Tuesday’s Daily Piece: Removing the Scary from Halloween Candy

I have been pondering this week what to post to encourage people living with diabetes as halloween is celebrated this week. Candy is not the forbidden evil of halloween. Rather, it can be enjoyed in moderation (1 – 2 piece of small candy (most halloween candy comes in smaller size anyway) each day). After reading a great article in diaTribe regarding halloween candy, I felt compelled to share it. Also, a shameless plug to subscribe to diaTribe if you do not already subscribe.

https://diatribe.org/issues/37/logbook?utm_source=diaTribe&utm_campaign=a9ddd88079-EMAIL_CAMPAIGN_2019_10_24_06_18&utm_medium=email&utm_term=0_22467a8528-a9ddd88079-152660205

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#halloween #candy #diabetes

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Saturday’s Daily Piece: SGLT2 Inhibitor vs. GLP1 Agonist When Have Type 2 Diabetes and Heart Disease

In a person with type 2 diabetes and heart (cardiovascular) disease, it can be a tough choice as to whether to select SGLT2 inhibitor (empagliglozin, canagliflozin, dapagliflozin) or GLP-1 agonist (liraglutide, semaglutide, albiglutide) usually after starting or when starting metformin. I list these specific drugs within each of the two drug classes because they have been studied for their benefit heart disease and diabetes.

Favor SGLT2 inhibitor if person has heart failure; fear of needles and prefers oral medication; chronic kidney disease with eGFR (measures how the kidneys can filter the blood) >45 ml/min/1.73m2.

Caution or avoidance of SGLT2 inhibitor if person has a high risk for amputation; peripheral arterial disease (blood flow in legs and feet are not so good); history of diabetic ketoacidosis; osteoporosis or at risk of falls

Image result for sglt2 inhibitors cartoon

Favor GLP1 agonist if person is at risk for stroke or heart attack without a history of heart failure; peripheral arterial disease with ulcer, infection or prior amputation ; obesity

Caution or avoidance of GLP1 agonist if person has had a prior gastric surgery or known gastroparesis (because this class of drugs works in the stomach); eGFR <30 ml/min/1.73 m2 (kidney is not really able to do very well with filtering the blood) or end stage kidney disease; history of medullary thyroid cancer (or MEN2); diabetic proliferative retinopathy.

Image result for glp-1 agonist cardiovascular benefit

Reference: Dhinsa DS, Mehta A, Sandesara PB, et al. Strategie for Appropriate Selection of SGLT2-i vs GLP1-RA in Persons with Diabetes and Cardiovascular Disease. Current Cardiology Reports (2019). 21:100. doi.org/10.1001/s11886-019-1197-6.

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#Diabetes #Heart #SGLT2-inhibitor #GLP-1-agonist

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Thursday’s Daily Piece: Exciting New Updates on Fiasp and Farxiga

Well, it is another exciting week in the world of diabetes. First, more rapid acting insulin aspart (Fiasp) now has expanded FDA indication for use in insulin pumps.

https://www.medscape.com/viewarticle/920162?nlid=132222_3901&src=wnl_newsalrt_191022_MSCPEDIT&uac=293412PG&impID=2139522&faf=1

Secondly, dapaglifozin (Farxiga) is now first medication indicated for treatment of Type 2 diabetes that is approved to reduce risk of heart failure hospitalization in adults with type 2 diabetes and established cardiovascular (heart) disease or multiple risk factors for heart disease. The data from the Dapagliflozin Effect on Cardiovascular Events-TIMI 58 (DECLARE-TIMI 58) trial led to this new approved indication. Please do keep in mind that in general the SGLT2 inhibitor drug class (class effect) has shown benefit for persons with type 2 diabetes and heart failure.

https://www.medpagetoday.com/cardiology/chf/82845?xid=nl_mpt_SREndocrinology_2019-10-22&eun=g1137305d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=EndoUpdate_102219&utm_term=NL_Spec_Endocrinology_Update_Active

https://univadis.com/player/yqzsqyhmi/alist_nlts_1571907600727?m=unv_eml_essentials_enl_v5-q3-2019-newsrndm_20191024&partner=unl&rgid=5xzzntsmvumvuucxuzefqyb&ts=2019102400&o=tile_1_id&utm_source=Retention&utm_medium=newsletter&utm_campaign=unv_eml_essentials_enl_v5-q3-2019-newsrndm_20191024_01

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#Fiasp #FDA #Farxiga #HF

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Saturday’s Daily Piece: Omada Health and Abbott Partnership – Integrated Digital Health

Omada Health, digital coaching platform, provides real time support and coaching for persons with type 2 diabetes and other chronic diseases to empower people to make sustainable behavior change. Abbott (maker of Freestyle Libre) is joining forces with Omada Health to offer Freestyle Libre flash glucose monitoring for persons with type 2 diabetes as part of the Omada program. What a bonus! If you are interested in learning more information, please click below.

https://www.omadahealth.com/press/abbott-and-omada-health-partner-to-offer-integrated-digital-health-and-coaching-experience-for-people-with-type-2-diabetes

https://abbott.mediaroom.com/2019-10-14-Abbott-and-Omada-Health-Partner-to-Offer-Integrated-Digital-Health-and-Coaching-Experience-for-People-with-Type-2-Diabetes

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#integrated #digital #health #coaching

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Tuesday’s Daily Piece: Insulin Co-Pay Update

