September 30, 2017 : Issue #905

• Intensive Control Again Shows Greater Benefits
• Metformin For T1D Benefits – REMOVAL Study
• Eating Disorders and Disordered Eating Symptoms in Adolescent Type 1’s
• Ertugliflozin, An SGLT-2, Meets Goals in Two Phase 3 Trials
• Abbott’s CGM Libre Approved by FDA
• Exclusive: Francine Kaufman on the Medtronic MiniMed 670G Insulin Pump

This week there was a lot of press about Abbott getting approval for their CGMS, the Libre Flash System (see item #5). The best part about this approval is the hope that there will be be more competition among the manufacturers, lower prices and increased third party coverage.

This would be good based on the information we have in Item #1, where we share data on another study that shows that intensive control of blood glucose levels and other health markers benefits people with type 2 diabetes more than standard care.

In the past the risk of hypoglycemia has been a limiting factor in achieving intensive control; however, recent studies have shown a decrease in this adverse event when the patient has been using a CGM on a regular basis.

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We can make a difference!

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Dave Joffe

Editor-in-chief

The US Food and Drug Administration (FDA) has approved a new faster-acting, mealtime version of insulin aspart (Fiasp, Novo Nordisk) for the treatment of type 1 and type 2 diabetes in adults. Fiasp (insulin aspart injection 100 units/mL) is a new formulation of the company’s NovoLog, to which niacinamide (vitamin B3) has been added to help increase the speed of the initial insulin absorption. Fiasp is designed to be dosed at the beginning of a meal or within 20 minutes after starting a meal, as the insulin will appear in the blood approximately 2.5 minutes after dosing. More info coming next issue.

Which new drug do you prefer for a second-line therapy for a patient with type 2 patient diabetes?

1) GLP-1 Agonist
2) SGLT-2 Inhibitor
3) Long-acting insulin
4) TZD
5) Other

Follow the link to share your response.

The FDA has approved the FreeStyle Libre Flash Glucose Monitoring System for use by adult patients with diabetes. This is the first continuous glucose monitoring system geared to patients and does not require finger-stick calibration. Last year, the FDA approved the professional version of the system to be used by clinicians for monitoring glucose in patients with diabetes. The FreeStyle Libre system reduces the need for fingerstick testing and instead continuously measures glucose levels with a small sensor that is inserted into the back of the upper arm for up to 14 days. Users then wave a dedicated, mobile scanner over the sensor to obtain readings. The device is intended for individuals 18 years and older. The FreeStyle Libre offers certain advantages, such as longer sensor wear, no requirement for calibration, and lower cost. Also in contrast to current CGMs, the device is factory-calibrated so it doesn’t require finger-stick blood glucose measurements for calibration. However, it does not have an alarm for users for low and high glucose values, a feature available in CGM systems. See Item #5 for more information.

Gocap is a smart cap for insulin pens that logs doses automatically, so you don’t have to record every dose by hand. It’s as simple as push, twist, and click. Your insulin dose is recorded on your gocap and can be sent to you healthcare provider. With the gocap app, you can connect to your smartphone wirelessly to see your dose logbook, glucose readings, and meals. It can remind you to take your insulin or test your blood sugar and give you feedback on how you’re doing. Learn more at Gocap.me.

Dr. Francine Kaufman was named Chief Medical Officer and Vice President of Global Medical, Clinical and Health Affairs in April 2009. In this role, Dr. Kaufman is the key architect of the company’s global diabetes strategy, as well as a leading voice for multidisciplinary medical strategy across Medtronic.

One of your patients is a 3-state regional salesman who has a fairly unpredictable work schedule. When he gets hungry while on the road, he tends to eat at the first restaurant he sees. For the past 3 months, he has managed his type 2 diabetes with metformin, glipizide, and glargine. Despite this regimen, his current A1C is 7.8%. You are in agreement that he needs to add a bolus insulin dose to his regimen. Which type of insulin would be the most appropriate choice?

1. Rapid-acting insulin analogues
2. Premixed insulin
3. Long-acting insulin analogues
4. Intermediate-acting insulin

Follow the link to see the correct answer.

Drinking four cups of your favorite hot beverage a day could stave off type 2 diabetes.  US researchers have discovered that a compound found in coffee improves cell function and insulin sensitivity in mice. Previous studies have suggested drinking three or four cups of coffee a day can reduce the risk of developing the disease, but until now scientists did not know why. Initially scientists thought the caffeine in coffee was responsible for controlling insulin levels, but lab tests revealed a compound called cafestol was the key. Cafestol increased insulin production in the pancreas when exposed to glucose. It also increased the rate at which muscle cells were absorbing glucose as effectively as anti-diabetic drugs. Researchers from the American Chemical Society set out to see if the compound would help prevent or delay the onset of type 2 diabetes. In tests on mice given two different doses of cafestol both sets had lower blood sugar levels and improved insulin production after 10 days. Cafestol also didn’t cause blood sugar levels to become too low, known as hypoglycemia, which is a possible side effect of some diabetes medications.  The researchers hope the compound could one day be used in a drug to prevent diabetes in people. — Diabetologia  July 2014, Volume 57, Issue 7, pp 1346–1354

Intensive control of blood pressure, glucose, and lipids benefits patients with type 2 diabetes, the long-awaited, large Japan Diabetes Optimal Integrated Treatment Study for 3 Major Risk Factors of Cardiovascular Diseases (J-DOIT3).

The results of the REMOVAL study were presented at the 2017 European Association for the Study of Diabetes (EASD) in Lisbon

Children and teenagers with type 1 diabetes are more likely to have eating disorders.

The investigational sodium/glucose cotransporter 2 (SGLT2) inhibitor ertugliflozin (Merck), being developed to improve glycemic control in adults with type 2 diabetes, met the primary outcomes in two yearlong phase 3 trials, VERTIS SU and VERTIS SITA2.

First Continuous Glucose Monitor that doesn’t require routine finger pricks.

Quote of the Week!

“Mastering others is strength. Mastering yourself is true power.”

…Lao Tzu

Diabetes in Control gratefully acknowledges the assistance of the following pharmacy doctoral candidates in the preparation of this week’s newsletter:

Josephat Macharia, Doctor of Pharmacy Candidate: Class of 2018; LECOM College of Pharmacy

Jessica Lambert, Doctor of Pharmacy Candidate; USF College of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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