Reece's Piece's In a Diabetes World

At ADA 2019, new recommendations for international consensus on CGM were presented (endorsed by ADA and EASD). Use of a standardized CGM report (such as ambulatory glucose profile); 14 day composite glucose profile; table with specific target range and time in range for type 1 and 2 diabetes (70 – 180 mg/dL) and special populations (pregnancy (63-140 mg/d), medically fragile (less stringent target)). Below is a link to consensus document.

https://care.diabetesjournals.org/content/early/2019/06/07/dci19-0028

Please share your thoughts and subscribe to receive my blogs.

#CGM #international #consensus

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

Recently, I was asked when is the best time of day to take metformin immediate release and extended release. Taking metformin immediate release with first and last meal of the day – 10 – 12 hours between doses is ideal. Taking metformin immediate release with food can decrease the stomach upset. Metformin extended release is best taken in the evening as it works overnight to prevent the excess release of glucose from the liver.

Please share your thoughts and subscribe to receive my blogs.

#metformin #timing #doses #diabetes

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

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.

Please share your thoughts and subscribe to receive my blogs.

#Victoza #FDA #adolescents #type2diabetes

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

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

Please share your thoughts and subscribe to receive my blogs.

#Qternmet XR #FDA #diabetes #treatment

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

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

Please share your thoughts and subscribe to receive my blogs.

#CREDENCE #ADA #updated #standards

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

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

Please share your thoughts and subscribe to receive my blogs.

#enzymes #protect #kidney

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

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

Please share your thoughts and subscribe to receive my blogs.

#declining #new #diabetes #cases

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

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.

Please share your thoughts and subscribe to receive my blogs.

#obesity #comprehensive #algorithm

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

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.

Please share your thoughts and subscribe to receive my blogs.

#Eversense #Bridge #Program

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

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.

Please share your thoughts and subscribe to receive my blogs.

#insulin #generic #Humalog

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.