“Golimumab” Helps Kids and Youth Newly Diagnosed with T1D

December 3, 2020

 

It might be tricky to pronounce at first, but a human monoclonal antibody, called golimumab (gō-lim-yü-mab), can help kids and young adults with newly diagnosed type 1 diabetes, according to new research. The fact that golimumab has been approved to treat a number of autoimmune conditions in both the adult and pediatric populations, led to curiosity over whether the drug could help patients with type 1 diabetes. The small proof of concept study strongly suggests that golimumab can indeed reduce the amount of injected insulin required by children and youth with newly diagnosed type 1 diabetes by preserving their ability to produce insulin on their own, called endogenous insulin.

 

The study is the culmination of decades of work conducted at the University at Buffalo in New York State and at the Diabetes Center at UBMD Pediatrics and Children’s Hospital. The main goal of the study was to see if golimumab could preserve beta-cell function in newly diagnosed patients, which it does, for as it seems at least a year after diagnosis.

 

Beta cells are unique cells in the pancreas that produce and secrete hormones directly into the bloodstream to regulate levels of glucose. When blood glucose levels start to rise (e.g., during digestion), beta cells quickly respond by secreting some of their stored insulin. This quick response to a spike in blood glucose usually takes about ten minutes. In people with diabetes, however, these cells are either attacked and destroyed by the immune system or are unable to produce enough insulin needed for blood sugar control.

 

In addition to insulin, beta cells also secrete the hormone Amylin and so called C-peptide, a byproduct of insulin production. Amylin slows the rate of glucose entering the bloodstream, making it a more short-term regulator of blood glucose levels. C-peptide is a molecule that helps to prevent neuropathy and other vascular complications by assisting in the repair of the muscular layers of the arteries.

 

The most important finding in the recent study is that golimumab is a potential disease-modifying agent for newly diagnosed type 1 diabetes. The team determined that beta-cell function was preserved based on the amount of C-peptide in patients’ blood during a four-hour mixed meal tolerance test. Because C-peptide reflects only insulin made by the body and not injected insulin, C-peptide levels reveal how well the pancreas is producing insulin.

 

The findings represent a major step forward in the effort to find ways to preserve the insulin-making capabilities of children and young adults with type 1 diabetes. Patients newly diagnosed with type 1 diabetes don’t stop making insulin all of a sudden. During the period just after diagnosis, called partial remission or the honeymoon period, patients are still able to make some insulin on their own. That is the period the scientists targeted with this study of golimumab.

 

Although none of the patients were able to stop taking insulin entirely, the results have important clinical implications. The need for less injected insulin is a major quality of life improvement and carries advantages, including lower rates of hypoglycemia. The scientists believe that the golimumab results represent another tangible step towards achieving the ultimate goal of developing therapies that will one day prevent and reverse type 1 diabetes. “People want a cure, but the fact is, a cure is not available yet. But this is an intermediate step towards a cure” according to one of the lead authors.

 

Based on these promising results, the research team have planned future studies seeking to determine if golimumab can be given even earlier in the disease process to more effectively prevent or delay type 1 diabetes in high risk patients. So, stay tuned for some more exciting news to come.

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New Diabetes Risk Factors Identified – Add Insomnia!

September 23, 2020

 

A new report indicates that insomnia is a novel risk factor for developing type 2 diabetes. The Sweden-based study that appears in the journal Diabetologia identified 19 risk factors for type 2 diabetes. It further evaluated 21 risk factors that had scarce evidence, and another 15 that reduced the risk of the condition.

 

Researchers have long identified factors that increase the risk of developing type 2 diabetes. These factors include family history, weight, fat distribution, inactivity, age and even race. Other suggestive risk factors that have been mentioned but may need to be further studied include alcohol consumption, skipping breakfast, daytime napping, anxiety disorders, urinary sodium, certain amino acids and inflammatory factors, and lack of sleep.

 

Obesity is still the predominant risk factor for type 2 diabetes. But insomnia was the headline maker in the Swedish study — people living with the condition are 17% more likely to develop type 2 diabetes than those without it. Insomnia was also seen as an element in the association between depression and type 2 diabetes.

