Daily Piece: Age Expansion for Victoza

Great news! FDA has approved liraglutide (Victoza) (GLP-1 agonist) is now approved for person age 10 and older with type 2 diabetes. This is exciting because there are limited medications (metformin and insulin (usually basal)) indicated for type 2 diabetes in adolescents. Please share with others.

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#Victoza #FDA #adolescents #type2diabetes

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Daily Piece: New Diabetes Combo Med Approved

Qternmet XR (AstraZeneca) has been FDA approved as oral adjunct treatment to diet and exercise in type 2 diabetes as adjunct in U.S. It contains dapagliflozin (SGLT2-inhibitor), saxagliptin (DPP-IV inhibitor) and metformin hydrochloride. This is an ideal combination in terms of the variety of drug mechanisms of action involved. To learn more, please click below.

https://www.mdedge.com/endocrinology/article/200430/diabetes/fda-approves-qternmet-xr-adjunct-therapy-glycemic-improvement

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#Qternmet XR #FDA #diabetes #treatment

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Daily Piece: ADA Standards of Care Incorporate CREDENCE Trial Findings

As you may already know, ADA Standards of Care are now the living standards which basically means updates are made in real time rather than once year. CREDENCE trial results revealed that the SGLT-2 inhibitor, canagliflozin, was associated with both reduced renal failure and cardiovascular events in persons with type 2 diabetes and chronic kidney disease. These are game changing results. Updates to sections 10 and 11 of the ADA Standards of Care have been made as a result of CREDENCE trial findings. A few highlights of the updates include…

  1. At least annual assessment of urinary albumin and estimated glomerular filtration (eGFR) rate in all persons with type 2 diabetes.
  2. GLP-1 agonist medication may lower risk for albuminuria risk progression and/or CV risk in persons with CKD at elevated risk of CV events.
  3. SGLT-2 inhibitor should be considered when eGFR is at or above 30 in persons with type 2 diabetes and chronic kidney disease especially with albuminuria above 300 mg/g to lower CV and renal risk.

To learn more, please click on links below.

https://www.nejm.org/doi/10.1056/NEJMoa1811744?query=pfw&jwd=000020040769&jspc=

http://care.diabetesjournals.org/living-standards#June/%203

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#CREDENCE #ADA #updated #standards

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Daily Piece: Renal Protective Enzymes Identified

Dr. Gordin and fellow researchers with Joslin Diabetes Center have published their findings on enzymes, pyruvaste kinase M2 (PKM2) and amyloid precursor protein (APP), which potentially protect against kidney disease in those living with Type 1 diabetes. To learn more about these very interesting findings, please click below.

http://care.diabetesjournals.org/content/early/2019/05/03/dc18-2585

https://www.medscape.com/viewarticle/913692

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#enzymes #protect #kidney

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Daily Piece: Rates of New Diabetes Cases Declining

Much work has been put forth by Centers for Disease Control, American Association of Diabetes Educators and American Diabetes Association in diabetes awareness and prevention. It looks as though this hard work has paid off. Recent analysis of data (1980 – 2017) from National Health Interview Survey reveals a decline in new diabetes cases. To learn more about these interesting findings, please click below.

https://www.medscape.com/viewarticle/913686

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#declining #new #diabetes #cases

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Daily Piece: Updated Obesity Care Algorithm Available

Obesity does not occur in a solo. The updated obesity algorithm from Obesity Medicine Association which has been recently released highlights the comprehensive care for obesity. The algorithm incorporates care for cardiovascular disease, diabetes and cancer. Please take a few moments to review the updated algorithm by clicking on links below.

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#obesity #comprehensive #algorithm

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Daily Piece: Patient Assistance Program for Eversense CGM

Senseonics has created a patient assistance program (Eversense Bridge Program)for its implantable CGM, Eversense. This program reduces the cost to $99 plus cost for sensor insertion and removal (this process has to be completed in healthcare providers office). To be qualify, you must be at least 18 years old, not have any federal or state funded health insurance plan, have prescription for Eversense, not have full coverage for Eversense with your insurance or not resident of Massachusetts. To learn about this assistance program, please click below.

https://www.eversensediabetes.com/patient-bridge/
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#Eversense #Bridge #Program

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Daily Piece: Insulin Lispro, Generic Humalog

Insulin lispro, generic Humalog, is now available in pharmacies. It is half the list price of Humalog at a list price of $137.50 per vial and $265.20 for a package of five KwikPens. It is interchangeable so pharmacists can substitute it for Humalog without a new prescription. The target population is those who are under- or uninsured, and those in Medicare Part D coverage gap.

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#insulin #generic #Humalog

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Advocacy: Expanding Access to Diabetes Self Management Training (DSMT) Act

The needs of a person living with diabetes changes through the various transitions of life so the specific needs for self management and support. There is no cookie cutter. Federal legislation, HR 1840 and S 8143, expands the current diabetes self management training that is covered by Medicare. How does it do this?

