June 24, 2017 : Issue #891

• A Tribute to Richard K. Bernstein MD, FACE, FACN, FCCWS, on His 83rd Birthday
• Liraglutide Gets FDA Indication For Reducing CVD Risk, But Not So Fast
• ADA: Alum-GAD (Diamyd) Vaccine Fails to Prevent Type 1 Diabetes
• ADA: Basal Oral Insulin Tablet Reduces Fasting Blood Glucose and HbA1c Levels Similar to Insulin Glargine in Patients with Type 2
• ADA: Effects of REMD-477, a Glucagon-Blocking Drug, in Patients with Type 1 Diabetes
• ADA: Efficacy and Safety of Hybrid Closed-Loop Systems in Patients with Type 1 Diabetes
• Current Interview: Dr. Ralph Defronzo on The Effectiveness of Triple Therapy

There just doesn’t seem to be enough time to cover everything that we got to see at the recent Scientific Sessions in San Diego. Since the ADA draws in scientists and researchers from around the world, it is the number-one place to present new findings both good and bad. In addition, if you get a chance to sit down with one of the “godfathers” of diabetes, you better take advantage of it.

Steve and Joy had a chance to spend considerable time with Dr. Ralph Defronzo. After knowing Dr. Defronzo for over 20 years, one thing I have learned is that he won’t shy away from the hard questions, nor will he pull any punches to smooth over controversial topics, and Steve did not hesitate to ask him the hard ones. Check out his responses here.

Since we are on the subject of controversial choices, you may want to check out Item 4. Our Current LECOM intern Joanna Martinez-Mendez reviewed all the information on a new basal oral, yes oral, insulin that really works. After getting excited to report on this, she found out that the company that developed the product halted further research, and the reason why will likely astound you.

We also want to wish a happy 83rd birthday to the most controversial endocrinologist ever, Dr. Richard Bernstein, a good friend and a member of our advisory board.

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We can make a difference!

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Dave Joffe

Editor-in-chief

The FDA has cleared as a Class II medical device Insulin Algorithms’ decision-support software, which helps clinicians manage every type of insulin for diabetes treatment. Insulin Algorithms’ software makes it easy for a clinician to regularly analyze a patient’s blood sugar measurements and quickly optimize their insulin regimen. The software is based on algorithms that are clinically proven to lower HbA1c even in challenging patient populations, no matter what insulin regimen they are on. This makes it possible to achieve better health outcomes, save billions of dollars in annual health care spending, and reduce rates of diabetes-related complications. With FDA clearance and its previous CE registration, Insulin Algorithms’ decision-support software can now be marketed and sold in both the United States and Europe.  www.insulinalgorithms.com

Do you feel comfortable recommending an SGLT-2 Inhibitor as a second treatment option after metformin for your type 2 patients?

Follow the link to see what your colleagues think.

Dr. Ralph Defronzo, MD, speaks about the current variability of diabetes medication as well as their effectiveness but lack of affordability, and he places a special emphasis on the effectiveness of triple therapy in the treatment of diabetes. Dr. Defronzo is a Professor of Medicine and Chief of the Diabetes Division at the University of Texas Health Diabetes Center in San Antonia, Texas. Dr. Defronzo is also Deputy Director of the Texas Diabetes Institute.

This is a form developed for patients to let them know just how important their A1c result is. Please use it as you see fit for your patients when you discuss their A1c results with them. What Is Your Quality of Life Number (PDF)

Which of the following GLP-1 agonists is not currently approved for use with basal insulin?

A. Exenatide (Byetta)
B. Dulaglutide (Trulicity)
C. Albiglutide (Tanzeum)
D. Liraglutide (Victoza)
E. None of the above

Did you get it right? Follow the link to find out!

Researchers recommend specific diabetes medications to protect bone health. Type 2 diabetes (T2D) and osteoporosis often coexist in patients, but managing both conditions can be a challenge. A comprehensive review highlights the most effective treatment options for treating these conditions together. Previous research has focused on the management of T2D and osteoporosis as separate diseases. However, several studies have shown that fracture risk is increasing in people with T2D. T2D directly affects bone metabolism and strength. Certain diabetes medications affect bone metabolism, and an association exists between diabetic complications and the risk for falls and subsequent fractures. They found that Metformin, sulfonylureas, DPP-4 inhibitors and GLP1 receptor agonists—medications for T2D—should be the preferred treatment for T2D in patients who also have osteoporosis. These medications were preferred because they can help protect bone health. Studies show that Metformin has beneficial effects on bone formation and bone mineral density. Positive or neutral effects have been seen in bone metabolism with the use of DPP-4 inhibitors and GLP1 receptor agonists. On the other hand, thiazolidinediones (TZDs) and canagliflozin should be avoided while other SGLT2 inhibitors are less well-validated options. Insulin should be used with caution and with careful measures to avoid hypoglycemia. To determine the most effective treatment options, the researchers systematically reviewed past human studies and guidelines to develop recommendations for the most appropriate joint treatment approaches for diabetes and osteoporosis. — “Type 2 Diabetes and Osteoporosis: A Guide to Optimal Management,” published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2017-00042.

Medical pioneer has educated his diabetes patients on how to get blood sugars to 83mg/dl, 24 hours a day

The Endocrinologic and Metabolic Drugs Advisory Committee also voted 19-0 that the drug’s use in type 2 diabetes patients did not result in excess cardiovascular risk.

Research will still continue due to its safety.

However, in 2016, Novo Nordisk halted the development of their basal oral insulin tablet.

Results presented in the ADA 77th Scientific Sessions suggests the use of an investigational glucagon-blocking agent can improve glycemic levels and reduce insulin requirements.

Results from two studies demonstrate improved glycemic control, reduction in nighttime- and exercise-induced hypoglycemia with the use of hybrid closed-loop systems.

Quote of the Week!

“A healthy attitude is contagious but don’t wait to catch it from others. Be a carrier.”

…Tom Stoppard

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

Joanna Martinez-Mendez, Lake Erie College of Osteopathic Medicine FL Campus, School of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
810 Bear Tavern Road Suite 102
Ewing, NJ, 08628
USA
www.diabetesincontrol.com