February 10, 2018 : Issue #924

• Point-Counterpoint, Part 1: How to Overcome the Complexities of Treatment Decisions for Your Patients with Type 2 Diabetes
• Meta-Analysis Evaluates Long-Term Safety of SGLT2’s
• Breastfeeding Reduces Risk of Developing Diabetes
• A Comparison of Safety and Efficacy of Semaglutide vs. Exenatide ER
• How Efficient Are Voice-Operated Apps for Insulin Pumps?
• Timing is Everything: A Focus on Gluten Initiation into Infants’ Diets
• Exclusive: Ronald Swerdloff on Male Hypogonadism And Diabetes

As I was driving home the other night I heard a duet by Bette Midler and Barbra Streisand. The lyrics included “Anything you can do, I can do better; I can do anything better than you.” For some reason this got me thinking about the use of AI (artificial intelligence). Seems like AI is everywhere. It is what tells Amazon to stock in its regional warehouses, tells Google what advertisements to post, and stops the cars backing out of driveways into traffic. Soon AI will be driving our cars as well.

When it comes to diabetes management there also seems to be a future for AI. In the latest part of our series on the use of software for selecting diabetes therapy, we have the first part of a point and counterpoint on the idea that “Anything a clinician can do, AI can do better; AI can do anything better than you.” Please take a look at what both Dr. John Interlandi, MD, and Dr. Bradley Eilerman, MD, have to say.

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We can make a difference!

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Dave Joffe

Editor-in-chief

How does cost play in your determination for treatment? Follow the link to see how you and your colleagues compare.

Fiasp® (insulin aspart injection) 100 Units/mL is a fast-acting mealtime insulin indicated to improve glycemic control in adults with type 1 and type 2 diabetes. Ozempic® (semaglutide) injection 0.5 mg or 1 mg is a once-weekly glucagon-like peptide (GLP-1) receptor agonist indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes.

Our recently updated Type 2 Comprehensive Diabetes Drug List is a unique list of the diabetes drugs available that includes the following categories:

Download the Updated Type 2 Comprehensive Diabetes Drug List(pdf).

Dr. Ronald S. Swerdloff graduated with his BS from UCLA/UCB in 1959 and an MDvin 1962 from UCSF. He began his clinical training at the University of Washington, only to be drafted and expected to serve as a medical officer in the Vietnam war. Instead he was assigned to a brilliant physician scientist at the NIH and finally finished his training back at UCLA. Dr. Swerdloff has been a leader in reproductive endocrinology for the last four decades, including pubertal development, male contraception, androgen physiology and modeling, androgen drug development and hormones in aging.

A 68-year-old male presents to your office for a follow-up visit. His past medical history is significant for a myocardial infarction (five years ago) and he has type 2 diabetes. His current medications include an ACE inhibitor, a statin, aspirin, and metformin. Despite good compliance with his medications and beneficial lifestyle changes, he is not able to achieve his individualized target A1C of 7.5-8%. You decide it would be beneficial to add a second antihyperglycemic agent. Which of the following medications should be avoided due to CVD risk?

A.Pioglitazone
B. Exenatide
C. Rosiglitazone
D. Sitaglipitin
E. None of the above

Follow the link for the answer.

Because medical costs for people with diabetes are twice as high as those without diabetes, a study was done recently with 1,000 U.S. adults, ages 26-64, half of them with diabetes. They reported that the cost associated with their condition has negatively impacted their finances.1 On top of that, many find themselves draining their savings and looking for other means of financial support, including routes that may set them back further, with fiscal management often at the top of their minds at the beginning of the new year due to healthcare plan changes. There is also the concern that their health will force them to retire before they are financially ready.1

In the survey, nearly half of adults with diabetes indicated they have gone to extreme lengths to cover the cost of their diabetes management, most commonly: accruing credit card debt (22%), borrowing money from family or friends (21%), and taking money out of a savings or retirement account (19%).1

Managing finances can add stress to your patient’s life and, on top of that, managing a chronic condition like diabetes can make budgeting even more complex. The survey also found that more than half of people with diabetes feel they are worse off financially than people who don’t have diabetes. This financial burden trickles into the way adults with diabetes think about saving for the future. More than two thirds of employed Americans with diabetes are concerned they’ll have to delay retirement specifically because of healthcare costs, and 62 percent of employed Americans living with diabetes are concerned health issues will force them to retire before they have the financial resources to do so.1

One subject not discussed in this study—how much does the stress increase their blood sugars?

1 – This study was conducted online by Wakefield Research The margin of error was +/- 4.4% for each audience.

In the last four issues, we discussed a new software that can go through over 6 million possible treatments using anywhere from 1 to 5 drugs for an effective treatment for type 2 diabetes. Along with determining the best treatment for the patient, it includes the ability to put in what the patient can afford in their budget. Dr. John Interlandi, one of our readers, has submitted a counterpoint to using this software to decide the best treatment options. In Part 1, Dr. Interlandi shares his concerns about the use of AI in medical decision making. 

Short-term efficacy and safety of SGLT2 inhibitors have been well established, but what happens with long-lasting use of these medications?

30-year study shows effects of breastfeeding on diabetes incidence in women of child-bearing age.

GLP-1 agonists randomized showdown. Which agent is better?

Evaluating if bolus calculators for insulin pumps can be accurately calibrated by speech recognition.

A study examining the timing of foods and its associated risk to islet autoimmunity.

Quote of the Week!

“The future rewards those who press on. I don’t have time to feel sorry for myself. I don’t have time to complain. I’m going to press on.”

…Barack Obama

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

Lamija Zimic, Doctor of Pharmacy Candidate 2018, USF College of Pharmacy

Adrianna Jackson, Doctor of Pharmacy Candidate 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