy of different counseling techniques in those newly diagnosed with type 2 diabetes.

So, with no pretension that the following selections are the most important, most newsworthy, most practice-changing of these hundreds of offerings, we offer this quick summary of seven posters that caught the eye of Medscape's editors.

A Better Marker for Cardiovascular Disease?

The study. Red blood cell distribution width (RDW) is a measure of the size variability of circulating erythrocytes and has been found to be an independent predictor of cardiovascular disease (CVD). Jong Suk Park from Yonsei University College of Medicine, Seoul, Republic of Korea, and colleagues examined carotid intima media thickness (C-IMT) in patients with type 2 diabetes and no history of CVD at varying tertile levels of RDW. There was a linear relationship between increasing RDW and C-IMT measures even after controlling for such confounders as age and sex.

The implications. RDW is a cheap and easy measure to assess in contrast to C-IMT and was independently associated with subclinical atherosclerosis. While it's too early to know with absolute certainty, tracking RDW may provide a way to measure changes in CV function. It may even serve as a measure to educate—and motivate—patients to engage in lifestyle changes.

Predicting Insulin Nonadherence

The study. MOSAIc (Multinational Observational Study Assessing Insulin Use) was an international 2-year prospective cohort study examining factors associated with insulin nonadherence in over 2000 adults with type 2 diabetes who had been taking insulin for at least 3 months. Mengdong He and colleagues reported the results of a multivariable logistic regression analysis that attempted to identify factors associated with nonadherence. Nonadherent patients were significantly more likely to be younger, have lower scores on tests of diabetes knowledge, more likely to be nonadherent at baseline, to use mixed insulin and require more than one injection daily, to have had a worse experience with insulin delivery systems, and to have poorer communication with their physician.

The implications. These results clearly highlight the need for better communication with patients who are younger, less knowledgeable about their disease, and may well be needing insulin, at least in part, because of poor adherence with other regimes.

Benefits of High-Intensity Interval Training

The study. In a small study of 10 patients, Maria Apostolopoulou of the German Diabetes Center and colleagues examined the effect of 12 weeks of high-intensity interval training, followed by a 4-week pause, on insulin sensitivity and beta-cell function. Markers of insulin sensitivity improved with the high-intensity training while insulin and glucagon secretions, markers of beta-cell function, did not.

The implications. Measures of insulin sensitivity returned to baseline following the 4-week pause, providing more evidence that the benefits of physical activity require constant vigilance. And while physical activity is a good thing and beneficial, it cannot undo the underlying damage to beta-cell function.

Can Metformin Affect Fitness?

The study. Metformin along with lifestyle changes is the cornerstone of diabetes management, yet some evidence has suggested that metformin may attenuate aerobic capacity. Sheliza Lalani, MD, and colleagues from George Washington University examined changes in peak metabolic equivalents (METs) in predominantly black obese men who participated in similar lifestyle programs, half of whom were on metformin. While there were no differences in METs prior to the intervention in the two groups, the men participating in the lifestyle intervention while receiving metformin, after controlling for confounders, had a significantly higher increase in cardiorespiratory fitness.

The implications. Given the widespread use of metformin in populations with prediabetes and diabetes, the clinical significance of this decrease needs further study. If metformin, perhaps because of its inhibitory effect on mitochondrial function, potentially negates the beneficial effects of physical activity, that would be a very big deal.

Healthcare Utilization

The study. While effectiveness of care delivered by physicians, nurse practitioners (NPs), and physician assistants (PAs) has been found to be comparable, little is known about resource utilization by each of these types of clinicians. Salim Virani, MD, PhD, of the Center for Innovations in Quality, Effectiveness and Safety at the US Department of Veterans Affairs and colleagues examined the records of over 1 million patients seen across the United States to answer that question. After controlling for severity of illness and other confounding factors, the study found at least comparable (and lower for some measures) resource utilization for NPs and PAs compared with physicians, although physicians had much larger patient panels.

The implications. In an era of growing patient loads due to an aging population, as well as the substantial burden of overweight and obesity plus ever-tightening budgets, the study provides important information to support a role for all types of clinicians.

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