Thursday’s Daily Piece: Out of Pocket Costs for Diabetes Beyond Insulin

For persons living with diabetes, they know first hand that diabetes is expensive. Much talk and advocacy efforts around the cost of insulin driving up the overall cost of insulin is happening. Recent research letters in JAMA Internal Medicine took a deep dive into the out of pocket costs for insulin. The findings revealed out of pocket costs are high for supplies including insulin pump supplies, glucose meters and continuous glucose monitors. We must look beyond insulin alone when considering the out of pocket costs for diabetes. For more details, please click on link below.

https://www.medscape.com/viewarticle/931631

Out-of-pocket costs | Wellmark
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#costs #supplies #diabetes

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Tuesday’s Piece: FDA Recalls Certain Versions of Extended Release Metformin Due to NDMA Levels

Due to the increased levels of N-nitrosodimethylamine (NDMA) found in extended release metformin, FDA recommends a voluntary recall of certain extended release versions of metformin. NDMA exposure at higher levels for long periods of time is associated with potential for causing cancer. Please click below for additional details.

https://www.medscape.com/viewarticle/931361?nlid=135750_3901&src=wnl_newsalrt_200529_MSCPEDIT&uac=293412PG&impID=2399725&faf=1

Online pharmacy finds high levels of NDMA in metformin
FDA releases updated COVID-19 food safety guidelines | New Hope ...

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#metformin #FDA #recall

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Thursday’s Piece: Insulin Copays Capped at $35/Month for Most Medicare Beneficiaries

In the upcoming Medicare enrollment beginning October 15, monthly insulin copays will be capped at $35 per month for more than 1,750 Medicare Part D plans and Medicare Advantage plans in 50 states, Washington, D.C. and Puerto Rico. Currently, monthly insulin copays are $50 – $150 for many Part D plans so this is a potential savings of $446 per year. Please make sure to check Part D or Medicare Advantage Plans that you consider this fall to see if this new reduced insulin copay is included. For more information, please click below.

https://www.medpagetoday.com/primarycare/diabetes/86706?xid=nl_mpt_DHE_2020-05-28&eun=g1137305d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202020-05-28&utm_term=NL_Daily_DHE_dual-gmail-definition

Tuesday’s Piece: Summertime: Diabetes Medications with Higher Risk for Hypoglycemia

We are at the end of May and summertime activities have begun. Swimming and lots of fun outdoor activities (with social distancing of course) means many of us are now more active. If you are taking a diabetes medications with higher risk for causing hypoglycemia (low blood glucose), increased activity could mean increased risk for hypoglycemia. So what diabetes medications have a higher risk for causing hypoglycemia?

-Sulfonylureas (glipizide, glyburide, glimepiride)

-Insulin

While these particular classes of diabetes medications have a higher risk, other classes of diabetes medications could potentially cause hypoglycemia if a person goes long periods without eating or significantly increases their activity level without potentially adding a small snack. So what step can be taken to decrease risk of hypoglycemia if you find yourself significantly more active in the summer?

-Check your blood sugar before engaging activities such as hiking, swimming, long walks, running

-Incorporate protein into your meals and snacks as this will help stabilize your glucose

-Pack 15 gram carbohydrate with protein snack (i.e. apple and almonds; peanut butter crackers) in your bag

-Watch for patterns in your glucose for specific days or activities that consistently cause hypoglycemia (I highly encourage to see if a flash or continuous glucose monitor is option)

-Discuss with your provider potential decrease in medication dose if you see a pattern of hypoglycemia

Low Blood Sugar (hypoglycemia)|Columbus Regional Health
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#hypoglycemia #summertime #medications

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Saturday’s Piece: Don’t Forget to Remove Second Cap on Insulin Pen Needle

Recently, when working with a person with diabetes taking insulin, he and I discovered that the reason his glucose was not lowering with insulin therapy is he removed the first but not the second cap on the insulin pen needle. You might be tempted to think, “really, are you serious?” Yes, I am serious. The underlying reason for this happening is he was not taught how to use the insulin pen when he first began taking insulin. I reassured him that he was not the first nor the last for this happen, and to not feel bad as he simply did not know. Guidance on how to use insulin pens is key prior to the first dose.

