January 13, 2018 : Issue #920

• How To Overcome The Complexities of Treatment Decisions For Your Type 2 Diabetes Patients (Part 1 of a special 4-part feature)
• How Does Empagliflozin Reduce Cardiovascular Mortality In Type 2 Patients, Including Those With PAD?
• Efficacy of Spinal Cord Stimulation in Painful Diabetic Neuropathy
• Factors Related to C-peptide Levels Following Type 1 Diabetes Diagnosis In Type 1 Children
• Understanding The Gap Between Efficacy In Randomized Trials And Effectiveness In Real-World Use Of GLP-1RA and DPP-4 Therapies
• The Insulin Pump Market: A Look Back at 2017 and Ahead to the New Year
  • Guest Post by David Kliff, Diabetic Investor
• Exclusive: Mary Loeken on Maternal Diabetes and Birth Defects

The insulin pump market is in a disarray as we enter 2018, as a major competitor has left the market just as Omnipod finally gets Medicare approval. This disarray will likely continue for some time to come and shake up pump therapy for many patients. We have a special feature from David Kliff, at Diabetic Investor, on what to expect.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Insulin Biosimilars for both long- and short-acting insulins will be available shortly from major insulin suppliers. Will you recommend them if they are at least 20% lower in cost?

Follow the link to see what your colleagues say.

Insulet Corporation, the leader in tubeless insulin pump technology with its Omnipod® Insulin Management System, announced that the Centers for Medicare and Medicaid Services (CMS) has issued guidance clarifying that Medicare Part D Plan Sponsors can provide coverage for products such as the Omnipod System under the Medicare Part D (prescription drug) program.

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Mary Loeken, Ph.D., received her Ph.D. in Reproductive Endocrinology at the University of Maryland School of Medicine and did postdoctoral training at the National Cancer Institute’s Laboratory of Molecular Virology

A 43-year-old patient presents to your clinic for an appointment. She has mild hypertension, which is currently well controlled with a beta blocker. She was diagnosed with type 2 diabetes 6 years ago, and has been taking metformin and glipizide. She has noticed that her recent self-blood glucose monitoring numbers have been creeping up with a most recent FPG of 160 mg/dl. At today’s visit, she has an A1C of 8.0%. She tells you that until now her job has required she travel several times a month. This week, she was promoted to a managerial position that does not require travel. Which of the following approaches would be the best for her?

1. Add a basal insulin dose once a day
2. Add pre-mixed insulin twice a day
3. Add pre-mixed insulin twice a day and change her non-insulin medications
4. Add a basal insulin dose once a day and change her non-insulin medications

Follow the link for the answer.

According to new research, living near a physical activity facility — such as a gym, swimming pool, or football field — can help you keep your New Year’s resolution.  Individuals living in close proximity to at least six exercise facilities had a waistline that was 1.22 centimeters smaller, a BMI that was 0.57 points lower, and a body fat percentage that was 0.81 percent lower, on average. This link was stronger for women and higher-income groups of people, note the researchers. Additionally, the study found that the farther people lived from a fast food outlet, the smaller their BMI, waistline, and body fat percentage. This association was the strongest among women. To find the answers, the researchers examined data from a large cohort study — which ran from 2006 to 2010 — and looked at whether residential proximity to fast food outlets and physical exercise centers had any bearing on weight measurements. The study included the waist and body mass index (BMI) measurements as well as body fat percentages of approximately 400,000 adults between 40 and 70 years old. The results of the study suggest that increasing access to local physical activity facilities and, possibly, reducing access to fast food close to residential areas could reduce overweight and obesity at the population level. From the results, it was suggested that designing and planning cities in a way that better facilitates healthy lifestyles may be beneficial, and should be considered as part of wider obesity prevention program. — The Lancet Public Health; DOI: https://dx.doi.org/10.1016/S2468-2667(17)30212-8

Part 1 of a series on a framework developed by Dr. Bradley Eilerman and Len Testa for recommending medications for treating patients with type 2 diabetes.

A thousand times today, in offices all over America, hospital patients will be diagnosed with type 2 diabetes. When that happens, a healthcare provider has to make a treatment decision of enormous complexity, often with partial information to go on, and in the span of just a few minutes.

The answer comes from a mediation analysis of the EMPA-REG OUTCOME Trial.

Higher score measuring severity of pain indicated elevated treatment failure risk.

Young patients with low BMIs, C-peptide levels, and significant symptoms at onset of diabetes at higher risk of undergoing rapid C-peptide decline.

Patients are not seeing the expected results because of medication adherence.

By Guest Writer David Kliff, Publisher, Diabetic Investor

As 2018 begins, my attention turns toward a look back at the year gone by and ahead to the year that’s starting. As always, my New Year will begin in that beautiful city by the bay at the JP Morgan Healthcare Conference. This is a conference I suspect will be one of the more interesting, and since I’ve attended nearly 20, that’s saying something. Lots is going on behind the scenes in our wacky world, and given the nature of JPM I suspect the veil of secrecy will be lifted.

Quote of the Week!

“I can’t change the direction of the wind, but I can adjust my sails to always reach my destination.”

…Jimmy Dean

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

Jessica Lambert, Doctor of Pharmacy Candidate 2018, USF College of Pharmacy

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

Your Friends in Diabetes Care
Steve and Dave
Diabetes In Control
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