DMJ August 2019 Edition


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Diabetes Management Journal August 2019

Diabetes Management Journal August 2019 References



  1. Merchant R, et al. Evaluating the predictability of medical conditions from social media posts. PLOS One, published online 17 June 2019. Avail at
  2. Saleh A. Diagnosis of type 2 diabetes using serial fasting plasma glucose versus HbA1c in the primary care setting. AJGP vol 48, no 5, May 2019.
  3. Beckman J, et al. Microvascular disease, peripheral artery disease, and amputation. Circulation. 2019;140:449–458
  4. Farber A. Chronic limb-threatening ischemia. N Engl J Med. 2018; 379:171–180
  5. Scholefield A. GP wins appeal as $200k negligence claim quashed. Australian Doctor, 11 June 2019. Avail at


p 8-12 Diabetic Kidney Disease – a practical approach

  1. Australian Institute of Health and Welfare 2018, Diabetes Snapshot. Canberra: AIHW.
  2. Feehally, J., et al., Comprehensive clinical nephrology. Sixth edition. ed. xvii, 1333 pages.
  3. Fabre, J., et al., The kidney in maturity onset diabetes mellitus: a clinical study of 510 patients. Kidney Int, 1982. 21(5): p. 730-8.
  4. Parving, H.H., Renoprotection in diabetes: genetic and non-genetic risk factors and treatment. Diabetologia, 1998. 41(7): p. 745-59.
  5. Ayodele, O.E., C.O. Alebiosu, and B.L. Salako, Diabetic nephropathy--a review of the natural history, burden, risk factors and treatment. J Natl Med Assoc, 2004. 96(11): p. 1445-54.
  6. Australia and New Zealand Dialysis and Transplant Registry, ANZDATA Registry. 41st Report, Chapter 1: Incidence of End Stage Kidney Disease. 2018: Adelaide, Australia.
  7. Cao, Z. and M.E. Cooper, Pathogenesis of diabetic nephropathy. J Diabetes Investig, 2011. 2(4): p. 243-7.
  8. Chadban, S., et al., National Evidence Based Guideline for Diagnosis, Prevention and Management of Chronic Kidney Disease in Type 2 Diabetes C. Diabetes Australia and the NHMRC, Editor.
  9. Waikar, S.S., et al., Biological Variability of Estimated GFR and Albuminuria in CKD. Am J Kidney Dis, 2018. 72(4): p. 538-546.
  10. Perrone, R.D., N.E. Madias, and A.S. Levey, Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem, 1992. 38(10): p. 1933-53.
  11. Stevens, P.E., A. Levin, and M. Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group, Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med, 2013. 158(11): p. 825-30.
  12. Brenner, B.M., et al., Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med, 2001. 345(12): p. 861-9.
  13. Lewis, E.J., et al., The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med, 1993. 329(20): p. 1456-62.
  14. Lewis, E.J., et al., Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med, 2001. 345(12): p. 851-60.
  15. Zinman, B., et al., Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med, 2015. 373(22): p. 2117-28.
  16. Wiviott, S.D., et al., Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med, 2019. 380(4): p. 347-357.
  17. Perkovic, V., et al., Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med, 2019. 380(24): p. 2295-2306.
  18. Neal, B., et al., Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med, 2017. 377(7): p. 644-657.
  19. Mann, J.F., et al., Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet, 2008. 372(9638): p. 547-53.
  20. Palevsky, P.M., et al., Incidence, Severity, and Outcomes of AKI Associated with Dual Renin-Angiotensin System Blockade. Clin J Am Soc Nephrol, 2016. 11(11): p. 1944-1953.
  21. Action to Control Cardiovascular Risk in Diabetes Study, G., et al., Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med, 2008. 358(24): p. 2545-59.
  22. Xie, X., et al., Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet, 2016. 387(10017): p. 435-43.
  23. Group, S.R., et al., A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med, 2015. 373(22): p. 2103-16.
  24. National Heart Foundation of Australia, Guideline for the diagnosis and management of hypertension in adults - 2016. 2016, National Heart Foundation of Australia: Melbourne.
  25. National Vascular Disease Prevention Alliance, Guidelines for the management of absolute cardiovascular disease risk. 2012, NVDPA: Melbourne.
  26. Ohkuma, T., et al., Combination of Changes in Estimated GFR and Albuminuria and the Risk of Major Clinical Outcomes. Clin J Am Soc Nephrol, 2019. 14(6): p. 862-872.
  27. Wanner, C., M. Tonelli, and M. Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group, KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient. Kidney Int, 2014. 85(6): p. 1303-9.
  28. Goraya, N. and D.E. Wesson, Dietary interventions to improve outcomes in chronic kidney disease. Curr Opin Nephrol Hypertens, 2015. 24(6): p. 505-10.
  29. Sacks, F.M., et al., Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med, 2001. 344(1): p. 3-10.
  30. National Kidney, F., KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update. Am J Kidney Dis, 2012. 60(5): p. 850-86.
  31. American Diabetes, A., 6. Glycemic Targets: Standards of Medical Care in Diabetes-2019. Diabetes Care, 2019. 42(Suppl 1): p. S61-S70.
  32. Marso, S.P., et al., Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med, 2016. 375(4): p. 311-22.
  33. Marso, S.P., et al., Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med, 2016. 375(19): p. 1834-1844.
  34. Holman, R.R., et al., Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med, 2017. 377(13): p. 1228-1239.
  35. White, W.B., et al., Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med, 2013. 369(14): p. 1327-35.
  36. Scirica, B.M., et al., Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med, 2013. 369(14): p. 1317-26.
  37. Rosenstock, J., et al., Effect of Linagliptin vs Placebo on Major Cardiovascular Events in Adults With Type 2 Diabetes and High Cardiovascular and Renal Risk: The CARMELINA Randomized Clinical Trial. JAMA, 2019. 321(1): p. 69-79.
  38. Green, J.B., et al., Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med, 2015. 373(3): p. 232-42.
  39. Rehman, M.B., et al., Efficacy and safety of DPP-4 inhibitors in patients with type 2 diabetes: Meta-analysis of placebo-controlled randomized clinical trials. Diabetes Metab, 2017. 43(1): p. 48-58.
  40. Johnson, D., CARI Guidelines: When to refer for specialist renal care. 2012, Kidney Health Australia.

