September 16, 2017 : Issue #903

• EASD: SGLT-2/GLP-1 Combo Better Than Monotherapy
• EASD: First Oral Drug for Type 1 Diabetes – Tandem3 Study – Sotagliflozin
• EASD: TOSCA IT Study: Older Diabetes Drugs Compared
• Diabetes Management in Children Engaging In Physical Activity
• Position Statement by the American Diabetes Association: Diabetes and Hypertension
• Exclusive: Henry Anhalt and Howard Steinberg on Insulin for Life

There always seems to be a resistance to using newer drugs in combination. Prescribers have never had a problem using metformin in combination with almost any other diabetes medication. Often you will see metformin, basal insulin, and a new drug used, but there has not been a lot of mixing of newer drugs like GLP-1 analogs, DPP4 inhibitors, and SGLT-2 inhibitors.

I am not sure if it is a cost thing or the hassle of having to do more than one prior auth, but it makes logical sense that we need to mix these newer drugs more. This week, we have a feature from the EASD meeting prepared by a longtime friend, Dr. Juan Frias, looking at the additive benefits of using GLP-1 analogs with SGLT-2 inhibitors.

We also can see great research from EASD on the use of a combo SGLT-1, SGLT-2 inhibitor, and the benefits for both type one and type two patients. And finally, if cost is a concern, we have a feature from the University of Naples, Italy, showing why pioglitazone can be a safe and effective medication for many patients.

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We can make a difference!

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Dave Joffe

Editor-in-chief

It is now indicated to reduce the risk of major adverse CV events (CV death, non-fatal myocardial infarction, or non-fatal stroke) in adults with type 2 diabetes and established CV disease. It reduced the risk of major adverse cardiovascular events (MACE) by 13%.

Can most of your patients with diabetes or prediabetes tell you what their A1c number is?

Follow the link to share your response.

One of the newest, most intriguing products is the YpsoPump® from Ypsomed. Basically, Ypsomed has taken a little bit from everyone. Their touch screen and user interface reminds us of the Tandem t: slim. Also like everyone else, they integrated a conventional glucose monitor and of course some cool cloud-enabled software. But what really separates this system from everyone else is something that long overdo – a pre-filled cartridge that takes away one the biggest hassles for pump patients.  This pump is not revolutionary but it combines the best of what everyone else has done into a neat little package.

The intuitive insulin pump system features the essential functions for easy use:

• Icon-based, language independent touchscreen for intuitive operation
• Small and light-weight device for discrete and comfortable wearing
• Pre-filled cartridge for quick and convenient cartridge change
• Self-filled reservoir for your insulin of choice
• Infusion set freely rotates 360° for perfect alignment at all times
• Bluetooth integration for wireless connection to the mylife Software and mylife App

Learn more about it here: ypsomed

The vent membrane in some infusion sets used with Medtronic’s insulin pumps prompted the company to initiate a recall of the affected sets, although no pumps or glucose sensors are affected by the recall. The components, which have already been discontinued by Medtronic, are prone to blockage by fluid during fill-tubing and priming, posing the risk of hypoglycemia and death.  Medtronic Recall

A 42-year-old patient was diagnosed with type 2 diabetes approximately one year ago and is currently taking metformin, a DPP-4 inhibitor, and a basal insulin dose (current daily dose .9 U/kg/day). Despite good compliance with her diet, exercise, and medication regimen, she reports postprandial glucose measurements of usually about 190 mg/dL. Her current A1C is 7.6%. Which of the following changes in her management do you consider most important?

A. Add a sulfonylurea to her regimen
B. Increase her basal insulin dose
C. Add a pre-meal rapid-acting insulin
D. Discontinue her basal insulin dose and add a prandial insulin dose

Follow the link to see the answer.

Husbands in their late 50s and 60s are more likely to develop type 2 diabetes if their wives were overweight or obese, but not true for wives with heavier husbands, reveals a new study based on couples. Also in a second related study, they found that these older men and women who had spouses with type 2 diabetes were more likely to be heavier than their peers whose spouses did not have diabetes, researchers reported.

“It doesn’t mean that the wife’s BMI [body mass index] is the most determinant” factor for a husband’s obesity, Dr Adam Hulman, from Aarhus University, Denmark, cautioned the press at the EASD 2017. The man’s “own BMI is still the most important factor,” he stressed.

Plus, “One explanation could be that at the end of the 1990s in the UK, women were more responsible for or the ones who determined the diet of the family or the household.” The implications for clinicians are, that to assess type 2 diabetes risk, “there is the regular question — whether your parents or a sibling have diabetes — and this study calls attention that there are [also] other connections within the family” that could play a role. Thus, “If you find that the spouse has obesity, pay attention to the other half of the couple.”

Senior author for both studies, Daniel R Witte, MD, PhD, from Aarhus University reiterated this message, “In the current very individualized way of approaching diabetes risk we sometimes forget [the patient’s social network], and I think this is a reminder that we should pay close attention to the home environment.”  There is a need to “approach the person as part of a family unit rather than as an individual.”

European Association for the Study of Diabetes 2017 Annual Meeting; September 11, 2017; Lisbon, Portugal. Abstracts 80, 308  in the English Longitudinal Study of Aging (ELSA).

Trial finds improvement in control and weight loss.

Addition to insulin therapy helped reduce hemoglobin A1c levels, researchers reported.

With fewer side effects, much less expensive drugs still found to be effective.

Children with diabetes are often sidelined during team sports and planned exercise.

Updated blood pressure control numbers may have cardiovascular benefits for some patients.

Quote of the Week!

“Strength does not come from physical capacity. It comes from an indomitable will.”

…Mahatma Gandhi

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

Josephat Macharia, Doctor of Pharmacy Candidate: Class of 2018; LECOM College of Pharmacy

Jessica Lambert, Doctor of Pharmacy Candidate; USF College of Pharmacy

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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