 

The team used a method called ‘Mendelian randomization’ (MR) to obtain their findings. This technique blends genetic information and conventional epidemiological methods. It also addresses questions related to causality without biases, that could compromise the validity of epidemiological approaches.

 

The Swedish researchers used data from the Diabetes Genetics Replication and Meta-analysis consortium. They evaluated 74,124 cases of type 2 diabetes and 824,006 control participants with European ancestry for the study population. The participants’ mean age was around 55 years, and 51.8% of them were male. The researchers also screened 238 studies before including 40 individual papers in their investigation. Among the 97 factors they looked at, only 19 increased diabetes risk.

 

Daytime napping also appeared to be a risk factor for type 2 diabetes. However, because it’s strongly related to insomnia, it’s unclear whether daytime napping is an independent risk factor.

 

Other risk factors found include:

 

  • depression
  • smoking
  • high blood pressure
  • caffeine consumption

 

The exposures associated with a decreased risk of type 2 diabetes include:

 

  • the amino acid, alanine
  • high-density lipoproteins, or good cholesterol
  • total cholesterol
  • the age when females start menstruating
  • testosterone levels

 

These findings should inform public health policies for the primary prevention of type 2 diabetes. These measures could include lowering obesity and smoking rates and improving mental health, sleep quality, educational level and birth weight.

 

More work is needed in this field, especially in less homogenous populations than Sweden’s, and since major risk factors for type 2 diabetes differ by ancestry. Studies have also found that the chance of developing diabetes is significantly higher for Black people — around 66 more cases of diabetes per 1,000 people — compared with white adults.

 

Ballooning diabetes numbers around the world scream for more testing. According to the International Diabetes Foundation (IDF), 79% of adults with diabetes live in low- and middle-income countries. In Southeast Asia, for example, the IDF says some 88 million adults live with diabetes, with over half undiagnosed.  By 2045, the global diabetic population is expected to exceed 150 million.

 

South and Central America are the two regions presenting an increased mortality trend with relation to diabetes.  The IDF estimated the average prevalence of diabetes there at 8.0%; this is expected to rise to 9.8% by 2045. This underscores the importance of analyzing all the risk factors influencing the disease and putting preventative measures in place.

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Stress and Diabetes – It’s a Catch-22

September 2, 2020

 

Everyone experiences stress at some point in their lives that can result in worry, anxiety, and tension. Stress affects everyone to some degree, but it may be more difficult to manage when people learn that they have diabetes. Diabetes is a relentless disease that requires constant attention, awareness, and decision-making. Diabetes self-management can therefore be demanding, complex and stressful. In fact, it´s a wrenching dilemma as diabetes gets you stressed out and the stress worsens your diabetes.

 

Stress can make it more difficult to control your diabetes as it may throw off your daily routine and can result in wear and tear on your body. When a person experiences stress, the body reacts by releasing adrenaline and cortisol into the bloodstream and the respiratory rates increase. The body directs blood to the muscles and limbs, allowing you to fight the situation. When you have diabetes, your body may not be able to process the glucose released by your firing nerve cells. If you can’t convert the glucose into energy, it builds up in the bloodstream, causing the blood glucose levels to rise.

 

A new study at the (US) Ohio State University Wexner Medical Center/Ohio State University College of Medicine documents a clear link between the stress hormone cortisol and higher blood sugar levels in people with type 2 diabetes. In healthy people, cortisol fluctuates naturally throughout the day, spiking in the morning and falling at night. But in participants with type 2 diabetes, cortisol profiles that were flatter throughout the day were shown to have higher glucose levels.

 

Previous research had shown that stress and depression are two of the major causes of a flatter cortisol profile. These sustained levels of cortisol make it much more difficult to control blood sugar and manage the disease, which is why it is so important for those with type 2 diabetes to find ways to reduce stress.

 

While the relationship between short-term stress and diabetes can cause temporary blood sugar increases, long-term stresses may expose a person to multiple on-going problems with diabetes. Stress relief is therefore a crucial and often overlooked component of diabetes management. Whether it’s a yoga class, taking a walk, or reading a book, finding ways to lower your stress levels is important to everyone’s overall health, especially for those with type 2 diabetes.

 

There are many other things you can do to reduce stress. Make sure you take your medications as directed and eat healthy meals. Use relaxation techniques such as deep breathing and meditation. Innovative resources such as Calm, Myspace and FlowVR provide super platforms for guided meditation. Plenty of exercise, in the form of activities that you enjoy, can also effectively reduce stress. It’s also important to share what you are going through with friends and family as talking to someone you trust can help to relieve your stress and perhaps solve those problems. Join a support group, where you may meet people with problems similar to yours and consider seeking out professional help in order to talk about what’s troubling you.

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Diabetes and Your Sex Life – Lots to Embrace

August 25, 2020

 

Diabetes can have a profound impact on the sex life of people living with diabetes, particularly since it affects the nerves in the form of neuropathy and can lead to a loss of sensation in the penis, clitoris and vagina.

 

Until recently, erectile dysfunction was one of the most neglected complications of diabetes. Erectile dysfunction is common in men who have diabetes, especially those with type 2 diabetes. It is estimated that up to 75% will experience some degree of erectile dysfunction over the course of their lifetime and it seems to occur earlier in men with diabetes than in men without the disease.

 

Erectile dysfunction is the inability to get or maintain an erection firm enough for sex. In order to obtain an erection, men need to have healthy blood vessels, nerves, male hormones and a desire to have sex. Causes of erectile dysfunction are complex and based around changes that occur to the body over time, affecting nerve, muscle, and blood vessel functions, often due to poor long-term blood sugar control. Erectile dysfunction can also be linked to other conditions common in men with diabetes, such as high blood pressure and heart disease.

 

Luckily, awareness of this significant and common complication of diabetes has increased in recent years, mainly due to better understanding of male sexual function and the rapidly expanding array of novel treatments.

 

Having erectile dysfunction can be a challenge and many men hesitate to discuss it with their doctors. But seeking advice can make a big difference. A healthcare provider will consider underlying causes of the dysfunction and provide advice about oral medicine, such as Viagra, Cialis and Levitra, and other treatments, including intracavernous injection therapy, vacuum constriction devices, intraurethral therapy and sex therapy. Recent preclinical and clinical trials have demonstrated that gene therapy strategies may also be feasible as the penis is a convenient tissue target for gene therapy with its external location and accessibility, the ubiquity of endothelial-lined spaces, and low level of blood flow, especially in the flaccid state. Good lifestyle choices can also have a profound impact. Losing excess weight, stopping smoking, limiting alcohol use and increasing physical activity are all important factors to prevent erectile dysfunction.

 

But it´s not only about the men. Diabetes and female sexual dysfunction tend to get less coverage than male sexual dysfunction but studies have found that the prevalence in women could be as much an issue as for men. Indeed, nerve damage can reduce sensitivity and vascular damage can affect blood supply to the vagina and clitoris, which can cause problems with dryness and arousal.

 

Sexual problems are an under-recognized, under-discussed, and commonly untreated complication of diabetes. They´re also one of the most treatable diabetic complications. Knowledge of sexual dysfunction is rapidly expanding, and effective new treatments are available or being introduced. It is therefore important for both people living with diabetes and healthcare professionals to be well informed and aware of the causes and treatments of sexual dysfunction due to diabetes.

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Glucose Monitors – “I Have Got You Under My skin”

August 6, 2020

 

Monitoring glucose levels is an integral part of successful diabetes management. The traditional way is capillary glucose sampling by finger prick – known as self-monitored blood glucose (SMBG). In recent years, less invasive continuous glucose monitoring (CGM) devices have been introduced, which have made a significant impact on how we manage and monitor blood sugar levels.

 

CGMs are placed on the body, often on the arm or abdomen, where the sensors measure the glucose in the interstitial fluid – the fluid in and around your body’s cells. CGMs provide real-time blood sugar readings 24 hours a day and can be used whether you wear a pump or use injections for your insulin delivery. Most CGMs report blood sugar levels every five minutes, for a total of 288 glucose readings per day, as well as blood sugar trends (up, down or stable) and a blood sugar curve covering the past hours.

