December 23, 2017 : Issue #917

• Are You Staying Informed With New Diabetes Treatments?
• A New Diabetes Epidemic: “Nonadherence”
• Can Aggressive Glycemic Control in Adults With Diabetes Be Harmful?
• Potential Effects of Exenatide Once-Weekly on Glycemic Control and CV Risk
• Cholecalciferol Improves Glycemic Control
• Metformin Linked to Improved Vascular Health in Children With Type 1 Diabetes
• Exclusive: Dr. Richard Pratley on Obesity and Treating Prediabetes Aggressively

Happy holidays from the entire staff here at Diabetes in Control.

This week we add another SGLT-2 inhibitor to our armada of diabetes medications. This new drug, Ertugliflozin, (see news flash) is coming to the market as a stand alone and in combination with both a DPP-4 inhibitor and Metformin. We will wait to see final pricing, but there is a chance for some patients that the SGLT-2/DPP-4 combination could be a really good choice.

The problem with this is, even though you are getting two new class drugs in one pill, will the patient be able to afford it; or more importantly will it be on their formulary? This week we have a special feature that looks at the cost of nonadherence in lives and dollars, that has its roots in patients dropping off of medications that they simply can’t afford.
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We can make a difference!

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Dave Joffe

Editor-in-chief

Would you be interested in learning about a program that can determine the best individual treatments for patients with type 2, based on what the patient can afford using their insurance?

Follow the link to see how your colleagues responded.

The FDA has approved the sodium/glucose cotransporter 2 (SGLT2) inhibitor ertugliflozin (co-developed by Merck and Pfizer) for glycemic control in adults with type 2 diabetes. Ertugliflozin is approved as monotherapy (Steglatro, 5-mg and 15-mg tablets) to be taken once daily. It is also approved as part of two fixed-dose combinations: with the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin (Steglujan; available as 5-mg ertugliflozin/100-mg sitagliptin and 15-mg/100-mg) to be taken once daily and with metformin (Segluromet; 2.5-mg ertugliflozin/500-mg metformin; 2.5-mg/1000-mg; 7.5-mg/500-mg; and 7.5-mg/1000-mg) to be taken twice daily.

With ‘SiDiary iPhone’ you are able to keep your diabetes logbook (blood glucose levels, blood pressure, medication, carbohydrates, etc.) without the slightest effort as you are already used to from the pc-version of SiDiary 6.

Richard E. Pratley, MD serves as the Medical Director of the Florida Hospital Diabetes Institute. He is also a senior scientist at the Florida Hospital /Sanford- Burnham Translational Research Institute for Metabolism and Diabetes and a professor at the Sanford-Burnham Medical Research Institute at Lake Nona.

A 47-year-old patient returns for a follow-up visit. He currently takes metformin 2000 mg daily, but is not achieving his glycemic target of A1C <7 %. His current A1C is 8.0%. You would like to add a second medication to his regimen, however, he voices concern that he is no longer covered by any health insurance and is worried about how to pay for his medications. Taking his concern into consideration, what drug would you add to metformin? A. DPP-4 inhibitor B. Thiazolidine C. Sulfonylurea D. Meglitinide E. SGLT2 Inhibitor F. GLP-1 Agonists Follow the link to see the answer.

Nearly one in four veterans receiving care from VA has diabetes. When diabetes advocates talk about groups of people at higher risk for the disease, they usually mention certain racial and ethnic groups. They might bring up age or obesity as risk factors. But veterans span all demographics and, as a group, a quarter live with diabetes. The U.S. Department of Veterans Affairs (VA) reports that one in four men and women (24 percent) who served their country have diabetes. That’s much higher than the 9 percent of all Americans who have diabetes. There are a few theories as to why diabetes disproportionately affects veterans. For one, they have a higher rate of overweight and obesity than the general population: More than 70 percent of patients in VA facilities are overweight or have obesity. VA patients also tend to be older, have lower incomes, and have limited access to high-quality, healthy food—social disparities that can lead to greater diabetes risk. And the VA has been examining suspected links between type 2 diabetes and herbicides such as Agent Orange, which was used during warfare by U.S. troops in the Vietnam War, as well as other aspects of war that could increase veterans’ risks for developing diabetes. We also must mention that the VA has one of the most comprehensive programs to deal with diabetes and the prevention of diabetes. As an example, one of the programs they offer is MOVE. About 580,000 veterans have participated in MOVE! through 4.5 million encounters (such as group meetings or one-on-one sessions with health care professionals or peers) in clinical settings in the VHA. They found that between veterans who participated in MOVE! and those who qualified but did not participate, the participants were able to lose an average of 30 pounds more than the control group after one year, and they maintained nearly all that weight loss at the two-year mark. They also saw significant improvements in participants’ A1c’s. Our healthcare system might learn something from the VA and do a better job in controlling diabetes in the general population. ”We Can Make A Difference”  — VA Health Administration;  Diabetes Forecast;  Diabetes Care

— Steve Freed, R.Ph., Publisher, Diabetes Educator

Poll finds less than half of health care professionals aware of newest drug up for FDA approval.

How can health care practitioners play a more prominent role in helping patients to take prescribed medications?

The first study to examine overtreatment and deintensification in a Medicare population with diabetes.

Injectable extended-release formulation of exenatide in patients with T2DM at a wide range of heart disease risk appeared not to cause increase in overall risk.

Study reports Vitamin D supplementation may improve HbA1c and lower cholesterol.

Medication also found to further aids in reducing daily insulin dose.

Quote of the Week!

“An investment in knowledge pays the best interest.”

…Benjamin Franklin

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

Jessica Lambert, Doctor of Pharmacy Candidate 2018, USF College 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