News in the Diabetes World
The CDC has released the 2017 diabetes United States statistics report. News reports today show that diabetes affects 30.3 million people. Of those, 23.1 million have been diagnosed, and 7.2 million are still un-diagnosed. There are 84.1 million adults with pre-diabetes. Pre-diabetes can eventually turn to diabetes if not treated with weight loss, change in eating habits, and exercise. The breakdown percentages remain about 5 % for type 1 diabetes and 95% for type 2 diabetes. These numbers are staggering, and the money spent on diabetes treatment, products and research is enormous in the diabetes world.
The competition in the world of diabetes is extremely high since diabetes is big business especially in new technology. Many existing and new Pharma-companies are joining the race to offer smarter methods of medication delivery. They are also developing more efficient medications, advanced testing supplies and testing systems. There are also a variety of apps to make living with diabetes much easier with better outcomes. The list is extensive, but let’s look at some of the latest offerings in the world of diabetes:
Medicare Diabetes Prevention Program
The MDPP is the first of its kind through Medicare that offers seniors access to help them avoid type 2 diabetes. For years, seniors were not trained in diabetes management until they had an A1C of 6.5% or above which is considered type 2 diabetes. According to the American Diabetes Association, “50% of seniors enrolled in Medicare have pre-diabetes and more than 25% have type 2 diabetes”. This means all those who had pre-diabetes had no real education or guidance to stop the progression to full blown diabetes.
Starting April 1, 2018, Medicare has now developed a program to help those in the pre-diabetes state learn how to reduce the risk of developing diabetes. The intent of the program is to, “decrease health care costs in seniors, be alert to those at risk for type 2 diabetes and improve their health.” The program is based on behavioral change and is considered a federal investment in prevention research. Talk to your health care provider about this program if you are in the pre-diabetes range. Pre-diabetes is considered a 100-125mg/dl fasting blood sugar, or an A1C of 5.7%-6.4%.
Remember, if you do have diabetes and you are on Medicare or a Medicare Advantage program, you are entitled to a 12-hour diabetes self-management program.
Dexcom Continuous Glucose Monitor
Medicare agreed in January 2017, to pay for CGM for seniors who use insulin for their diabetes control. Unfortunately, Smart Phone integration is restricted at this time. You will still need to perform finger sticks along with the CGM technology, but blood glucose trends can be followed much more accurately with less problems of hypoglycemia or hyperglycemia. Many commercial insurance plans already cover CGM technology.
New Glucose Monitoring Skin Patch
The new glucose monitoring skin patch was developed in the United Kingdom, at the University of Bath. They state, “it eventually can replace finger sticks.” It is, “a graphene based adhesive skin patch” worn on the skin without a need to pierce the skin. It consists of miniature sensors, using an electric current to pull glucose out of the interstitial fluid which is found between the cells.” The glucose is measured in “tiny reservoirs” about every 15 minutes. The device is disposable and could transmit the readings to a Smart Phone App. Clinical trials are still being done.
Fitbit Ionic Watch
Most people are already familiar with Fitbit which measures an array of physical parameters and is sold in almost every big box store and online. The Fitbit Ionic was launched last month to compete with other Smartwatch companies such as Garmin and Apple. The Fitbit is the “current king of wearables” and has sold 70 million units since 2007, starting with a simple style pedometer. Fitbit has already paired up with health and wellness Apps such as My Fitness Pal.
The latest Ionic Fitbit will have the ability to display blood glucose levels as well. They partnered with Dexcom, makers of the original continuous glucose monitor or CGM, to bring the data to the watch. The kick-off date is October of 2018, and the watch should sell for around $300.00 when pre-ordered. Apple watch will probably follow suit.
Food Apps on your Smart Phone will become more popular to help people identify better food choices, especially when they have diabetes. Apps such as Fooducate, Shop well, Consumr and Food Facts are available. These Apps help you “sort through nutritional information and rate less processed foods higher than more processed foods.” Fooducate was developed by dietitians and grades each food based on nutrient density – the higher the nutrient density of the food, the better the food for you. Shop well offers suggestions of new foods to fit into your lifestyle especially when “on the go.”
Consumr lets you see customer reviews of the products you want opinions about by simply scanning the barcode. Using food Apps does not replace the need for meeting with a certified diabetes educator (CDE) or a dietitian specializing in diabetes, but they are helpful.
Eversense is a new CGM implanted under the skin, in the arm, for up to 3 months or 90 days. Made by Senseonics, it has FDA approval. The sensor, provides “real time” blood glucose information for type 1 and type 2 people with diabetes through a Smart Phone App. At present time, the results indicate a, “87-93% accuracy rate.” The sensor is paired with a transmitter applied as a patch over the sensor. Patients will still be required to self-test-2 times a day, for calibration.
Eversense alerts the patients during hypoglycemia and hyperglycemia events through the App, but the transmitter also vibrates to immediately alert the user. Eversense would be considered, “an adjunct to fingerstick glucose testing use to determine insulin dosages.” It takes only 10 minutes for the physician to place the CGM under the skin using local anesthesia. Europe has just approved a 180-day cycle of wearing the sensor which is up from 90 days in the US.
