Diabetes In Control. A free weekly diabetes newsletter for Medical Professionals. News and information for Medical Professionals.
Letter from the Editor
Medication persistence gets a lot of attention these days, as we all have seen patients discontinue or miss doses of chronic medications. Sometimes it is the pill burden, and for others it is the multiple copays for all the medications they get from the pharmacy. If you add the burden of different refills due on different days, you can understand why patients stop taking some or all of their medications.
Many manufacturers make combination products with two medications for diabetes, but just recently Astra-Zeneca took a bold step and added a third drug to their combination SGLT-2 Inhibitor, DPP4-Inhibitor. The new combination, called Qternmet XR, adds metformin in a single pill.
Nice thing about this triple therapy is that the price of all three meds in a single tablet is about the same as either brand alone. This means cash patients will have less out of pocket, and insured patients will have one copay instead of three.
*****************************
We can make a difference!
*****************************
Dave Joffe
Editor-in-chief
TOP STORIES -- Diabetes News and Research
Can using DE-MRI image scans determine the prevalence of unrecognized MIs in asymptomatic patients with diabetes?
Circadian clocks control cardiovascular disease risks; researchers are looking for new ways to “fix” the clocks.
Diabetes has never been simpler to control with this once daily pill.
Did You Know: Rybelsus Dosing Regimen
The first oral GLP-1 Agonist, Rybelsus, has a problematic dosing regimen that patients must understand and be willing to follow before you prescribe it to them.
Rybelsus (reh-BEL-sus, semaglutide) is a tablet version of injectable Ozempic. Glucagon-like peptide-1 (GLP-1) is inactivated in the stomach, so that’s why other GLP-1 agonists, Bydureon (exenatide), Trulicity (dulaglutide), Victoza (liraglutide), etc., are injected. Rybelsus is formulated to prevent breakdown and improve absorption. But it’s difficult to take correctly like a bisphosphonate. Emphasize that Rybelsus must: be taken DAILY with a sip or no more than 4 ounces of water, at least 30 minutes before the first food, other beverage, or oral meds of the day. Not doing so reduces efficacy. Keep in mind that Bydureon, Ozempic, and Trulicity are injected WEEKLY, at any time of day, with or without meals. In making your decision, weigh current CV data. So far, evidence isn’t strong enough to say that Rybelsus lowers CV risk in type 2 patients with CV disease or at high CV risk, even though Ozempic does. Still, you can expect Rybelsus to sound appealing to some patients. For example, it lowers A1C by about 1% and leads to short-term weight loss of about 4 to 9 pounds, in the same range as injectable GLP-1 agonists. But GI side effects may last longer when starting Rybelsus, likely because it’s titrated monthly, slower than most injectables. Rybelsus will cost about $770/month, versus $620 to $920 for injectables. Since it is new it may not be preferred by payers. Consider saving Rybelsus for type 2 patients without CV disease or high CV risk who want an oral medication, and who can follow its unusual administration.
Lancet 2019;394(10192):39-50; N Engl J Med 2019;381(9):841-51; Diabetes Care 2019;42(9):1724-32; Diabetes Technol Ther Published online Oct 1, 2019; doi:10.1089/dia.2019.0185
Diabetes in Control gratefully acknowledges the assistance of the following pharmacy doctoral candidates in the preparation of this week’s newsletters:
Adam Chalela B.S., PharmD Candidate, USF College of Pharmacy Class of 2020
Maya Rudolph, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate
Nour Salhab, Pharm.D. Candidate, USF College of Pharmacy
Taylor-Eugene Simmons, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate
Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
810 Bear Tavern Road Suite 102
Ewing, NJ, 08628
USA
www.diabetesincontrol.com
About LaterPay: You will notice that some of our articles are now marked with a small credit card icon. This means you will be asked to pay a small fee to access the full article text (the cost is $0.39 per article, and you will be charged only after you have reached $5.00 in article views). The costs of producing a newsletter like Diabetes in Control have been increasing, which is why we are asking our readers to help support our ability to continue to bring you quality information about diabetes through charging a minimal price to read certain articles. Thank you for helping to support Diabetes in Control.