February 19, 2019 : DCMS #437

DISASTERS AVERTED — Near Miss Case Studies

Samples Are Not the Answer

DICInsight — Exclusive Commentary on Breaking News and Research

Late Breaking Research: Variants in DNA that Significantly Influence how the Body Stores and Distributes Fat

HOMERUN SLIDES — Great Clinical Presentation Highlights

Diabetes Apps Presentation Part 4

CLINICAL GEMS — The Best from Diabetes Texts

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #165: Molecular Genetics of Type 1 Diabetes Part 2

MOST POPULAR ARTICLES OF THE MONTH

#1 Can Green Tea Increase The Risk For Type 2 Diabetes?
#2 CGM Simplicity Can Be Complex Information for Beginners
#3 Warn, Teach, and Revisit Metformin

As the National Accounts Manager for a Pharma company and a pharmacist, I have mixed emotions about the use of samples. There is no doubt that from an economic standpoint giving samples to the prescriber to give to the patient is very cost effective; however, as a pharmacist I would rather have the patient go to the pharmacy with a voucher for a free starter supply.

The reason I like the voucher has to due with drug interactions and medication adherence. When a prescriber gives samples they really have no way to know if the patient is using a medication from another prescriber that may be contraindicated, and there is no way to insure that the patient will actually ever fill the prescription. Sending the patient to the pharmacy for their first fill free helps overcome these problems.

This week our Medical Editor, Joy Pape, shares an experience that her office had with one of her patients that points towards the value of a voucher. Check out this week’s Disaster Averted to see how handing your patients samples may actually make your job harder.

Dave Joffe

Editor-in-chief

A woman, 72 years of age was recently diagnosed with type 2 diabetes. She has a Medicare plan. I don’t know her financial situation but do know she gets Social Security and has other retirement income. Her A1C was rising. We had recommended and taught lifestyle changes which she had difficulty with; she made some changes but not enough to lower her glucose. We added metformin which she did not tolerate, so we discussed one of the SGLT-2s. After hesitating, she agreed to trying one. We gave her samples, she took them. Her A1C lowered to the goal we mutually decided upon.

Exclusive insights from Dr. Ruth Loos on the new research on how genes contribute to body-fat distribution, which has identified 24 new genetic variants involved in determining where fat is stored, and how examining the links between fat distribution and diseases like diabetes may someday aid in developing new treatments.

In this week’s Homerun Slides, mobile diabetes apps as an effective method to provide diabetes education and coaching.

HLA-DR and -DQ: The highest risk of T1DM is conferred by heterozygosity for the DRB1*0301-DQA1*0501-DQB1*0201 and DRB1*04-DQA1* 0301-DQB1*0302 haplotypes, referred to as the DR3.DQ2/DR4.DQ8 genotype. This allelic combination is carried by 30–40% of individuals with T1DM, but only around 2.5% of the general population [3]. A recent meta-analysis of multiple ethnic groups suggested that this translates into an OR value greater than 16, an unusually large odds ratio for a complex disease [14]. This is consistent with an earlier study which estimated that the risk of developing T1DM was between 1 in 15 and 1 in 25 among those with the DR3.DQ2/DR4.DQ8 genotype, compared with 1 in 300 in the general population [15]. High risk is also conferred by the DR3.DQ2/DR3.DQ2 and DR4.DQ8/DR4.DQ8 homozygous genotypes (OR = 6.32 and OR = 5.68, respectively, from meta-analysis).

People consistently drinking green tea may not be getting all the benefits as hoped.

Woman, 55 years of age visited with me 3 weeks ago. Her glucose levels were in the 200-250 mg/dL range. She was actually a new patient of ours; her A1C was 9.2%. We recommended a CGM. She purchased one and brought it to the office for me to teach her how to use it. I did so. This patient is well-educated and seemed tech-savvy. When she left the visit, she “seemed” to understand CGM, what it is, what to do, and how to insert the sensor, get readings, interpret readings, etc.

If this happens in my practice, I’m sure it likely happens with your patients too.

So many of our patients take metformin. They may be new to using metformin or have been taking it for many years. Either way it’s not unusual to have untoward GI side effects from taking it. They may have done fine taking it for years, so they don’t even think about it being their metformin.