May 7, 2016 : Issue #832

• What Is The Actual Cost of insulin for Your Patients?
• Intensive Glucose Control Linked with ESRD Reduction
• Quality of Life Versus Shorter Lives with Diabetes
• New Oral GLP-1 Promising for Type 2 Diabetes
• SBP Level May Be Key to Setting Blood Pressure Treatment Goals for Diabetes
• Featured Writer: Dr. Sheri Colberg, Ph.D., FACSM
  • The Conundrum Arising from Being Active and Getting Injured

According to Pulseanalytics, 46% of all employees have a $1000 or higher deductible, the majority of plans have 5 tiers of copays, and each year 20% more products require a prior authorization.

This makes it harder and harder for our patients to get their medications, and according to Item 1 the cost of insulin continues to increase at a rapid pace. But is all that increase due to the Pharma companies or is there something else at play?  A review of earnings calls from the insulin companies, shared with us by our good pal Dave Kliff, points to the increasing trend of downward earnings for all of them. The insurers are no longer “fooled” by the supposed superiority of one brand over the other, and are just simply looking for the brand that offers them the largest rebate and lowest price.

One way that many of our patients could reduce their insulin costs would be to use less. Often this is hard for a type 1 patient, but we all know that exercise and movement can lower insulin use for our overweight type 2 patients on insulin. This week Dr. Sheri Colberg shares techniques and methods to avoid the injuries and pains that often derail the best exercise plans when our patients decide to get more active.

Announcements:

dLifeTV.com: Sunday, May 8, 7PM ET

From dLife.com:”dLife follows psychologist, filmmaker, and type 1 adventurer Dr. Jonny White as he travels down the coast of Africa by bicycle. Also, the story on nighttime eating syndrome; Dr. Nat Strand with shoe shopping tips; and Jim Turner swaps low stories.” Sundays live online at dLifeTV.com at 7 PM ET, 6 PM CT, and 4 PM PT. Keep up on the latest dLife news at dLifeTV.com.

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We can make a difference!

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Dave Joffe, Editor-in-chief

See this week’s Fact.

By popular demand: updated Insulin chart with all the new insulins, showing the onset, peak and duration of action. Now also includes Walmart’s ReliOn brand.

The YMCA’s Diabetes Prevention Program is based on the landmark Diabetes Prevention Program led by the National Institutes of Health (NIH) and supported by the Centers for Disease Control (CDC). Will you recommend this program for your patients with prediabetes? Follow the link to share your opinion!

Mrs. Wilson is an overweight 71-year old African American patient who has come to your clinic today for a new patient visit. She recently moved to the area to live with her daughter and is concerned about her diabetes care plan. She was diagnosed with type 2 diabetes 12 years ago at a wellness check through routine screening. In hindsight, she wonders if maybe she “went undiagnosed for a while” because she “didn’t get to the clinic very often and was having some problems with frequent urination at night” before she was screened. She currently takes metformin, glyburide, captopril, pravastatin, aspirin and has recently titrated to.6 U/kg/day insulin NPH as a nightly basal dose. Her current A1C goal is <7.5% and she has been working hard to get to that level. However, for the first time her life, she is finding herself to be nauseated and irritable in the morning, but always feels better after a little breakfast. She states she feels “pretty good for her age” although she occasionally has “a little chest tightness when walking more than 4 or 5 blocks.” Last time she remembered to check it a few days ago, her postprandial glucose was a little high at 214 mg/dL. Her office A1C is 8.6%. Based on what you know about the patient, what is the most likely cause of her morning distress? Select one answer: [A] Hyperglycemia [B] Hypoglycemia [C] Anxiety [D] Cognitive Have you got it right? Follow the link to find out!

The US Food and Drug Administration (FDA) announced that the diabetes drug metformin can be used safely in patients with mild and, in some cases, moderate kidney impairment after decades of warning against it.  Metformin previously had been contraindicated for patients with renal disease or dysfunction, as suggested by serum creatinine levels at or above 1.5 mg/dL for men and 1.4 mg/dL for women, or abnormal creatinine clearance.

The FDA now says that after reviewing a number of studies, it has concluded that this contraindication is no longer necessary for certain patients with reduced kidney function.

The FDA is advising metformin manufacturers to revise their label information to incorporate both the new guidance and a new measure of kidney function to determine whether a patient should receive the drug. The new labels will recommend switching from serum creatinine concentration, a single laboratory parameter, to the glomerular filtration rate estimating equation (eGFR). The agency deems the latter superior because in addition to blood creatinine concentration, it factors in a patient’s age, sex, race, and other parameters.  Under the FDA’s latest recommendations, clinicians should obtain a patient’s eGFR before starting metformin. If the eGFR is below 30 mL/minute per 1.73 m2, the drug is contraindicated. The FDA also does not recommend that clinicians start metformin therapy in patients with an eGFR between 30 and 45 mL/minute per 1.73 m2. All patients taking metformin should have their eGFR checked at least annually. The elderly and others at increased risk for renal impairment should be tested more frequently, according to the FDA.–More information on today’s announcement is available on the agency’s website.

For patients in the U.S., the price of this lifesaving treatment has risen dramatically.

Researchers saw long-term reduction in end-stage renal disease, without evidence of increased risk for cardiovascular events or death.

According to a new study, people with diabetes have a slightly shorter life expectancy than people without diabetes, and many of those years will be marred by disability.

First-time data for the investigational oral formulation of Novo Nordisk’s semaglutide were presented at the annual meeting of the Endocrine Society. Billed as one of the company’s brightest pipeline prospects, it has sailed through a phase II trial.

New meta analysis suggests overly aggressive goals may increase cardio risk for patients with systolic blood pressure below 140 mm Hg.

You finally decide to get active to help manage your diabetes better or to prevent type 2 altogether, and once you’ve hit your stride, you get an injury that puts you back on the couch! Getting injured from being active happens often enough that you need to know how to prevent and treat injuries so you can stay on track. The best medicine is prevention, so trying to prevent injuries before they happen is the best way to avoid having to take time off from exercising and sidetracking your fitness program.

Quote of the Week!

“Attitude is a little thing that makes a big difference.”

…Winston Churchill

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