Good news in terms of insulin co-pays for those with insurance coverage through Cigna (and Express Scripts) and three Minnesota Insurance companies (Blue Cross and Blue Shield, Medica and UCare) beginning in January 2020! Now, please keep in mind this does not address the deeper issue of the cost of insulin however it does address co-pays. To learn more, please click to read diaTribe’s explanation (great job as always dia Tribe).

https://diatribe.org/2020-health-plans-give-people-access-much-insulin-they-need-cigna-bcbs-mn-medica-mn-ucare-mn?utm_source=diaTribe&utm_campaign=3580be2562-EMAIL_CAMPAIGN_2019_10_15_01_07&utm_medium=email&utm_term=0_22467a8528-3580be2562-152660205

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#insulin #co-pay #Cigna #Minnesota

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Saturday’s Daily Piece: Tis the Season for Flu Shot

I am like everyone else in that I often put off the most important “to-do” things for my health. Well, this week, I am excited to share that I received my flu shot. Now, I must clear up a couple of myths.

Myth #1: I will be 100% protected from getting flu if exposed to a person with the flu after I receive the flu shot

Truth: You may still get the flu if exposed to person with the flu but the duration and severity will be decreased.

Myth #2: I will get the flu if I receive the flu shot

Truth: Flu shot is developed from a dead virus therefore it is impossible to develop the flu from a dead virus.

Please make sure to put getting your flu shot at the top of your “to-do” list. Join me in protecting yourself.

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#Flu #shot #vaccine #protection

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Wednesday’s Daily Piece: Green Light for Dexcom’s G6 Pro

Great news in the diabetes world today! FDA has approved Dexcom’s G6 Pro CGM. Now you may be wondering what is a pro (professional) CGM? Isn’t all CGMs the same? Professional CGM is placed on a person with diabetes by a healthcare professional in office or clinic setting. CGM is worn for typically 7 – 14 days followed by download in your healthcare provider’s office. CGM download provides lots of useful information in terms of a person’s time in range (amount of time a person’s blood sugar is in 70 – 180 mg/dL range), above range (> 180 mg/dL) and below range (<70 mg/dL). This vital insight can be provide feedback to both person with diabetes and healthcare professional to guide the overall treatment plan, and learn what is working and not working. Like all numbers in diabetes, please remember these numbers do not judge rather they simply provide feedback.

To learn more about this exciting approval, Dexcom G6 Pro, please click below. Lastly, you do not have to be on insulin therapy to qualify professional CGM.

https://dexcom.gcs-web.com/news-releases/news-release-details/dexcom-announces-fda-clearance-new-dexcom-g6-pro-cgm?utm_source=Closer+Look+Subscribers+2018&utm_campaign=abec556ffd-2019-10-07_CL_10%2F7_%28HTML_LINKS%2910_06_2019&utm_medium=email&utm_term=0_c55d924bf1-abec556ffd-412262441

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#Dexcom #G6 #pro #FDA #approval

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Saturday’s Daily Piece: Insulin Pricing Federal Legislation, Insulin Price Reduction Act

Currently, both U.S. House and Senate have legislative bills, Insulin Price Reduction Act, addressing insulin pricing head on, and it is a bipartisan bill in both the House and Senate.

Most recently, Insulin Price Reduction Act, was introduced into U.S. House of Representatives by Representatives Diana DeGette (CO) and Tom Reed (NY). The key points are listed below.

-Reduce the list price of most insulin products by more than 75%.

-Require Medicare and all private insurers to cover insulin with no deductibles.

-Protect pharmaceutical companies who reduce their prices from pressure of having to offer additional rebates.

-Prohibit insurers from refusing to cover any insulin product that’s been priced at, or below, its 2006 list price.

For additional information, please click on the links below.

https://degette.house.gov/media-center/press-releases/degette-unveils-new-bipartisan-legislation-to-cut-skyrocketing-cost-of

https://degette.house.gov/sites/degette.house.gov/files/DEGETT_043_xml.pdf

In the U.S. Senators, Senators Tom Carper (DE), Jeanne Shaheen (NH), Susan Collins (Maine) and Kevin Kramer (ND) introduced a similar bill, Insulin Reduction Price Bill.

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#insulin #reduction #bill #bipartisan #bill #federal

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Wednesday’s Daily Piece: Novel Renal Indication for Invokana

This week, FDA has approved an additional novel indication for canagliflozin (Invokana) for persons with type 2 diabetes and diabetes related kidney disease. Specifically, canagliflozin is now indicated to reduce worsening kidney function, risk of end stage renal disease, cardiovascular death and heart failure hospitalization in adults living with type 2 diabetes and kidney disease. Wow! Please click below to learn more.

https://www.medscape.com/viewarticle/919184?nlid=131848_3901&src=wnl_newsalrt_190930_MSCPEDIT&uac=293412PG&impID=2113721&faf=1

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#canagliflozin #novel #kidney #indication

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Wednesday’s Daily Piece: Novel Agent, Imeglimin, for Type 2 Diabetes

Recently, findings from phase 3 trial for first in class novel drug, imeglimin, were presented were presented at EASD meeting in Spain. This drug works to improve mitochondrial function which improves insulin sensitivity and secretion, and decreasing hepatic/liver glucose production (now that it is a great triple action). Results from phase 3 trial in Japan are very positive. Imeglimin is the first in new novel “glimin” class of glucose lowering agents. Now, it is important to keep in mind the medication was studied in Japanese population so it remains to be seen its benefit in other populations. Sound interesting? Please click below to learn more.

https://www.medscape.com/viewarticle/918670

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#imeglimin #novel #drug #diabetes

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