 

CGMs allow people living with type 1 or type 2 diabetes to closely track blood glucose levels and trends. CGMs can help people with diabetes make informed decisions about food choices, exercise, and other aspects of diabetes management by alleviating much of the guesswork about daily patterns and fluctuations.

 

A key benefit of CGMs is the ease with which they allow people living with diabetes to access information about their blood glucose levels. It helps to detect blood glucose trends, eliminates the need for numerous finger pricks, which may be painful and difficult to manage frequently, and alerts users when glucose levels are too low or too high.

 

Despite the positives, the use of CGMs has some reported drawbacks. The main complaints include users reporting various glitches and frustrations arising from using CGM, including difficulty inserting and/or removing the device, finding a comfortable and discrete place for it on the body, occasional loss of signal and the cost of buying and operating the device. There´s also the need to calibrate the device at regular intervals, since although the CGMs deliver glucose readings automatically at short intervals, twice-daily finger pricks are needed to ensure accuracy.

 

There are two main types of CGMs. The so called “Flash” displays current blood sugar levels as well as values from the past eight hours every time the sensor is scanned. The other type connects the sensor to a receiver, a smart phone or a smart watch that displays real-time blood sugar levels. Here you can find an overview of some of the CGMs currently on the market.

 

The world of diabetes devices is evolving at a fast pace, and CGMs are at the heart of that evolution. A Belgian-based startup called Indigo Diabetes is creating a continuous glucose monitoring sensor that is designed to go under the skin to monitor a patient’s glucose levels. The nano-sensors are expected to last for up to two years and will measure ketones as well as glucose. Unlike the CGMs on the market today, the sensor will be invisible. When linked to an insulin pump, people living with diabetes would no longer have to intervene or adjust anything at all. The aim is to make finger pricking and visible patches on the skin for glucose monitoring things of the past.

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Can a Limp-Fish Handshake Signal Diabetes?

July 27, 2020

 

The onset of type 2 diabetes can be gradual and symptoms can be mild during the early stages. As a result, many people may not realize that they have diabetes. In fact, the International Diabetes Federation estimates that some 230 million people around the world are unaware of their condition. Early detection is of crucial importance, since prolonged undiagnosed diabetes can have negative effects, such as a higher risk of diabetes-related complications. Innovative screening tools are vital to prevent vascular complications associated with type 2 diabetes, as low muscular strength is linked to increased diabetes risk.

 

Research has shown that a reduction in the strength of person’s grip can be an important diagnostic clue for diabetes in adults who appear healthy otherwise. Recently, scientists have even identified specific cut points for the grip strength that indicate type 2 diabetes, making it possible for doctors to perform quick, easy testing for diabetes.

 

The scientists arrived at these cut points by analyzing data that came from grip strength tests of 5,108 individuals using inexpensive handgrip dynamometer devices. A dynamometer captures the combined grip strength of an individual’s left and right hands as a kilogram value. Dividing this number by the person’s weight in kilograms gives the person’s normalized grip strength.

 

The April 2020 US study’s cut points take into account age, gender, and body weight, which allows healthcare providers to determine quickly and inexpensively each individual’s risk of type 2 diabetes — including that of apparently healthy adults — and the need for further, more in-depth testing.

 

Identification of the relevant tools for public health and clinical screening of type 2 diabetes that may prompt diagnostic tests has long been a high priority. Loss of muscle strength in people with type 2 diabetes is evident in those newly diagnosed and is accelerated in those with higher blood sugar levels values or longer duration of diabetes.

 

Using the handgrip test for detecting risk of type 2 diabetes in adults is a novel and promising method. It can be easily implemented both in clinical and community settings as the handgrip dynamometers are portable, cost-effective, and only require minimal training. This approach could enhance early detection of type 2 diabetes and prevent further muscular impairment by prompting prevention and timely treatment interventions.

