Month: January 2019

Much news over the last couple of years with regards to SGLT2 inhibitors and cardiovascular outcomes from studies has been highlighted. A study of dapagliflozin and its impact on cardiovascular outcomes in 17,160 patients with Type 2 diabetes (who had or were at risk for atherosclerotic cardiovascular disease) who were followed for a median of 4.2 years. Specifically, patients were randomly assigned to receive receive either dapagliflozin or placebo.  The primary efficacy outcomes were major adverse cardiovascular events (MACE) (cardiovascular death, myocardial infarction, or ischemic stroke) and a composite of cardiovascular death or hospitalization for heart failure. The primary safety outcome was a composite of MACE. Treatment with dapagliflozin resulted in a lower rate of cardiovascular death or hospitalization for heart failure which reflects a lower rate of hospitalization for heart failure. However, treatment with dapagliflozin did not result in a higher or lower rate of MACE as compared to placebo. To learn more, please click below.

https://www.nejm.org/doi/full/10.1056/NEJMoa1812389

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#dapagliflozin #cardiovascular #outcomes

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A current first ever randomized trial of oral insulin use in persons with Type 2 diabetes shows feasibility. This trial which is sponsored by NovoNordisk has been discontinued yet it shows promise for the future studies of oral insulin. To learn more, please click below.

https://www.medscape.com/viewarticle/908204

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#oral #insulin #trial

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FDA advisory committee recently voted on a new SGLT 1/2 inhibitor, Zynquista, for Type 1 diabetes. If approved, this medication can be used with insulin which would decrease insulin doses and weight. It is a dual inhibitor pill that is taken once daily. It is being developed by Lexicon and Sanofi. STICH is proposed acronym for persons with Type 1 to take if ketones are high (while taking SGLT inhibitor).

STop SGLT inhibitor; Inject bolus insulin; Consume 30 grams of carbs; Hydrate (ideally with water)

What makes it particularly exciting is if approved Zynquista would be the first oral diabetes medication approved for use in Type 1 diabetes. Now that would be a game changer.

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#zynquista #dual #SGLT inhibitor

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We know that physical activity improves our health and quality life. A recent study of adults with bipolar disease, major depressive disorder and those without history of mood disorders found that physical activity can be an effective target for strategies to change mood states. In this study, physical activity affected how energetic participants felt and how long they slept. To learn about this study, click below.

https://www.nih.gov/news-events/nih-research-matters/physical-activity-helps-reduce-depression-symptoms#.XD-aLdKHSD4.linkedin

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#physical #activity #mood

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As we all know, insulin costs are soaring and out of control. The cost of insulin has almost tripled in the last 15 years. Something has got to give here. In late November 2018, The Endocrine Society released recommended policy changes to help increase access to affordable (yes, affordable) insulin. Below are a few of the recommended changes and a link to the full list of recommended changes.

-Future list price increases should be limited, and reasonable financial incentives should be pursued by ALL stakeholders.

-Rebates should be passed along to consumers without increasing premiums or deductibles.

-Patient Assistance Programs should be less restrictive and have an accessible, common application that can be used for multiple programs.

https://www.endocrine.org/news-room/2018/supply-chain-transparency-needed-to-combat-soaring-insulin-costs

Thanks to the Endocrine Society for these recommendations.

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#insulin #supply #chain #transparency

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I will be highlighting insulin for my next couple of Daily Pieces as my heart aches and is heavy for those who have died from a lack of insulin. Fullerton published in Cochrane Database System Review a review of short-acting insulin analogues versus regular human insulin for adult, non-pregnant persons with Type 2 diabetes mellitus. Ten randomized controlled trials met the criteria. The authors’ conclusion, “our analysis found no clear benefits of short acting insulin analogues over regular insulin in people with type 2 diabetes. Overall, the certainty of evidence was poor and patient-relevant outcomes were sparse.” Bottom line: regular human insulin is a viable option especially when cost is an issue. The link to the review is below.

https://www.ncbi.nlm.nih.gov/pubmed/30556900

No person should die from a lack of insulin – Relion R insulin (available at Walmart for $25/vial) is an alternative to short acting insulin analogues and Relion NPH insulin (available at Walmart for $25/vial) is an alternative to basal insulin analogues especially if cost is an issue.

