February 17, 2018 : Issue #925

• Last Chance: Take 3 Minutes to Participate in Our Groundbreaking CGMS Research
  (Survey closes on Sunday, February 18)
• Point-Counterpoint, Part 2: Using Software to Determine the Best Type 2 Diabetes Treatment
• SGLT2 Inhibitors in Treatment of Type 1
• Study Explores Breast Cancer Outcomes and Treatment in Women Who Have Diabetes
• ESRD in Type 1 Diabetes: What Has Changed?
• Does Diabetes Impact Long-Term Cognition?
• Can Metformin Lower A1c For Patients With Type 1 Diabetes?

When I was working with endocrinologists they would often place their type one patients on metformin. I would share this with primary prescribers, and they too had good results using a type 2 drug for insulin dependent patients. We now have more choices than ever for patients and it only makes sense to try these on our type one patients. This week our USF Doctor of Pharmacy candidate, Lamija Zimic, has prepared some great information on the use of SGLT-2 Inhibitors by type 1 patients.

Don’t forget to share your opinion on CGMS use on our survey. This is a good way to let a major player in the CGMS game know exactly how you feel.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Medication combines two therapies (dapagliflozin (SGLT2i) and metformin hydrochloride extended-release) to offer comprehensive control of blood sugar with added advantage of weight reduction and BP control.

This latest testing device contains sensors that measure blood glucose levels via sweat on the skin’s surface. It transmits the data to a hand-held device with a digital display of the levels. It is designed to be used at set intervals throughout the day when patients would usually take a finger-prick test.  A recent small study showed the device measured blood glucose levels as accurately as a standard blood test. — Published in the Journal Science Advances, Jan. 2018

Do you prescribe sleep for your patients?

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

The suggested hierarchy of usage (AACE Algorithm) for a patient on metformin who has not reached goal according to the new 2018 AACE goal in 3 months is:

A. GLP-1RA, SGLT-2i, TZD, Basal Insulin, DPP4i
B. SGLT-2i, GLP-1RA, TZD. DPP4i, Basal Insulin
C. GLP-IRA, DPP4i, GLP-1RA, Bromocriptine QR
D. SGLT-2i, TZD, GLP-1RA, Colesevelem
E. SGLT-21, GLP-1RA, Basal Insulin, Colesevelem

Follow the link for the answer.

Nine states are considering laws that would require their residents to purchase health insurance. The proposals come less than two months after Republicans, as part of a sweeping tax code overhaul, voted to repeal the Affordable Care Act’s (ACA) mandate requiring individuals to have health insurance.

Lawmakers in Maryland, California, Connecticut, Hawaii, Minnesota, New Jersey, Rhode Island, Vermont, and Washington, as well as the District of Columbia are considering a law requiring residents to buy health insurance. The ACA’s individual mandate was implemented as a way to keep premiums low by requiring everyone to have insurance. Proponents of the mandate say that without it, healthy people are less inclined to buy insurance, causing premiums to rise dramatically for those who need it the most and making it more difficult to afford.

The proposals to impose health coverage mandates in some states marks a shift of authority over health care from the federal government to the states, possibly leading to significant coverage differences between red states and blue states.

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. Dr. Interlandi shares his concerns about the use of AI in medical decision making.  

Meta-analysis explores safety and efficacy of sodium-glucose co-transporter 2 inhibitors in patients with type 1 diabetes.

Females with breast cancer and diabetes have poorer prognosis than those with breast cancer without diabetes, but why?

Although the risk of end-stage renal disease remains high for individuals with type 1 diabetes, lifetime likelihood of ESRD has substantially decreased over the last 50 years.

Study in England links high HbA1c levels to long-term cognitive decline.

Both patients with diabetes and health care professionals expect wider adoption of continuous glucose management systems in the future for patients with type 2 as well as type 1, and agree that cost is a key factor in patient choices

Insulin resistance has been proposed as one of the causes of poor glycemic control in youth with type 1 diabetes who have excess weight or obesity.

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
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