December 16, 2017 : Issue #916

• A Summary of ADA’s New 2018 Standards of Medical Care in Diabetes
• Common Causes of Death Among Patients with Both Diabetes and ASCVD
• Greater HbA1c Reduction with DPP4 Inhibitor, AGI Combination
• Safety and Efficacy of a New Long-Acting Exenatide Formulation: BYDUREON® BCise™
• Efficacy And Safety When Adding Ertugliflozin to Metformin and Sitagliptin
• Maternal Obesity and its Association to Type 1 Diabetes in Children
• Exclusive: Aaron Kowalski on JDRF and the Quest for a Cure

My good friend David Kliff always seems to hit the nail on the head when it comes to evaluating diabetes companies and the battles for insurance coverage and pricing. He often discusses the idea that insulin is a commodity, and formulary choices are not based on advertised prices, but on how high are the rebates paid back to the PBM’s. These rebates are often as much as 80%, meaning the manufacturer would rebate $400 on a medication that is priced at $500 in the retail setting.

This is why you sometimes don’t see a new generic available on formulary. A good example of this occurred when Lilly got approval for Basaglar, their biosimilar insulin meant to replace Sanofi’s Lantus. While most of you thought everyone would use Basaglar, this is not necessarily true. In fact, Sanofi would quietly float the idea that Basglar was not as good, while Lilly touted that they were the same.

Now the tables will be turned as Sanofi just got FDA approval for Admelog, their copycat version of Humalog.

It will be interesting to see if either company changes their tune about the value of Biosimilars now that they both have one.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Do you use texting or email to converse with your patients?

Follow the link to see how you compare to your colleagues.

The InPen system is available by prescription only and is a covered benefit under many insurance plans. The InPen is for use with U-100 Lilly Humalog® and Novo Nordisk Novolog® rapid-acting insulin and indicated for persons ages 12 years and older.

The American Diabetes Association (ADA) has issued its 2018 standards for diabetes care. See Article 1.

The FDA has approved Admelog (Sanofi-Adventis), the first copycat version of short-acting insulin lispro (Humalog, Eli Lilly)  to treat individuals age 3 years and older with type 1 diabetes and adults with type 2 diabetes. The product is approved for use as an injection, via pump, or intravenously. It will be available both in vials and as a prefilled pen (Admelog SoloStar).

Aaron Kowalski, PhD is the Chief Mission Officer and Vice President of Research at JDRF. He was appointed the JDRF’s first Chief Mission officer in December 2014 and serves as a key link between JDRF and the broad diabetes community.

One of your patients has referred her 21-year-old stepson for a new patient exam. He has recently arrived home from college for the summer and she is concerned because he always seems to be thirsty. When prompted, she recalls her husband saying his ex-wife struggled with her weight and took “pills for her blood sugar.” Physical examination is notable for mildly elevated BP (137/84) and BMI 26 kg/m2. He denies any cigarette or alcohol use, states his favorite activities revolve around video games, and that he doesn’t really enjoy any physical activities. Labs are notable for random plasma glucose 312 mg/dl, UA positive for glucose. What would your initial drug therapy strategy be?

A. Initiate monotherapy with metformin
B. Initiate a combination therapy with two noninsulin agents
C. Initiate lifestyle modifications
D. Initiate insulin therapy

Follow the link for the answer.

Naveed Sattar, MD and professor of metabolic medicine at the BHF Glasgow Cardiovascular Research Center at the University of Glasgow, Scotland, stated that at any given BMI, men have higher risks for mortality and diabetes, especially in middle age. Previously, it was shown that men have higher rates of diabetes in middle age than women. In a cross-sectional study, they analyzed data from about 300,000 participants ages 40 to 69 years of which 267,000 were women in a population-based cohort study initiated in 2007 to examine lifestyle, environmental, and genetic determinants of a range of diseases. Researchers compared the prevalence of self-reported diabetes across white (96.4%), South Asian (1.6%), black (1.6%), and Chinese (0.3%) adults. Results were standardized for age, socioeconomic status, BMI, and lifestyle factors, including physical activity, TV viewing, smoking status, and intake of various foods. The overall crude diabetes prevalence among men and women was 6.9% and 3.7%, respectively. The difference persisted after standardizing for age, socioeconomic status, BMI, and lifestyle factors, falling slightly in men to 6.4% and rising slightly among women to 3.9% (P < .0001). Across all ethnic groups, the standardized prevalence of diabetes was higher for men vs. women. Rates were 6% vs. 3.6% for white men and women, 21% vs. 13.8% for South Asian men and women, 13.3% vs. 9.7% for black men and women. — Ferguson LD, et al. Diabet Med. 2017;doi:10.1111/dme.13551.

Comprehensive recommendations feature notable new recommendations for people with cardiovascular disease and diabetes.

Identifying causes of death and related risk factors in patients with type 2 diabetes and cardiovascular disease may help with prevention.

Additive glucose-lowering effect of a dipeptidyl peptidase-4 (DPP4) inhibitor and an alpha-glucosidase inhibitor (AGI) might be beneficial in patients with T2DM.

Once-weekly injectable suspension can provide as much benefit as traditional twice-daily dosing.

New SGLT-2 inhibitor can be used as add-on therapy to provide better improvement in HbA1C in patients with type 2 diabetes.

Obesity, independent of diabetes diagnosis, found to increase diabetes risk.

Quote of the Week!

“Failure is simply the opportunity to begin again, this time more intelligently.”

…Henry Ford

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

Graciela Nieto, Doctor of Pharmacy Candidate 2018, LECOM School of Pharmacy

Fabio Rodriguez, Doctor of Pharmacy Candidate 2018, LECOM School of Pharmacy

Kay Lynn Tran, Doctor of Pharmacy Candidate: Class of 2018; LECOM College of Pharmacy

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