 

And there’s a positive twist. Research also shows that building muscle strength may lower the risk for type 2 diabetes by 32 percent. This is encouraging as even small amounts of resistance training may be helpful in preventing type 2 diabetes by improving muscle strength. The proper dose of resistance exercise may vary for different health outcomes and populations. It does not need to be complicated as it’s possible to get a good resistance workout with squats, planks or lunges and then consider adding free weights or weight machines.

 

So, let’s get going – pump some iron and firm up your handshake!

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Diabetes and Bones – A Risky Business!

July 15, 2020

 

It´s estimated that worldwide an osteoporotic fracture occurs every 3 seconds, which amounts to almost 25 000 fractures per day or 9 million per year. Sadly, it´s quite likely to be a person living with diabetes as research shows that they are three times more likely to break a bone than persons how don’t have diabetes. Scientists have for years tried to figure out why the bones of people with both Type 1 and Type 2 diabetes are so fragile.

 

Every day physical activity causes some wear and tear on bones in the form of micro-fractures, which the body routinely repairs. The bone healing process involves breaking down the minerals and proteins in worn-out regions and replacing them with healthy new proteins. These fresh proteins consist of amino acids, which naturally react with sugars in the body. The chemical reaction between amino acids and sugar inside the body has been compared to the gradually browning of a sliced apple when exposed to air. This process, which is called non-enzymatic glycation, occurs in tissues throughout the body, including in bone.

 

Just like the apple, non-enzymatic glycation has a browning effect on proteins, creating tiny chemical bridges called crosslinks. We all develop crosslinks because everyone has some sugar in their bodies. Even though they are naturally formed, non-enzymatic crosslinks are not good for us. They are harmful because they stiffen the proteins to which they are attached, thus preventing them from flexing when subjected to simple daily activities such as walking. As bones need a bit of flexibility to prevent micro-fractures from forming, non-enzymatic crosslinks weaken bones by making them more brittle.

 

Usually, the body easily manages crosslinks by breaking them down and getting rid of them. But in the bones of people with diabetes, it is a different story. Research has identified two factors. First, as sugar is the fuel for the chemical reaction that forms crosslinks, it’s likely that there are more crosslinks inside the bones of people with diabetes who normally have high blood sugar levels. Scientists believe that the accumulation of these crosslinks may be one reason that people with diabetes have more fragile bones. Second, people with diabetes have a low level of bone remodeling, which means their ability to clean out crosslinks is reduced. This can further contribute to the already high number of crosslinks in their bones.

 

Crosslinks have been studied in other organs. In people with diabetes, they have been found to contribute to complications such as vascular damagekidney damage, and diabetic retinopathy – all well known diabetic complications. The damage that diabetes can do to bones is a complication that is often overlooked. The classical diagnosis of osteoporosis by dual-energy X-ray absorptiometry and the fracture risk estimation by FRAX, the fracture risk assessment tool, are only partially useful in assessing fracture risk. Therefore, some experts recommend that when a person living with diabetes begins to show signs other complications, it should ring a bell for bone problems as well. So, for example when diabetic retinopathy is detected during routine screening, it could be an indication that screening for bone disease would be prudent.

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Lower Insulin Prices for Medicare Beneficiaries in 2021

July 7, 2020

 

This is a guest blog by Danielle K. Roberts, Medicare Expert

 

According to the American Diabetes Association (ADA), there are 7.4 million Americans that use at least one form of insulin to treat diabetes. Out of those 7.4 million, 3.3 million are Medicare beneficiaries. With diabetes being the seventh leading cause of death in America, the access to affordable insulin is still few and far between for many diabetic patients.

 

Insulin is an essential item to keep diabetics healthy and alive. The cost of insulin has more than doubled since the early 2000s for Medicare beneficiaries. With that said, this has led seniors to ration or not receive insulin at all. In 2020, one vial of insulin can cost upwards of $500 and some people need more than one vial a month. Many senior citizens live on a fixed income, making it more challenging to budget month-to-month solely for insulin.

 

The shocking increase of insulin prices has not gone unnoticed, and you will begin to see changes in 2021. The White House has announced that the Part D Senior Savings Model will be available for the upcoming Annual Election Period and will lower insulin prices for Medicare beneficiaries in 2021.