p 14-16 How Depression and Anxiety Interact with Diabetes

  1. Whitworth SR, Bruce DG, Starkstein SE, Davis WA, Davis TM, Bucks RS. Lifetime depression and anxiety increase prevalent psychological symptoms and worsen glycemic control in type 2 diabetes: The Fremantle Diabetes Study Phase II. Diabetes research and clinical practice 2016;122:190-197.
  2. Markowitz SM, Gonzalez JS, Wilkinson JL, Safren SA. A review of treating depression in diabetes: emerging findings. Psychosomatics 2011;52:1-18.
  3. Collins MM, Corcoran P, Perry IJ. Anxiety and depression symptoms in patients with diabetes. Diabet Med 2009;26:153-161.
  4. Bruce DG, Davis WA, Cetrullo V, Starkstein SE, Davis TM. Clinical impact of the temporal relationship between depression and type 2 diabetes: the Fremantle diabetes study phase II. PLoS One 2013;8:e81254.
  5. Starkstein SE, Davis WA, Dragovic M, Cetrullo V, Davis TM, Bruce DG. Diagnostic criteria for depression in type 2 diabetes: a data-driven approach. PLoS One 2014;9:e112049.
  6. Safren SA, Gonzalez JS, Wexler DJ, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes. Diabetes Care 2014;37:625-633.
  7. Nobis S, Lehr D, Ebert DD, et al. Efficacy of a web-based intervention with mobile phone support in treating depressive symptoms in adults with type 1 and type 2 diabetes: a randomized controlled trial. Diabetes Care 2015;38:776-783.
  8. Perrin N, Bodicoat DH, Davies MJ, Robertson N, Snoek FJ, Khunti K. Effectiveness of psychoeducational interventions for the treatment of diabetes-specific emotional distress and glycaemic control in people with type 2 diabetes: A systematic review and meta-analysis. Prim Care Diabetes 2019.

