Diabetes In Control. A free weekly diabetes newsletter for Medical Professionals. News and information for Medical Professionals.
Letter from the Editor
This week, the FiercePharma website had a great article on pay-for-performance arrangements. Although these aren’t commonplace now, about 14% of U.S. payers have at least one pay-for-performance pricing arrangement, up from 10% in 2014, according to a new specialty reimbursement report from EMD Serono. Another 30% of plans say they’ll have an outcomes-based deal in place within 12 months.
Diabetes seems to be the ideal disease state for these type of agreements. The disease never goes away and it has to be the one disease that patient actions and lifestyle can have the biggest impact on, and with all our modern devices it is also probably one of the easiest to evaluate progress. It will be interesting to see how pharma and device companies come together to take advantage of these new contracts. Could you imagine if Lilly hooked up with Dexcom to develop better dosing algorithms that the patient didn’t have to think about, and what if this data was seamlessly streamed to Lilly and to the doctor, for immediate correction? Then you add in a Fitbit or a Shine or a Garmin and you can see where all this is headed, and how possibly patients may be held responsible for their own actions. That would be a novel concept.
Since we mentioned the term novel concept in the last paragraph, you may want to check out this week’s 3rd item and decide for yourself if electro-acupuncture is worthwhile.
Announcements:
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From dLife.com: Susan Weiner RD, CDE and Leslie Josel, professional organizer from TV’s
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We can make a difference!
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Dave Joffe, Editor-in-chief
This Week's Poll
Do you use Diabetes Apps with your patients? Follow the link to let us know and see what others are doing!
News Flash: Diabetes Increases to More than 422 Million
Patient App
Diabetes Personal Calculator is an all-in-one insulin calculator and carbohydrate database. It is developed for people with type 1 diabetes injecting pre-meal fast or rapid acting insulin.
Test Your Knowledge
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 below 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.
After discussing her situation with her, you decide to modify Mrs. Wilson’s antihyperglycemic regimen. Which of the following treatment options would you choose?
[A] metformin + long-acting analogue + rapid-acting analogue
[B] metformin + glyburide + long-acting insulin analogue + rapid-acting analogue
[C] metformin + glyburide + NPH + rapid-acting analogue
[D] metformin + NPH + rapid-acting analogue
Follow the link to see if you’re correct!
Fact: Diabetes Increased Fourfold
From 1980 to 2014 across the globe, diabetes has now affected more than 422 million adults with the biggest rate increases found in Pacific Island nations, the Middle East and North Africa, according to a World Health Organization study in The Lancet. The findings showed no country had a meaningful decrease in diabetes prevalence, but northwestern Europe had the lowest diabetes rates for men and women. The researchers said aging populations and rising levels of obesity across the world mean diabetes is becoming a defining issue for global public health. Published in The Lancet journal ahead of the United Nations World Health Day on April 7, the study used data from 4.4 million adults in different world regions to estimate age-adjusted diabetes prevalence for 200 countries. The researchers found that between 1980 and 2014, diabetes has become more common among men than women, and rates of diabetes rose significantly in many low and middle income countries, including China, India, Indonesia, Pakistan, Egypt and Mexico. Nutrition and lack of physical activity play a large role and account for the main reasons we are seeing such increases in diabetes. 28·5% was due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors. The data also showed that half of adults with diabetes in 2014 lived in five countries – China, India, the United States, Brazil, and Indonesia. Rates more than doubled for men in India and China between 1980 and 2014. The Lancet Volume 387, No. 10027, p1513–1530, 9 April 2016
In study, 40 percent of adults with type 2 diabetes achieved a fasting glucose level of less than 126mg/dL.(7mmol/L) after eight weeks on a very low-calorie diet.
To combat the negative effects of too much sitting, standing desks have been rising in popularity. But does the science support their supposed benefits?
Electro-acupuncture may be beneficial through different mechanisms: weight loss, anti-inflammatory effects, and improvement of lipid metabolism and adipokines.
Meta-analysis examines the effectiveness of interventions in improving and preventing diabetes depression.
Type 2 patients who used saxagliptin or sitagliptin had similar risks for heart failure as those who received other anti-hyperglycemic agents, according to a retrospective cohort study.
According to more than 200 studies involving 1.4 million patients, metformin reduces heart disease risk in diabetes patients more effectively than its competitors.
Quote of the Week!
“He who is not courageous enough to take risks will accomplish nothing in life.”
…Muhammad Ali
Your Friends in Diabetes Care
Steve and Dave
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