January 19, 2019 : Issue #973

• The Diabetes Treatment Lottery
• Why Checking for Depression Is Important for Patients With Diabetes
• How Many Steps Are Needed to Improve Quality of Life for 70-Year-Olds?
• Elevated Depressive Symptoms and Disability Among Patients Newly Diagnosed with Diabetes
• Feasibility of Incorporating Personalized Health Planning into Shared Medical Appointments for Patients Who Have T2
• Large-Scale Study Clarifies Polycystic Ovary Syndrome Diagnosis
  • Exclusive interview with Dr. Andrea Dunaif

Every time the ADA or ACE updates their guidelines, the position and order of glucose-lowering medications changes. Although year after year metformin is the #1 choice, the second and third choices become more ambiguous and it seems that any order is possible. including early basal insulin use.

The selection is also clouded by cost, insurance coverage, and copay amounts, and the cost has to be further divided into glucose control medications and medications for the comorbidities that are aggravated by higher A1c’s.

With all these factors, how are you supposed to make proper decisions as to medication management?

This week, we share some results from the use of the GlucosePATH software to help you make decisions with all the above factors in mind. They are also looking to validate their algorithms with your help. After you read Item 1, reach out to our publisher and let him know you want to participate.

In addition, our Medical Editor, Joy Pape, just got done reviewing Steve’s interview with Dr. Andrea Dunaif, an internationally recognized expert in endocrinology and women’s health, regarding a new large scale study that clarifies how to diagnose Polycystic Ovary Syndrome (PCOS). She sent me a message to stress that all of you should read Item 6.

*****************************

We can make a difference!

*****************************

Dave Joffe

Editor-in-chief

Is obesity a disease or a lifestyle choice? Follow the link to share your opinion and see what your colleagues think.

Members of the Endocrinologic and Metabolic Drugs Advisory Committee couldn’t reach a consensus on whether or not the benefits outweighed the risks of Sanofi’s investigational drug, which the drugmaker wants OK’d as an add-on to insulin therapy in patients with type 1 diabetes.

The Eversense XL 180-day continuous glucose sensor was successfully implanted in the first participant of Senseonics’ 180-patient Promise trial, designed to evaluate safety and efficacy in patients with diabetes.

The company also said it has given the FDA the documents needed to remove the MRI exposure-related contraindication for its 90-day sensor and to support an insulin-dosing claim.

Which of the following commonly prescribed drugs to treat type 2 diabetes carries a high risk of cardiovascular events, including heart attack, stroke, heart failure, or amputation, according to a recent study?

– Basal insulin
– Biguanides
– Meglitinide derivatives
– Alpha-glucosidase inhibitors
– Glucagon-like peptide–1 (GLP-1) agonists
– Dipeptidyl peptidase IV (DPP-4) Inhibitors
– Selective sodium-glucose transporter-2 (SGLT-2) inhibitors

Follow the link for the answer.

Researchers at the University of Arizona have discovered that metformin might also be used to treat heart failure with preserved ejection fraction (HFpEF), a condition that is predicted to affect over 8% of people age 65 or older by the year 2020. The published study shows that metformin relaxes a key heart muscle protein called titin, allowing the heart to properly fill with blood before pumping it around the body. Nearly half of all patients who have heart failure are considered to have HFpEF, in which the heart can properly contract, but, because the wall of the left ventricle is stiffer than normal, it fails to fully relax between beats, reducing its capacity to fill with blood. This reduces blood supply to the rest of the body, leading to shortness of breath with exertion and difficulty exercising.  HFpEF is more common in women, and other risk factors include hypertension, old age, and obesity. Unlike other forms of heart failure, however, there are currently no drugs available to treat HFpEF. — December 19, 2018;  https://jgp.rupress.org/cgi/doi/10.1085/jgp.201812259?PR

The best and most affordable treatment for type 2 diabetes

Adults with high levels of HbA1c may be at risk of lowered adherence to diabetes medication during poor management of depression.

Older adults with diabetes may be able to benefit from specific exercise recommendations.

Depression and new diagnosis of diabetes in older adults can increase time to disability.

Study compares enhanced patient care experience with standard shared medical appointments to determine if a significant benefit will result.

Diabetes in Control is pleased to bring you an exclusive interview with Dr. Andrea Dunaif, the Lillian and Henry M. Stratton Professor of Molecular Medicine and Chief of the J. Lester Gabrilove Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Dunaif is an internationally recognized expert in endocrinology and women’s health. Her research on polycystic ovary syndrome (PCOS), the most common hormonal disorder of reproductive-age women, has shown that it is a leading risk factor for type 2 diabetes mellitus. Further, this research has revolutionized the treatment of PCOS with insulin-sensitizing drugs.

Quote of the Week!

“Take the attitude of a student, never be too big to ask questions, never know too much to learn something new.”

….Og Mandino

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

Michael Zaccaro, Pharm. D. Candidate 2019, LECOM School of Pharmacy

Angela Reyes, Pharm.D. Candidate, LECOM College of Pharmacy

Annahita Forghan, Pharm.D. Candidate 2019, LECOM College of Pharmacy

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

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

Michael Zaccaro, Pharm. D. Candidate 2019, LECOM School of Pharmacy

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