Daily Piece: Cardiovascular and Renal Updates to 2019 ADA Standards

The ADA 2019 Standards of Care is now a living document, Living Standards of Care, which provides updates in real time rather than every 12 months. Sections 9 – 11 have been updated with data from Dapagliflozin (Farxiga) Effect on Cardiovascular Events -Thrombosis in Myocardial Infarction 58 (DECLARE-TIMI 58) trial. These sections now incorporate Farxiga’s benefit on heart failure hospitalizations and CDK progression, and safety in moderate renal impairment. Section 10 has been updated with findings from Reduction of Cardiovascular Events with Icosapent Ethyl (Vascepa)-Intervention Trial (REDUCE-IT). ADA recommends Vascepa for triglyceride lowering in persons with diabetes and high atherosclerotic cardiovascular disease risk. To learn more, please click on link below.

http://care.diabetesjournals.org/?utm_source=soc-032719&utm_medium=email&utm_content=diabetes-care&utm_campaign=PRO&s_src=email&s_subsrc=645245

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#ada #living #standards #farxiga #vascepa

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Daily Piece: Oral GLP-1 Agonist in Type 2 Diabetes 2

Semaglutide, an injectable glucagon-like peptide 1 (GLP-1) receptor agonist is being studied in an oral formulation for type 2 diabetes — first oral formulation of GLP-1 agonist. A series of 10 trials, PIONEER, on oral semaglutide have been conducted over last several years. Within the last week, the results of PIONEER-3 trial were presented. In this trial, 1864 adults with type 2 diabetes and A1c 7 – 10.5% (even with use of metformin with or without sulfonylurea) were randomized to three doses (3 mg, 7 mg or 14 mg) of oral semaglutide or 100 mg sitagliptin (Januvia). As expected, significantly more gastrointestinal adverse effects occurred with 14 mg oral semaglutide. A1c reduction and weight reduction were significantly greater for 7 mg and 14 mg or oral semaglutide as compared to sitagliptin. To learn more about these findings, please click below.

https://jamanetwork.com/journals/jama/fullarticle/2729339?utm_source=Closer+Look+Subscribers+2018&utm_campaign=6149eef21e-2019-03-25_%28HTML_LINKS%29_EMA_approves_Fo03_25_2019&utm_medium=email&utm_term=0_c55d924bf1-6149eef21e-412262441

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#oral #semaglutide #type2 #diabetes

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Daily Piece: New Diabetes Guidelines for Older Adults

The Endocrine Society has released new diabetes guidelines for older adults. These guidelines provide great insight into the uniqueness of providing diabetes care for this special population with a focus on shared decision making and individualized treatment goals, treatment of co-morbidities (hypertension and dyslipidemia) and impact co-morbidities such as renal impairment and heart disease have on medication selection. Lastly, emphasis on identifying and addressing prediabetes in older adults. To learn more about these new guidelines, please click below.

https://www.endocrine.org/2019diabetes

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#diabetes #guidelines #older #adults

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Daily Piece: App that Detects Diabetes

When I first read about an app that detects diabetes, I must admit that I was skeptical. The app, Azumio Instant Heart Rate, uses smartphone based photoplethysmography (PPG) to detect diabetes. The contact PPG (using fingertip scan) was used to obtain waveforms of color changes in blood vessels with heart beat to develop the screening test. Further research is being conducted to see how PPG signal detected diabetes compares with diabetes detected from blood glucose or hemoglobin A1c. The app is a screening not diagnosis tool so healthcare provider would need to confirm the findings. To learn more about this interesting app, please click below.

https://www.medscape.com/viewarticle/910476#vp_2

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#fingertip #scan #detect #diabetes

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Daily Piece: Muscle Strength Matters in Type 2 Diabetes Prevention