Pills for Type 1 Diabetes Management
Until now, the standard of care for type 1 diabetes was using insulin only, in many different variations. Regulators in the US and Europe are reviewing the possibility of adding “2 pills as an adjunct to people with type 1 diabetes in addition to insulin.” The pills being looked at are Farxiga (already approved for type 2) which is a SGLT-2 inhibitor. Farxiga works by pulling glucose out of the body through the urine. Another pill, which is brand new, called Sotagliflozin (no commercial name yet) a SGLT-1/SGLT2 dual inhibitor is also being studied. These pills would not replace insulin but would be used as an add-on to reduce insulin dosages. Both pills are taken once daily. Studies already done have shown, “weight loss, a slight reduction in A1C, less daily insulin injected and more time spending in the range of 70-180mg/dl blood sugars.”
WellDoc’s Wellness Digital Program
WellDoc’s new diabetes wellness 12-week digital program is available for people with type 2 diabetes on a Samsung health App. It features quizzes, videos, food ideas, blood glucose and medication log books along with immediate feedback on glucose readings. It is offered for free for a limited time and then will cost $2.99 per month or $8.97 for 12 weeks. No prescription is required. This program is well suited for those who are new to type 2 diabetes along with receiving a regular diabetes management program or for those who have “fallen off the track” of self-care or are still working to get on a good path of diabetes self-care.
Ozempic, is a new once weekly GLP-1 agonist injectable and has FDA approval for people with type 2 diabetes. It seems to have a slightly higher risk of people experiencing retinopathy (eye complications) and should be avoided by those already experiencing any eye retinopathy. Ozempic joins the other GLP-1 agonists: Tanzeum, Lyxemia, Trulicity and Bydureon. There are also a once daily GLP-1 agonist injectable called Victoza and Adlyxin. These medications, specifically for type 2 diabetes are not insulin although they are injectable. They help produce minimal weight reduction, lower insulin resistance, slow glucose absorption, reduce appetite, lower glucagon release after meals and lower 3 month-A1C levels. A pill version of Ozempic is now in clinical trials.
Improved Nutritional Counseling for Medical Students
Nutritional counseling first started at Tulane Medical School in New Orleans 6 years ago. Since then, more medical schools (including The University of Central Florida Medical School and George Washington University Medical School) are adding “hands on” nutrition courses for medical students. They are combining nutritional counseling, healthy eating and cooking to help young physicians have a growing awareness and better understanding of general nutrition. This is to help battle the current surge of obesity, heart disease, diabetes, cancer and other chronic disease conditions. They blend a chef, a dietitian and a doctor into a medical culinary course. This is to teach hands-on how to prepare a meal and expand food choices without being a dictator.
For years, medical schools offered one traditional didactic lecture nutrition course. This course covered basic nutrition, but never covered “healthy eating or well-being through food”. This new course remains an elective, so it is not mandatory. Prior students say, “it has been successful in adding knowledge to their patients as well as understanding the need to refer to a registered dietitian and use of nutritional services”.
Meal Delivery Services
Using meal delivery services is not a necessity if you can shop, plan and execute a meal, but it can be very helpful to the elderly, to young people who have limited food preparation knowledge or to people with chronic illness who do not know what or how to prepare a quality meal. A study showed, “using a meal delivery service can decrease medical spending among patients”. Medically tailored meals, “promote lower in-patient admissions and regular meal delivery services reduced the overall cost of health care”. For those who like a home cooked meal without the hassle of grocery shopping and understanding portion size, consider meal kit services delivered directly to your door.
If weight loss is needed, think about NutriSystem D or Bistro MD, especially for those with diabetes. Bistro MD is planned exclusively by dietitians and approved by physicians. Blue Apron has a service for assistance on planning a “diabetic friendly plan”. Other services for people with diabetes are Diet-to-Go which balances meals with less than 45 grams of carbohydrate and more than 15 grams of protein per meal. Diet-to-Go follows the American Diabetes Association meal guidelines. Magic Kitchen, Mom’s Meals and Martha’s Senior Gourmet are other diabetes plan examples. Make sure to monitor sodium, fat, sugar and total carbohydrates listed on the meal ingredients. Bistro MD also offers free dietitian support to every person in their program.
Fiasp is a new fast acting insulin from Novo-Nordisk. It can be taken 15 minutes prior to the meal or up to 20 minutes into the meal. Fiasp has added vitamin D3 (Niacinamide) which speeds up the insulin absorption compared to other fast acting insulins. Fiasp hits the bloodstream in 3 minutes. Fast acting insulin is taken prior to meals to prevent blood sugar spikes related to carbohydrates eaten in that meal. Fiasp is available in a 10ml vial or a flex pen. Check to see if your insurance covers this new insulin prior to starting.
Inojex offers a state of the art system that virtually alleviates the pain of injections for children and adults with diabetes. It is needle-free and uses a spring to deliver the insulin. The liquid medication enters through a tiny hole as a fine stream, directly beneath the skin, into the fat . It is FDA approved. Using Inojex can reduce “the fear of needles”. It is easy to use, compact, convenient, quick, comes with a full life-time replacement warranty. It also eliminates the risk of needle stick injuries and the ability of cross-contamination. “Inolife injectors are reusable but uses disposable ampoules and accessories”. Having a needle-free insulin delivery system may increase compliance as well as safety. It also eliminates the need for a sharps container and proper needle disposal since there are no needles.
This is just a small sampling of what is new for people with diabetes. Talk to your health care provider to see which services, systems or products may benefit you and your diabetes control. Keep learning what is available to help you live better with diabetes.
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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.