  1. Allows the initial 10 hours of DSMT during first year after diagnosis of diabetes to remain available until fully utilized. Life happens and it may not always be possible to utilize the 10 hours of training the first year.
  2. Increases the hours of DSMT from 2 to 6 hours in subsequent years.
  3. Allows DSMT and Medical Nutrition Therapy (MNT) to be provided on same day as currently they can not be provided on same day.
  4. Excludes DSMT from Medicare Part B cost sharing and deductible requirements.
  5. Permits physicians and non-physician practitioners who are not directly involved in managing an individual’s diabetes to refer them to DSMT services. For example, with this expansion, an emergency room provider could refer a person for diabetes education.
  6. Allows DSMT to be provided in a community based location (i.e. community center, churches, etc). Meeting people where they are.
  7. Establishes a 2 year demonstration of virtual DSMT. It is not always feasible for various reasons for a person to travel to a diabetes education center.

Whether you are a person living with diabetes, a caregiver, diabetes educator or healthcare professional, please contact your Congressman and Senators, and ask them to co-sponsor HR 1840 and S 814. Diabetes is a bipartisan issue.

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#diabetes #AADEAdvocacy

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Latest Blog: Diabetes Educator: Who, What and When

Imagine being informed that you have prediabetes, gestational, Type 2 or Type 1 diabetes.  A range of thoughts flood the mind. What? How? Are you serious? Not me! Now life takes a new twist.  As a diabetes educator who has walked the journey alongside persons with prediabetes, gestational diabetes, Type 2 and Type 1, I have had the gut-wrenching experience of seeing first-hand the anguish, grief and disappointment the diagnosis can bring.  Walking the journey after being given one of these diagnoses is certainly not easy yet it does not have to be travelled alone.  The health care team, peer support community, loved ones and friends are valuable resources on the journey.  Within the health care team, a diabetes educator is a unique resource for those living with prediabetes, gestational diabetes, Type 2 or Type 1 diabetes.  You may be wondering, who is a diabetes educator? What support and services can they provide? When is it appropriate to see an educator?  

Who? Diabetes education is considered a specialty with the diabetes educator having a primary health discipline (i.e. medicine, nursing, pharmacy).  A Diabetes educator, from a discipline standpoint, can be a nurse, dietician, physician assistant, nurse practitioner, pharmacist, physician, physical therapist, social worker, clinical psychologist, exercise physiologist, health educator, occupational therapist, optometrist, podiatrist, and additional disciplines – what a variety! Diabetes educators can become Certified Diabetes Educators (CDE) through National Certification Board for Diabetes Educators (NCBDE). 

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What? Unfortunately, some folks imagine someone reading off a list of dos and don’ts with a handout thrown in when they consider the “what” of diabetes educator services. Wow, it is SO much more.  Rather, a diabetes educator can provide a broad spectrum of services for the person living with diabetes and prediabetes and their caregivers. In terms of education, consider someone sitting down with you to discuss your concerns and needs, developing a plan for self-managing your diabetes in collaboration with you, and providing ongoing support in the day to day of living with diabetes and prediabetes addressing the unique needs and concerns at various times. Depending on the educator’s primary discipline, clinical management of diabetes in collaboration with person living with diabetes is also a service.  Providing technology support in terms of tools (continuous glucose monitors, insulin pumps, apps, etc.), interpreting data to adjust treatment based on the data and driving innovation with use of technology. Supporting the emotional well-being of the whole person living with diabetes or prediabetes with a focus on behavioral health.  Ultimately, the diabetes educator’s day to day activities may look different based on their primary discipline yet all educators are advocates for person centered care and all persons living with diabetes and prediabetes.

When? According to a joint statement from American Diabetes Association, American Association of Diabetes Educators and Academy of Nutrition and Dietetics, the four critical times for diabetes self-management education and support for person with Type 2 diabetes are at diagnosis; annually to assess education, nutrition and emotional needs; when complicating factors influence self-management, and when transitions in care occur.  Complicating factors that influence self-management are health conditions (i.e. kidney disease, stroke, heart attack), complicated medication regimen, steroid therapy, limitations such as visual or physical impairments, anxiety, depression, limited access to food and financial limitations. Transitions in care goes beyond discharge from hospital back into community. Also change in medical care team, treatment change due to insurance coverage or age-related changes that impact cognition or ability to care for one’s self. 

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For persons living with Type 1 diabetes, diabetes educators are often housed within endocrinologist, some primary care offices or hospitals. Within this population, diabetes educators are often collaborating with person with Type 1 diabetes in technology such as insulin pumps in starting and adjusting pump therapy and continuous glucose monitor.  Additionally, educators teach survival skills and provide vital ongoing support.

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In terms of prediabetes, diabetes educator will work collaboratively with individuals to help facilitate behavior change in nutrition and physical activity to prevent the development of Type 2 diabetes.  This collaboration often occurs in a group setting through Diabetes Prevention Programs which is a covered benefit for Medicare and many private insurance plans.  The prevention programs are typically a year in length with focused sessions on aspects of behavioral change and vigorous ongoing support. As we all know, behavioral change can be a challenge for ALL of us. 

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I have provided several links below with more information on critical times for diabetes self-management and support, diabetes certification and diabetes prevention programs.

https://www.diabeteseducator.org/docs/default-source/practice/algorithm-of-care.pdf?sfvrsn=2

https://www.ncbde.org/

https://www.cdc.gov/diabetes/prevention/index.html

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#diabetes #educator #who #what #when

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