Type 2 diabetes can be prevented yet the journey of prevention is challenging. Making changes to our nutritional habits and physical activity are two keys for type 2 diabetes prevention. When it comes to physical activity, cardiovascular exercises such as walking, running, bike riding are often emphasized more than resistance training. Well as it turns out muscle strength should also be considered. In a prospective health outcomes study, moderate muscle strength was actually associated with 32% reduction in incidence of type 2 diabetes when compared to those with lower muscle strength. These findings sure motivate me to rise early in the morning to head to gym for my usual Wednesday morning workout which happens to include weights. To learn about about this study, please click below.

https://www.mayoclinicproceedings.org/article/S0025-6196(18)30789-4/fulltext

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#moderate #muscle #strength #type2 #diabetes

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Daily Piece: Statin Therapy and Risk of Type 2 Diabetes

Fariba Ahmadizar, PhD, of the department of epidemiology at Erasmus University Medical Centre, Rotterdam, the Netherlands, published a prospective, population based study showed risk of risk of type 2 diabetes with statin use. As it turns out in this study, the association between statin use and development of type 2 diabetes was strongest among those who were overweight or obese. So should everyone stop taking their statin? Certainly not. For those who are overweight or obese, reducing risk of type 2 diabetes through lifestyle changes and reducing insulin resistance is key. The major limitations to this study were lack of family history of type 2 diabetes, no hemoglobin A1 value or dose of statin. While this study is helpful, it certainly is limited in applying the results to general population. To learn more, please click below.

https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.13898

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#statin #type2 #diabetes

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Daily Piece: Human Insulin in Type 2 Diabetes

Let me begin by stating that I firmly believe the pricing of analog insulins must be addressed as this is vital issue affecting people living with diabetes. On to an interesting summary of a couple of studies on the use of human insulin in type 2 diabetes. A nice summary piece on a couple of recent studies published in JAMA on switching from analog to human insulin, and comparison of groups started on human versus basal analog insulin in persons with type 2 diabetes. The outcomes from these studies were positive for human insulin. To read this excellent summary, please click below.

https://www.medpagetoday.com/reading-room/endocrine-society/diabetes/78528

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#human #insulin #type2 #diabetes

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Daily Piece: Springing Forward

Time has sprung forward so don’t forget to update time on your diabetes devices. It only takes a few moments.

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#diabetes #devices # #time #spring #forward

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Daily Piece: Important Diabetes Medication Label Expansions

Dapagliflozin (Farxiga, Xigduo) has an important label update – it can now be used in setting of moderate renal impairment (eGFR 45-59 mL/min/1.73 m2). This allows dapagliflozin to be used in a greater number of patients which is especially important in light of its cardiovascular benefit. The link below further describes this label update.

https://www.businesswire.com/news/home/20190227005113/en/FDA-Approves-Expanded-FARXIGA-XIGDUO-XR-Labels

Another important label update is insulin glargine and lixisenatide injection (Soliqua 100/33) now having an indication for persons who had not achieved glycemic target on oral diabetes medication. Remember, Soliqua is a great alternative to basal bolus insulin regimen for persons with Type 2 diabetes. More details are provided in the link below.

http://www.news.sanofi.us/2019-02-27-FDA-expands-indication-for-Soliqua-R-100-33

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#FDA #label #expansion #dapagliflozin #Soliqua

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Daily Piece: Positive Outcomes from Trial Using GLP-1 Agonist and SGLT-2 Inhibitor

In practice, I often find it helpful to use glucagon-like )GLP-1) receptor agonist in combination with sodium glucose cotransporter-2 (SGLT-2) inhibitor for type 2 diabetes as they tackle type 2 diabetes from different avenues. Using these two drug classes together creates synergy. Findings from a recent study of semaglutide, GLP-1 agonist, being added to SGLT-2 inhibitor (either alone or in combination with metformin or sulfonylurea) in persons with Type 2 diabetes who have inadequately controlled glucose improved glycemic control. Greater A1c and weight reduction were positive outcomes. Please click below to read this trial summary.

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30066-X/fulltext

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#synergy #GLP1 #agonist #SGLT2 #inhibitor

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