 

Part D Senior Savings Model

 

The Part D Senior Savings Model is predicted to save Medicare beneficiaries 66 percent in out-of-pocket spending for insulin. The substantial annual savings will be due to the maximum copay of $35 for a 30-day supply of insulin. This Model will be a new, voluntary option that Part D and Medicare Advantage plans can opt-in.

 

According to Centers for Medicare & Medicaid Services (CMS), over 1,750 Medicare Part D and Medicare Advantage plans have already requested to participate in the Model for the upcoming year. Predictable copays is the overall goal of the Model and are now encouraged by the CMS.

 

The Model is anticipated to be available in all 50 states, including Puerto Rico and the District of Columbia. President Trump has created a partnership with pharmaceutical manufacturers and will deliver these lowered insulin prices to America’s senior citizens.

 

Part D requirements

 

For a Part D sponsor or a health insurer to participate in the Model, there are specific requirements they must meet and uphold. All participants must cover both pen and vial dosage forms for the different types of insulin on the drug formulary. Drug manufacturers must also include all their insulin products to the Model participants with no exclusions.

 

The copay for a 30-day supply for insulin will cap at $35, and a Model participant cannot increase this number. However, Part D sponsors and health insurers are competitive. Therefore, it is likely that you will find a copay lower than $35 and may find higher quality of insulin with certain carriers for a lowered price. You will discover this when you begin researching the enhanced Part D plans.

 

Enrolling in an enhanced Part D plan

 

In September 2020, CMS will release the enhanced Part D premiums and copays for Medicare beneficiaries. Around this time, you will also be receiving your Annual Notice of Change. When you receive this letter, you will want to read through it thoroughly, so you can make an informed decision on if switching plans should be your next step.

 

The Annual Election Period will be the time for you to drop, change, or enroll in a Medicare Advantage or Part D plan. The AEP timeframe begins on October 15, 2020, and will end on December 7, 2020. Medicare.gov has a Medicare Plan Finder tool that is user-friendly. This tool will filter out the non-participating plans in the Model and display the premiums and copays for the enhanced Part D plans.

 

The Part D Senior Savings Model is long overdue but will create a positive impact on Medicare beneficiaries with diabetes. CMS Administrator, Seema Verma, has mentioned that if the Model is successful, they hope to expand the Model to counter other drugs.

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The Many Faces of Diabetes

July 6, 2020

 

Millions around the world live with diabetes or know someone living with the metabolic disease. Diabetes causes blood glucose (sugar) levels to rise above normal. This is also called hyperglycemia. When glucose builds up in the blood instead of going into cells, it can cause two problems: Right away, your cells may be starved for energy and over time, high blood glucose levels may damage your eyes, kidneys, nerves or heart.

 

Since 1965 the World Health Organization has periodically updated and published guidance on how to classify diabetes mellitus, the last one published in 2019. According to the current classification there are two major types: Type 1 diabetes and Type 2 diabetes. But recent developments in molecular genetics have allowed clinicians to identify growing numbers of subtypes of diabetes, sometimes with important implications for choice of treatment.

 

Type 2 diabetes is the most common form of the condition. If you have Type 2 diabetes, your body doesn´t use insulin properly. This is called insulin resistance. At first, your pancreas makes extra insulin to make up for it. But, over time, it can´t make enough insulin to keep your blood glucose at normal levels. Type 2 diabetes is treated with lifestyle changes, oral medications, and insulin. Some people with Type 2 can control their blood glucose with healthy eating and being active. But your doctor may need to prescribe oral medications or insulin to help you meet target blood glucose levels. Type 2 usually gets worse over time, even if you don´t need medications at first, you may need them later.

 

Contrary to popular belief, Type 1 diabetes is not a childhood disease but occurs at every age, in people of every race, shape and size. More adults than children have Type 1 diabetes, despite its previous label – ´juvenile diabetes´. In Type 1 diabetes, the body doesn´t produce insulin, a hormone that the body needs to get glucose from the bloodstream into body cells. With the help of insulin therapy and other treatments, even young children can learn to manage their condition and live long, healthy lives.