p 18-19 The New Injectables

  1. AusDI [Internet]. AusDi. 2019 [cited 2019 Jun 24]. Available from:
  2. AusDi. Insulin and Insulin Analogues (Systemic) - AusDI [Internet]. AusDi. 2019 [cited 2019 Jun 24]. Available from:
  3. Pratley RE, Emerson SS, Franek E, Gilbert MP, Marso SP, McGuire DK, et al. Cardiovascular safety and lower severe hypoglycaemia of insulin degludec versus insulin glargine U100 in patients with type 2 diabetes aged 65 years or older: Results from DEVOTE (DEVOTE 7). Diabetes, Obes Metab [Internet]. 2019 Apr 15 [cited 2019 Jun 25];21(7):dom.13699. Available from:
  4. Kerlan V, Gouet D, Marre M, Renard É. Use of insulin degludec, a new basal insulin with an ultra-long duration of action, in basal–bolus therapy in type 1 and type 2 diabetes. Ann Endocrinol (Paris) [Internet]. 2013 Dec 1 [cited 2019 Jun 25];74(5–6):487–90. Available from:
    p 18-19 The New Injectables – cont’d
  5. Investigators TOT. Basal Insulin and Cardiovascular and Other Outcomes in Dysglycemia. N Engl J Med [Internet]. 2012 Jul 26 [cited 2019 Jun 25];367(4):319–28. Available from:
  6. Byetta (exenatide) dosing, indications, interactions, adverse effects, and more [Internet]. Medscape. 2019 [cited 2019 Jun 27]. Available from:
  7. New Drugs: Exenatide. Aust Prescr [Internet]. 2007 Dec 1 [cited 2019 Jun 27];30(6):163–7. Available from:
  8. Buse JB, Rosenstock J, Sesti G, Schmidt WE, Montanya E, Brett JH, et al. Liraglutide once a day versus exenatide twice a day for type 2 diabetes: a 26-week randomised, parallel-group, multinational, open-label trial (LEAD-6). Lancet [Internet]. 2009 Jul 4 [cited 2019 Jun 27];374(9683):39–47. Available from:
  9. fda, cder. HIGHLIGHTS OF PRESCRIBING INFORMATION [Internet]. [cited 2019 Jun 27]. Available from:
  10. Garber A, Henry R, Ratner R, Garcia-Hernandez PA, Rodriguez-Pattzi H, Olvera-Alvarez I, et al. Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): a randomised, 52-week, phase III, double-blind, parallel-treatment trial. Lancet [Internet]. 2009 Feb 7 [cited 2019 Jun 27];373(9662):473–81. Available from:
  11. Trujillo JM, Nuffer W, Ellis SL. GLP-1 receptor agonists: a review of head-to-head clinical studies. Ther Adv Endocrinol Metab [Internet]. 2015 Feb 25 [cited 2019 Jun 25];6(1):19–28. Available from:
  12. Kugler AJ, Thiman ML. Efficacy and safety profile of once-weekly dulaglutide in type 2 diabetes: a report on the emerging new data. Diabetes Metab Syndr Obes [Internet]. 2018 [cited 2019 Jun 27];11:187–97. Available from:
  13. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JFE, Nauck MA, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med [Internet]. 2016 Jul 28 [cited 2018 Apr 14];375(4):311–22. Available from:
  14. Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Lakshmanan M, Pais P, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet (London, England) [Internet]. 2019 Jun 7 [cited 2019 Jun 27];0(0). Available from:
  15. Kumarathurai P, Anholm C, Fabricius-Bjerre A, Nielsen OW, Kristiansen O, Madsbad S, et al. Effects of the glucagon-like peptide-1 receptor agonist liraglutide on 24-h ambulatory blood pressure in patients with type 2 diabetes and stable coronary artery disease. J Hypertens [Internet]. 2017 May [cited 2019 Jun 28];35(5):1070–8. Available from:
  16. Ilag LL, Deeg MA, Costigan T, Hollander P, Blevins TC, Edelman S V., et al. Evaluation of immunogenicity of LY2963016 insulin glargine compared with Lantus® insulin glargine in patients with type 1 or type 2 diabetes mellitus. Diabetes, Obes Metab [Internet]. 2016 Feb 1 [cited 2019 Jun 28];18(2):159–68. Available from:
  17. Holman RR, Bethel MA, Mentz RJ, Thompson VP, Lokhnygina Y, Buse JB, et al. Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med [Internet]. 2017 Sep 28 [cited 2019 Jun 28];377(13):1228–39. Available from:
  18. Insulin Degludec Monograph for Professionals - [Internet]. [cited 2019 Jun 28]. Available from:
  19. Rosenstock J, Schwartz SL, Clark CM, Park GD, Donley DW, Edwards MB. Basal insulin therapy in type 2 diabetes: 28-week comparison of insulin glargine (HOE 901) and NPH insulin. Diabetes Care [Internet]. 2001 Apr 1 [cited 2019 Jun 28];24(4):631–6. Available from:
  20. Mathieu C, Rodbard HW, Cariou B, Handelsman Y, Philis-Tsimikas A, Ocampo Francisco AM, et al. A comparison of adding liraglutide versus a single daily dose of insulin aspart to insulin degludec in subjects with type 2 diabetes (BEGIN: VICTOZA ADD-ON). Diabetes, Obes Metab [Internet]. 2014 Jul 1 [cited 2019 Jun 28];16(7):636–44. Available from:
  21. Rodbard HW, Cariou B, Zinman B, Handelsman Y, Philis-Tsimikas A, Skjøth T V., et al. Comparison of insulin degludec with insulin glargine in insulin-naive subjects with Type 2 diabetes: a 2-year randomized, treat-to-target trial. Diabet Med [Internet]. 2013 Nov 1 [cited 2019 Jun 28];30(11):1298–304. Available from:

