Insulin pumps and continuous glucose monitors (CGM) have changed the standard of care for managing Type 1 Diabetes. A closed-loop system (also described as an artificial pancreas or automated insulin delivery system) consists of a CGM, an insulin pump, and a control algorithm that automatically calculates basal insulin delivery based on real-time glucose levels. Closed-loop insulin pumps may offer an opportunity to improve glycemic management while reducing some of the associated stress. However, there are limited data evaluating the safety and efficacy of this technology in children less than 14 years old.
Guest Authors: Mary K Culp, PharmD and Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES
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Fredrick Banting, the Canadian scientist who discovered insulin in 1921 and sold the patent for just $1 to the University of Toronto and made it available to pharmaceutical companies royalty-free, would be disappointed to know that the high cost of insulin is now a major barrier to treatment. The average price of insulin has nearly tripled, from $4.34/ml in 2002 to $12.92/ml in 2013. Insulin’s high cost affects everyone: (1) uninsured patients, (2) insured patients with high co-payments and deductibles, (3) Medicare beneficiaries with coverage gaps and fixed income, and (4) everyone else paying higher premiums to offset the insurers’ expenditures. Are the newer insulins really worth the extra cost? A new study by investigators at Kaiser Permanente Northern California suggests that most patients can safely use NPH insulin instead of more expensive insulin analogs.
Download the podcast patient case: NPH vs Insulin Analogs
Guest Authors: Jaini Patel, PharmD, BCACP and Regina Arellano, PharmD, BCPS
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Patients with type 1 diabetes often have sub-optimal glycemic control. The gold standard of treatment is basal-bolus insulin or continuous subcutaneous insulin infusion via an insulin pump. However, only a third of patients with type 1 diabetes achieve the American Diabetes Association A1C goal <7%. There has been particular interest in using SGLT-2 inhibitors in patients with type 1 diabetes due to their ability to decrease body weight and blood pressure as well as improve glycemic control and perhaps cardiovascular outcomes. InTandem3 was a phase III, multicenter, randomized, double-blind, placebo-controlled trial evaluating the safety and efficacy of sotagliflozin, a novel dual SGLT 1 and 2 inhibitor, in patients with Type 1 diabetes.
Guest Author: Diana Isaacs, Pharm.D., BCPS, BD-ADM, CDE
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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.
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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
The American Diabetes Association and European Association for the Study of Diabetes (ADA/EASD) guidelines acknowledge that “CSII is a less commonly used and more costly alternative” to basal-bolus therapy in patients with T2DM. The Opt2mise was a robust study intended to clarify the role of CSII in patients with T2DM.