Saturday, July 10, 2021 : Issue #1148

TOP STORIES - Diabetes News & Research

ADA 2021:

Summary for Classification, Prevention, and Treatment of Heart Failure in Patients with Diabetes

Effectiveness of Liraglutide and Insulin Based on GRADE Study

Economic Benefits of Initiating Empagliflozin vs. GLP-1 Receptor Agonist

Letter from the Editor

Last week, we were one of the first publications to alert you to the availability of Novo’s rapid aspart insulin under the Walmart ReliOn label. The pricing they are offering is under $86 for a box of 5 pens. This is a big saving from $240 a box at CVS or Walgreens. This points out the need for us to realize that, if the medicine costs too much for the patients, then it does not really matter how good it is.

If you are thinking about the same thing in your non-insulin dependent patients, you will want to check out this week's feature from Torré Anderson, Doctor of Pharmacy Candidate, Florida A&M University College of Pharmacy. He takes a look at which non-insulin medication delivers the best bang for the buck.

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We can make a difference!

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Dave Joffe

Editor-in-chief

Did You Know: What's Best for Diabetes After Metformin?

In looking at liraglutide, insulin, glimepiride, sitagliptin, and an SGLT2 inhibitor use after metformin has hit its max benefit, the results are in. Liraglutide and insulin glargine outperformed glimepiride and sitagliptin as single add-on agents to metformin for treating patients with type 2 diabetes in a multicenter U.S. trial that randomized just over 5000 patients. The GRADE trial ran for roughly five years at 36 U.S. centers and was designed to determine the best second-line agent for patients with type 2 diabetes already taking metformin. Results were reported at the virtual American Diabetes Association (ADA) 81st Scientific Sessions. ( See article #2. ) The comparison included two oral medications: the sulfonylurea glimepiride and dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin; and two injectable medications: insulin glargine and glucagon-like peptide 1 (GLP-1) receptor agonist liraglutide. The primary endpoint was a change in A1c level and overall glycemic control. Secondary endpoints include changes in weight and cardiovascular, renal, gastrointestinal, and other complications. During the average 5-year follow-up, the rates of patients progressing to a confirmed A1c of 7% or higher were lowest, at 67%, among patients randomized to insulin glargine, 68% for those maintained on liraglutide, 72% for patients taking the sulfonylurea glimepiride, and 77% in those taking sitagliptin.

While SGLT2 inhibitors were not included in the study, they have the potential to improve longer-term (and expensive) diabetes-related outcomes; cost barriers mean that many patients cannot afford the apparent mortality benefit associated with SGLT2 inhibitors compared with sulfonylureas. Therefore, high drug pricing must be reined in to reduce current inequities in the treatment of diabetes.

“Comparative Effectiveness of Sodium-Glucose Cotransporter 2 Inhibitors vs Sulfonylureas in Patients With Type 2 Diabetes” and “Sodium-Glucose Cotransporter 2 Inhibitors vs Sulfonylureas: The Price of Prevention.” JAMA Internal Medicine, online June 28, 2021.

Diabetes in Control gratefully acknowledges the assistance of the following pharmacy doctoral candidates in the preparation of this week’s newsletters:

Torré Anderson, II, Fourth Year Doctor of Pharmacy Candidate, Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health

Jasmine Dumontier-Hiott, PharmD Candidate 2022, University of South Florida Taneja College of Pharmacy

Macrina Ghali, PharmD Candidate 2021, Florida A&M University, College of Pharmacy and Pharmaceutical Sciences

Shalonda Kimble, PharmD Candidate, South College School of Pharmacy

Alan Martinez, PharmD Candidate, University of South Florida Taneja College of Pharmacy

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Steve and Dave
Diabetes In Control
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Saturday, July 10, 2021 : Issue #1148

TOP STORIES - Diabetes News & Research

TOP STORIES - Diabetes News and Research

Did You Know: What's Best for Diabetes After Metformin?

Diabetes in Control gratefully acknowledges the assistance of the following pharmacy doctoral candidates in the preparation of this week’s newsletters: