Episodes
Friday Oct 13, 2017
Painting a New CANVAS for SGLT-2 Inhibitors?
Friday Oct 13, 2017
Friday Oct 13, 2017
While good glycemic control has been shown to prevent microvascular complications (e.g. retinopathy, nephropathy, neuropathy), only a few anti-diabetic agents have been shown to reduce macrovascular complications (e.g. cardiovascular events. Empagliflozin, a sodium glucose transporter-2 (SGLT2) inhibitor, not only reduced the risk of CV events but also all-cause mortality in the EMPA-REG OUTCOME study. Based on this data, the SGLT2 inhibitors were given favorable second-line treatment status in the most recent AACE/ACE clinical practice guidelines. But do all SGLT2 inhibitors confer the same benefits… and risks? The Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes (CANVAS) trial assessed the cardiovascular and renal benefits from long-term canagliflozin use. The results are both reassuring and unexpected.
Guest Author: Sean Lasota, Pharm.D.
Music by Good Talk
Friday Sep 08, 2017
Testing the Limits on Blood Glucose Monitoring: Can We Safely Cut Back?
Friday Sep 08, 2017
Friday Sep 08, 2017
Is self-monitoring of blood glucose (SMBG) cost-effective? SMBG is often recommended to help guide treatment decisions. Consumer-oriented advertising often promotes frequent SMBG as means to achieve better glycemic control but current clinical practice guidelines do not provide specific recommendations regarding the frequency of blood glucose monitoring. The lack of conclusive evidence supporting the clinical benefits of routine SMBG combined with the rising costs of healthcare has led some payers to place limits on SMBG testing supplies. Is this wise policy? Or does it lead to poor health outcomes?
Guest Authors: KyAnn Wisse, PharmD, BCACP and Dawn Fuke, Pharm.D, BCPS
Music by Good Talk
Friday Apr 14, 2017
Peeling Back the Layers on Coated Aspirin
Friday Apr 14, 2017
Friday Apr 14, 2017
More than 15 million Americans have coronary heart disease and most should be taking aspirin daily. Given aspirin’s ubiquity in cardiovascular medicine and patients’ pill boxes, it is shocking that there are still so many unanswered questions about aspirin use. Which dose and dosage forms should be prescribed? How common is aspirin resistance? What is the relationship between platelet inhibition and clinical outcomes?
Guest Author: Daniela Valencia, Pharm.D.
Theme Music by Good Talk
Friday Feb 24, 2017
Friday Feb 24, 2017
Hypertension affects more than 70% of patients with type 2 diabetes mellitus and further increases the risk of cardiovascular disease in this high-risk population. While renin angiotensin system (RAS) blockers are clearly indicated in patients with heart failure, chronic kidney disease with proteinuria, and coronary artery disease (CAD), experts have come to different conclusions regarding their role as initial antihypertensive therapy for patients with diabetes.
Theme Music by Good Talk
Friday Jan 13, 2017
Is there a Role for Fixed-Ratio Injectable Combinations in Type 2 Diabetes?
Friday Jan 13, 2017
Friday Jan 13, 2017
Pharmacotherapy for diabetes management has expanded in recent years with several new drug classes. Current guidelines recommend several options for patients who have not reached their goal A1c on metformin monotherapy including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or basal insulin. However, if basal insulin is chosen as the first add-on treatment with metformin, the post-prandial blood glucose (PPG) often will remain elevated. A combination product that includes both a basal insulin plus a GLP-1 RA has the potential to addresses both fasting blood glucose and PPG … and perhaps has some other advantages over using either product alone.
Theme Music by Good Talk
Friday Nov 11, 2016
Friday Nov 11, 2016
Approximately one in three patients with diabetes in the United States have chronic kidney disease (CKD). The Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) trial, published in 2015, demonstrated a reduction in cardiovascular and all-cause mortality in patients treated with empagliflozin. More recent data from the EMPA-REG OUTCOME trial suggests that empagliflozin may also confer significant renal protection.
Thursday Sep 29, 2016
Eleven Things Every Clinician Should Know About the “Egregious Eleven”
Thursday Sep 29, 2016
Thursday Sep 29, 2016
A recent paper published in Diabetes Care proposing a new classification system for diabetes challenges our existing paradigm and has significant implications for our treatment approach for diabetes.
Friday Sep 02, 2016
Liraglutide: the new LEADER for second line therapy in diabetes management?
Friday Sep 02, 2016
Friday Sep 02, 2016
According to the current (2016) ADA guidelines, no agent is “the preferred” second line therapy after metformin monotherapy — instead the benefits, risks, cost, and convenience of each option should be considered and treatment should be individualized. The liraglutide and cardiovascular outcomes in type 2 diabetes (LEADER) trial, which assessed the long-term cardiovascular effects of liraglutide, a GLP-1 receptor agonist, comes at an interesting time shortly after the publication of the empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes (EMPA-REG OUTCOME) trial. Both studies found a cardiovascular benefit. How, then, will the results of these trials affect the algorithm for type 2 diabetes management and more importantly, clinical practice?
Friday Apr 22, 2016
Lixisenatide and Cardiovascular Outcomes: The Burden of Proof
Friday Apr 22, 2016
Friday Apr 22, 2016
After cardiovascular (CV) safety concerns emerged with rosiglitazone use, the Food and Drug Administration (FDA) now requires outcome studies to be performed for all new diabetes medications. The first CV safety study (ELIXA) for a drug in the glucagon-like peptide 1-receptor agonist (GLP-1 RA) class – lixisenatide - was published in December 2015. Lixisenatide is a once-daily injectable GLP-1 RA approved for use in Europe and awaits FDA approval in the United States.
Friday Mar 11, 2016
Reconsidering Strategies for Insulin Intensification
Friday Mar 11, 2016
Friday Mar 11, 2016
Basal, prandial, NPH, ultra-long, inhaled, 70/30, 75/25, 50/50, U-100, U-200, U-300, and U-500 insulin … the list of options for patients with diabetes requiring insulin continues to expand. Current guidelines for glycemic management of patients with type 2 diabetes provide specific recommendations for the initiation of insulin therapy, but not insulin intensification. The recently published LanScape study provides a foundation for making evidence-based clinical decisions.