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#insulin #alternatives #human #analogue

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An interesting article came out a few days ago in Washington Post on factors to consider when pondering a switch to mail order pharmacy. As a pharmacist who prefers using a local independent pharmacy for my medications, I found the article interesting. I did appreciate that factor that they highlighted the individual wanting convenience and having chronic condition (i.e. high blood pressure, diabetes, hormonal therapy) (i.e. my daughter) might prefer mail order pharmacy as compared to individuals who have antibiotic prescription or prefer the personal touch of a local pharmacist (i.e. myself). One factor missing from the list is that if medication such as insulin sits in someone’s mailbox on a hot June day the insulin will be ineffective. Please click below to read the article.

https://www.washingtonpost.com/lifestyle/home/should-you-switch-to-a-mail-order-pharmacy-here-are-the-factors-to-consider/2019/01/07/8b56f87a-0ede-11e9-8938-5898adc28fa2_story.html?noredirect=on&utm_term=.787a80058302

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#factors #pharmacy #choice

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Tis the season of cold and flu. Being proactive to protect yourself from cold and flu is of the essence. The most basic step to take is to wash your hands with soap and water throughout the day especially after touching door knobs and handles. Cleaning your hands with alcohol is an alternative to hand washing although hand washing is the best. Getting a sufficient amount of sleep (ideally 6 – 8 hours), eating balanced healthy meals and being physically active are also great prevention steps.

For some protection against getting a cold, taking vitamin C 500 mg daily is fine although not proven protection. If you take more than 500 mg of vitamin C at a time, your body will simply eliminate it so more is not better.

Lastly, the flu vaccine is of particular importance. Now a flu shot is not a guaranteed protection against getting the flu. Rather it lessens the severity and duration of the flu – bottom line it is worth it. FluMist, the nasal version of the flu vaccine, has been approved for this flu season but it is not as effective injected (intramuscular) formulation of the vaccine. A commentary published recently in Pediatrics highlights this finding.

http://pediatrics.aappublications.org/content/early/2019/01/03/peds.2018-3290

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#protection #against #cold #flu

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This is great news! Why you may ask? It is usually quite difficult to know the cost of medication for the patient when the provider enters it into the electronic health record (EHR). This leads to sticker price shock at the pharmacy. And no, it is certainly not the fault of the pharmacy or pharmacist. Please do not shoot the messenger.

One of the major health information technology companies, Cerner, has collaborated with CoverMyMeds to integrate prescription princes into the electronic health record so both providers and patients can know the cost of medication before is prescribed. Also, know the price allows for a more informed decision on all fronts. Genius!! Time saved and frustrations minimized. Please click on the link below to learn more about his exciting collaboration. Wishing you a great week!

https://www.healthcarefinancenews.com/news/cerner-and-covermymeds-integrate-prescription-prices-and-patients-ability-pay-within-ehr

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#integration #medication #cost #collaboration 

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So you may we wondering…why am I writing a daily piece about diet and not medications? Well, when it comes to our health, our nutrition and eating habits is natural medicine for our bodies. Our eating habits matter. I was excited to see that the Meditterranean diet is chosen as the best diet for 2019 according to U.S. News and World Report. This eating plan does not cut out certain food groups or produce magical short term weight loss. Creating sustainable long term changes in our eating habits rather than following the most popular fad diet is vital. To learn more click below.

https://www.medscape.com/viewarticle/907133

https://www.healthline.com/nutrition/mediterranean-diet-meal-plan

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#mediterranean #eating #habits #2019 

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