P20-22 Injection Perfection - Technique Matters for Optimal Diabetes Management

  1. Frid AH, Kreugel G, Grassi G, et al. New Insulin Delivery Recommendations. Mayo Clin Proc. 2016;91(9):1231-1255. doi:10.1016/j.mayocp.2016.06.010
  2. Frid AH, Hirsch LJ, Menchior AR, Morel DR, Strauss KW. Worldwide Injection Technique Questionnaire Study: Population Parameters and Injection Practices. Mayo Clin Proc. 2016;91(9):1212-1223. doi:10.1016/j.mayocp.2016.06.011
  3. DE CONINCK C, FRID A, GASPAR R, et al. Results and analysis of the 2008-2009 Insulin Injection Technique Questionnaire survey. J Diabetes. 2010;2(3):168-179. doi:10.1111/j.1753-0407.2010.00077.x
  4. Selam J-L. Evolution of Diabetes Insulin Delivery Devices. J Diabetes Sci Technol. 2010;4(3):505-513. doi:10.1177/193229681000400302
  5. Anderson BJ, Redondo MJ. What Can We Learn from Patient-Reported Outcomes of Insulin Pen Devices? J Diabetes Sci Technol. 2011;5(6):1563-1571. doi:10.1177/193229681100500633
  6. Baruah MP. Insulin pens: the modern delivery devices. J Assoc Physicians India. 2011;59 Suppl:38-40. Accessed June 4, 2019.
  7. (ADEA) ADEA. Clinical Guiding Principles for Subcutaneous Injection Technique.; 2019.
  8. Frid A, Hirsch L, Gaspar R, et al. New injection recommendations for patients with diabetes. Diabetes Metab. 2010;36:S3-S18. doi:10.1016/S1262-3636(10)70002-1
  9. Al Hayek AA, Robert AA, Braham RB, Al Dawish MA. Frequency of Lipohypertrophy and Associated Risk Factors in Young Patients with Type 1 Diabetes: A Cross-Sectional Study. Diabetes Ther. 2016;7(2):259-267. doi:10.1007/s13300-016-0161-3
  10. Blanco M, Hernández MT, Strauss KW, Amaya M. Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes Metab. 2013;39(5):445-453. doi:10.1016/j.diabet.2013.05.006
  11. Barola A, Tiwari P, Bhansali A, Grover S, Dayal D. Insulin-Related Lipohypertrophy: Lipogenic Action or Tissue Trauma? Front Endocrinol (Lausanne). 2018;9:638. doi:10.3389/fendo.2018.00638
  12. Pozzuoli GM, Laudato M, Barone M, Crisci F, Pozzuoli B. Errors in insulin treatment management and risk of lipohypertrophy. Acta Diabetol. 2018;55(1):67-73. doi:10.1007/s00592-017-1066-y
  13. Al Ajlouni M, Abujbara M, Batieha A, Ajlouni K. Prevalence of lipohypertrophy and associated risk factors in insulin-treated patients with type 2 diabetes mellitus. Int J Endocrinol Metab. 2015;13(2):e20776. doi:10.5812/ijem.20776
  14. Vardar B, Kızılcı S. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes Res Clin Pract. 2007;77(2):231-236. doi:10.1016/j.diabres.2006.12.023
  15. Deng N, Zhang X, Zhao F, Wang Y, He H. Prevalence of lipohypertrophy in insulin-treated diabetes patients: A systematic review and meta-analysis. J Diabetes Investig. 2018;9(3):536-543. doi:10.1111/jdi.12742
  16. Gupta SS, Gupta KS, Gathe SS, Bamrah P, Gupta SS. Clinical Implications of Lipohypertrophy Among People with Type 1 Diabetes in India. Diabetes Technol Ther. 2018;20(7):483-491. doi:10.1089/dia.2018.0074
  17. Deeb A, Abdelrahman L, Tomy M, et al. Impact of Insulin Injection and Infusion Routines on Lipohypertrophy and Glycemic Control in Children and Adults with Diabetes. Diabetes Ther. 2019;10(1):259-267. doi:10.1007/s13300-018-0561-7
  18. Famulla S, Hövelmann U, Fischer A, et al. Insulin Injection Into Lipohypertrophic Tissue: Blunted and More Variable Insulin Absorption and Action and Impaired Postprandial Glucose Control. Diabetes Care. 2016;39(9):1486-1492. doi:10.2337/dc16-0610
  19. Spollett G, Edelman S V., Mehner P, Walter C, Penfornis A. Improvement of Insulin Injection Technique. Diabetes Educ. 2016;42(4):379-394. doi:10.1177/0145721716648017
  20. Strauss K, De Gols H, Hannet I, Partanen T-M, Frid A. A Pan-European Epidemiologic Study of Insulin Injection Technique in Patients with Diabetes. Vol 19.; 2002. Accessed May 28, 2019.
  21. Frid A, Hirsch L, Gaspar R, et al. The Third Injection Technique Workshop In Athens (TITAN). Diabetes Metab. 2010;36:S19-S29. doi:10.1016/S1262-3636(10)70003-3
  22. Frid AH, Hirsch LJ, Menchior AR, Morel DR, Strauss KW. Worldwide Injection Technique Questionnaire Study: Injecting Complications and the Role of the Professional. Mayo Clin Proc. 2016;91(9):1224-1230. doi:10.1016/j.mayocp.2016.06.012