 

 

As we covered in a previous blog, Type 1.5 diabetes is an unofficial term for Latent Autoimmune Diabetes in Adults (LADA), which is a slow-progressing form of autoimmune diabetes. Like the autoimmune disease Type 1 diabetes, it occurs as the pancreas stops insulin production but unlike Type 1 diabetes, people with Type 1.5 often do not need insulin for several months up to years after they are diagnosed. Around 15-20% of people diagnosed with Type 2 diabetes may actually have Type 1.5 diabetes.

 

Pregnant women who have never had diabetes but who have high blood glucose levels during pregnancy, are said to have gestational diabetes. We don´t yet know what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother´s insulin in her body. This “insulin resistance” makes it hard for the mother´s body to make and use all the insulin it needs for pregnancy, up to three times the normal amount. Without enough insulin, glucose cannot leave the blood to be changed to energy and builds up in the blood to high levels.

 

Other types of diabetes mentioned in the WHO guidance are for example a slowly evolving form of immune-mediated diabetes; a ketosis-prone form of diabetes; monogenic diabetes; diabetes of the exocrine pancreas; drug or chemical-induced diabetes; and infection-related diabetes like we recently covered in our blog ´Can COVID-19 Cause Diabetes?´. For more examples and further details, read the entire report here.

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Skyrocketing Insulin Prices Challenge Diabetes Management

June 10, 2020

The World Health Organization (WHO) lists insulin as one of the world’s essential medicines. For people with type 1 diabetes it is necessary to take insulin as without insulin, sugar in the blood accumulates, which can lead to acute complications such as diabetic retinopathy, one of the leading causes of blindness and, in the worst case, death. However, according to a 2017 study led by Health Action International, half of the estimated 100 million people who need insulin globally do not have reliable access, meaning either they can’t afford insulin or it’s not available. Costs for insulin have risen so much in recent years that almost half of people with type 1 diabetes have temporarily skipped taking their insulin, according to a survey from 2018.

 

 

Rising insulin prices are in some cases forcing people living with diabetes to choose between purchasing their medications or paying for other necessities, thereby exposing them to serious short- and long-term health consequences.  In the United States (US), the skyrocketing cost of insulin has become a serious challenge. In the last decade, the US list prices of common types of insulin have roughly tripled, according to one study.

 

T1International, an advocacy group, found that more than a quarter of people with type 1 diabetes in the US rationed their insulin last year, the highest percentage of insulin rationing of any high-income country surveyed. Some 24% asked their doctor for a lower-cost medication, according to the Centers for Disease Control and Prevention. News of Americans traveling to Canada to buy insulin for a fraction of its cost at home are spreading.

 

In many European countries, laws require public healthcare plans to cap out-of-pocket health care costs, and to cover all medically necessary treatment, including insulin. This means that when people with type 1 diabetes hit the limit, the plan pays the rest. In Germany and the United Kingdom, governments actively negotiate prescription drug prices, which is believed to have helped drive down the price of insulin and holding consumer costs in check.

 

Globally, limited market competition keeps the prices high, according to Médecins Sans Frontières, which has been campaigning to improve access to the treatment. “You have the three big pharmaceutical companies that dominate the global insulin market, which is unprecedented when you look at how medicine markets work around the world,” says Christa Cepuch, a regional pharmacist for MSF.

 

The WHO is also working to address this problem. Last year, it launched a pilot program to boost the availability of insulin worldwide. The idea is to work with insulin manufacturers to increase global supply and potentially drive down the price of the treatment. This developing world program centers on a process called “prequalification,” which the WHO developed in 2001. Seven pharmaceutical companies have already shown interest in participating in the pilot program.

In December 2019, the US FDA announced that the agency would reclassify insulin as a “biological product” by 2020, in what the FDA commissioner called a “watershed moment for insulin”. These so-called biologics will then have an easier pathway to approval than before, promoting the development of “products that are biosimilar to, or interchangeable with” existing insulin. More recently it was announced that a new Medicare prescription plan would cap insulin cost at $35 a month starting in 2021 for older adults.

 

All these efforts to make insulin more widely available and affordable will hopefully result in more people living with type 1 diabetes around the world getting the medication they need to survive.

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