Pen Needles | Alpine Health
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#guidance #education #insulin #pens

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Saturday’s Daily Piece: Cardiovascular Benefit with Liraglutide Likely Mediated by A1c

Liraglutide (Victoza), GLP-1 receptor agonist, is known for its ability to lower cardiovascular risk in persons with type 2 diabetes who have blood glucose values consistently above target range and who at high risk for a cardiovascular event (i.e. heart attack). What exactly mediates this benefit? Buse and colleagues uncovered that this benefit most likely is mediated by hemoglobin A1c. Please click below for additional details on this exploratory analysis.

https://www.healio.com/endocrinology/diabetes/news/online/%7B09ebef6b-62b1-42d0-bbf0-3c2ed5e6b68c%7D/hba1c-likely-mediates-liraglutides-cv-benefit?M_BT=4557970002905

When Changing from Daily to Weekly GLP-1, Make Sure Patient is Clear
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#A1c #liraglutide #CV #benefit

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Thursday’s Daily Piece: Greater Benefits with Higher Doses of Dulaglutide

A recent study (AWARD 11) by Dr. Frias in adults with type 2 diabetes currently on metformin without achieving target glucose goals were assigned to dulaglutide 1.5 mg, dulaglutide 3 mg and dulaglutide 4.5 mg. A stepwise dose escalation every 4 weeks to doses of dulaglutide 1.5 mg, 3 mg or 4.5 mg was completed. Dulaglutide 3 mg and 4.5 mg produced greater improvements in glycemia and body weight reduction however only dulaglutide 4.5 mg was superior to dulaglutide 1.5 mg. The results are promising for higher doses of dulaglutide however time will tell whether FDA approves these higher doses. Please click on link below for additional details.

https://www.healio.com/endocrinology/diabetes/news/online/%7B52416ea4-897f-46b7-9c8c-982afa65b7d7%7D/higher-dose-dulaglutide-reduces-hba1c-body-weight-in-type-2-diabetes?M_BT=4557970002905&page=2

Trulicity (dulaglutide) for the Treatment of Type 2 Diabetes ...
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#dulaglutide #AWARD11 #diabetes #medication

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Saturday’s Daily Piece: JDRF and Beyond Type 1 Alliance Addresses Coronavirus + Diabetes

If you are a person with type 1, caregiver or healthcare professional working with persons with type 1 diabetes, you know the amazing value that both JDRF and Beyond Type 1 provide for persons with Type 1 diabetes. These rock star organizations have joined forces in creation of an alliance to address coronavirus + diabetes. They have developed an informative website with proactive steps to minimize risk of exposure to coronavirus as well as taking care of your physical, emotional and mental health. Please click below to access this vital information. Thank you JDRF and Beyond Type 1.

JDRF - Home | Facebook
Home
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#coronavirus #diabetes #JDRF #beyondtype1 #alliance

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Wednesday’s Daily Piece: Dapagliflozin Now Has Cardiovascular Indication Beyond Diabetes

How exciting! Dapagliflozin (Farxiga) initially approved for treatment of type 2 diabetes now has an indication beyond its use in diabetes. FDA has given dapagliflozin an indication for heart failure with reduced ejection fraction (HFrEF) to reduce risk of cardiovascular death and hospitalization for heart failure. Please click below to read more details.

https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-type-heart-failure

FARXIGA® (dapagliflozin) | Type 2 Diabetes Medication for Adults
How Many Drugs has FDA Approved in its Entire History? New Paper ...
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#heart #failure #indication #Farxiga #FDA

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Thursday’s Daily Piece: Ertugliflozin’s Cardiovascular Trial Shows No Benefit

Results from VERTIS CV (Evaluation of Ertugliflozin Efficacy and Safety Cardovascular Outcomes) trial were a bit disappointing. Erugliflozin (a SGLT-2 inhibitor) did meet the its primary endpoint of noninferiority for major adverse heart (cardiovascular) events compared to placebo in persons with type 2 diabetes and established (diagnosed) heart disease (bottom line: ertugliflozin does NOT increase risk for major adverse heart events). However, it did not achieve secondary endpoints in superiority compared to placebo for composite of CV (heart related) death or hospitalization for heart failure, CV (heart related) death alone, and renal (kidney related) death (bottom line: ertugliflozin does NOT decrease risk of CV (heart related) or renal (kidney related) death in a person with diabetes and established cardiovascular (heart) conditions).

https://www.medscape.com/viewarticle/929647

Because we know diabetes does not happen in a silo and is often associated with cardiovascular (heart) and renal (kidney) conditions, the ideal is to have a diabetes medication that provides also heart and kidney related benefits. Bottom line is that ertugliflozin does NOT provide these benefits.

Dosing and Administration for STEGLATRO™ (ertugliflozin)
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#ertugliflozin #diabetes #cardiovascular

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