P25-27 Late-onset T1D

  1. Diabetes Australia. Type 1 Diabetes. Avail at Accessed 12 July 2019.
  2. Tait BD, et al. HLA antigens and age at diagnosis of insulin-dependent diabetes mellitus. Hum Immunol. 1995 Feb;42(2):116-22
  3. Turner R, et al. UKPDS 25: autoantibodies to islet-cell cytoplasm and glutamic acid decarboxylase for prediction of insulin requirement in type 2 diabetes: UK Prospective Diabetes Study Group. Lancet 350:1288-1293, 1997
  4. Fourlanos S, Perry C, Stein M, Stankovich J, Harrison LC, Colman PG. A clinical screening tool identifies autoimmune diabetes in adults. Diabetes Care 2006; 29(5):970-5
  5. Karjalainen J, et al. A comparison of childhood and adult type I diabetes mellitus. N Engl J Med. 1989 Apr 6;320(14):881-6

P28-29 Reality Check – Why This GP Doesn’t Like Glucose Tolerance Tests

  1. HAPO Study Cooperative Group (2008) Hyperglycemia and Pregnancy Outcomes;  N Engl J Med; 358:1991-2002
  2. Deed G et al (2018) General Practice Management of Diabetes 2016 -2018, RACGP,
  3. SA Perinatal Practice Guidelines (2016)  Diabetes Mellitus and Gestational Diabetes, South Australian Health Department;
  4. Australasian Diabetes in Pregnancy (2014) Consensus Guidelines For The Testing And Diagnosis Of Gestational Diabetes In Australia;

p33 – p34  Food Stuff – Non-Hungry Eating

  1. Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutrition Journal 2011 10:9
  2. Nicholson Z. Love what you eat; the non-diet approach & intuitive eating.
  3. Dolezal L, Lyons B. Health-related shame: an affective determinant of health? Medical Humanities 2017;43:257-263.