May 26, 2018 : Issue #939

• Four Essentials In The New Trump Drug Pricing Reform Plan
• Best First-Line Treatment for Gestational Diabetes
• Changes in Weight Over Time Can Determine Risk of Type 2 Diabetes
• Prevalence of Behavioral Risk Factors for Type 2 Diabetes
• Preventing H. Pylori Infections with Metformin
• Those Pesky Facts About Insulin Costs

Regardless of your political leanings, there is no doubt that there is a lot of miscommunication and false truths concerning the new drug pricing reform plan. The biggest message seems to be “it is a work in progress”! This week Kennen Munoz Munoz, our current Pharm. D. Candidate from LECOM College of Pharmacy, has dissected the information into a step by step process of what is currently happening, what will happen in the near future, and what might happen some day. If only we had a crystal ball to see into the future.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Given the near total lack of availability of potassium chloride for injection concentrate in vials
(2 mEq/mL), along with problems accessing the 250 mL pharmacy bulk package
(2 mEq/mL), some healthcare providers have benefitted from outsourcing facilities that have compounded this product starting with the active pharmaceutical ingredient
(API). However, outsourcing facilities are not subject to all of the same labeling requirements
that are mandated for commercial manufacturers for potassium chloride injection concentrate. ISMP has asked FDA to convene an FDA Pharmacy Compounding Advisory Committee meeting to discuss medication errors related to the labeling and packaging of products from outsourcing
facilities and to inform the next steps. Until then, healthcare providers should consider the following recommendations.

Would you treat a new patient with a family history of heart disease, diagnosis of type 2 diabetes, and an A1c of 8% with the double therapy of a GLP-1 plus an SGLT-2 inhibitor?

Follow the link to share your response.

This special tag can be downloaded to be used as a note, sticker, however you care to adapt it to help get prior authorization for the more expensive diabetes drugs. Proven to be effective for getting the approval. Download the Prior Approval Form here.

Mrs. Hunter is 36-year-old African-American who comes to your office for her annual wellness exam. She has excessive weight (BMI 27 kg/m2), but is otherwise healthy. She jokes that she, “just can’t seem to lose that extra baby weight” after giving birth 3 years ago. However, her daughter recently started preschool so she has been able to go to her new gym several times per week. In fact, one of the added bonuses of her membership is that she has been participating in their free, weekly nutrition and exercise support groups. In addition to her routine labs, you order an A1C, which comes back elevated at 7.1%. You and Mrs. Hunter set a goal for A1C<6.5%. She returns 3 months later for a follow-up visit and her office labs show an A1C 6.8%. You congratulate her on her progress and ask her to return in another 3–4 months. When she does, she is above her goal with an A1C 8.1%. She explains that she has gone back to full-time work and just doesn’t have the time to get to the gym anymore. At this time, what would your next step be and what would her individualized glycemic targets be?


A. Encourage lifestyle modifications and start metformin with a target A1C less than 6.5%

B. Encourage lifestyle modifications and start metformin with a target A1C less than 7.5%

C. Encourage lifestyle modifications and start a 2-drug combination target A1C target less than 7%

D. Encourage lifestyle modifications and do not initiate drug therapy at this time

Follow the link for the answer.

Skeletal muscle is the primary site of glucose uptake, yet the impact of age-related changes in muscle strength on diabetes risk is unknown, so this study was done with 424 women participants (60% Black, 40% White) from the Michigan site of the Study of Women’s Health Across the Nation. They contributed annual grip strength measures and were followed from 1996 to 2012 to identify incident cases of diabetes. The 16-year diabetes incidence was 37%. The average baseline weight-normalized grip strength (NGS, kg per kg body weight) was 0.41 ± 0.12 and a mean of 0.29 ± 0.14 kg of absolute grip strength was lost per year. Each 0.1 higher NGS was associated with a 19% lower hazard of incident diabetes (P = 0.006) after adjustment for age, race/ethnicity, economic strain, smoking, menopause status, hormone use, physical activity, and waist-hip ratio. In race/ethnic-stratified models, each 0.10 increase in NGS was associated with a 54% lower hazard of incident diabetes (P < 0.0001) among white women, but the association among Black women was not statistically significant. In models without adjustment for waist-hip ratio or restricted to women <48 years of age at baseline, there was a statistically significant association between baseline NGS and incident diabetes among Black women. The rate of change in grip strength was not associated with diabetes incidence. It was concluded that midlife is an important risk period for diabetes onset. Improving muscle strength during mid-life may contribute to preventing diabetes among women. — Age and Ageing, afy067, https://doi.org/10.1093/ageing/afy067

Administration releases “American Patient First” blueprint to lower drug prices, reduce out-of-pocket costs.

Glyburide versus subcutaneous insulin did not result in a greater frequency of perinatal complications.

Weight loss between young adulthood and midlife found to create statistically significant reductions in risk for diabetes.

Very small proportion of U.S. adults engage in risk reduction behaviors like proper diet and exercise for type 2 diabetes.

Use of metformin may decrease chances of developing gastric cancer in patients with T2D.

Guest Post by David Kliff, Editor, Diabetic Investor

The so-called “high” cost of insulin continues to get lots of attention. But as I’ve noted before, little perspective has been given to this debate and far too many facts are missing. Yes, I know facts are pesky things, but they are facts nonetheless. Allow me for a moment to provide some examples.

Quote of the Week!

“Courage is resistance to fear, mastery of fear, not absence of fear.”

…Mark Twain

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

Kennen Munoz Munoz, Pharm. D. Candidate 2019, LECOM College of Pharmacy

Vidhi Patel, Pharm. D. Candidate 2018, LECOM College of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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