Association of Diabetes Care & Education Specialists

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What's new in diabetes?

Oct 29, 2013

Recently, there have been a few news briefs about the management of diabetes.  These summaries have been of main interest to myself and my clinical practice so I wanted to share with other members.

Medtronic Paradigm Veo System
I have been taking the AADE Insulin Pump modules to refresh and refine my knowledge with insulin pumps.  While taking this course, a recent news brief was sent through my email about Medtronic Paradigm Veo System. This device is a combination insulin pump and continuous glucose monitor.  The pump can suspend insulin delivery for two hours when the sensor detects a glucose level below a pre-specified threshold.  The device is not available in the United States, as it has not been approved by the Food and Drug Administration (FDA). 

In the Journal of the American Medical Association, this pump was indicated as a novel device that will stop the programming of insulin if a high-risk patient with type 1 diabetes has a severe hypoglycemic event.  With this device, the authors found 3.6 times less likely chance of requiring any assistance for hypoglycemia due to the glucose-suspense feature.  This safety endpoint is important since the patients did not have an overall higher hemoglobin A1c or ketotic events, compared to a standard insulin pump alone.  Therefore, it can benefit patients to have a looped insulin pump with a continuous monitoring device.

“Artificial Pancreas”
On September 28, 2013, the FDA approved the first “artificial pancreas,” which is the MiniMEd 530G with Enlite pump.  It is the first type of artificial pancreas.  This system has a threshold suspend, which will automatically stop insulin delivery if glucose levels drop below the preset threshold. The user is able to set the sensor on and off and the threshold range is 60 to 90 mg/dL.  If the delivery of insulin is suspended, the patient will not be able to administer any boluses and can resume basal insulin delivery at any time.  Another unique feature with the suspend threshold, is the pump will re-suspend insulin delivery if the glucose level is below threshold at 4 hours after resuming from a full 2-hour suspension.  This device definitely offers another options for those patients on multiple daily insulin injections and has a risk of hypoglycemia.

Lixisenatide versus Exenatide
Recently, I attended a regional AADE meeting in South Carolina and the discussion was centered around incretin mimetics and the risk of cancer.  Within the group, the certified diabetes educators discussed the role of these drugs in their practices (i.e., endocrine, primary care).  More evidence needs to be published about these agents regarding the cancer risk.  However, a new glucagon-like, peptide-1 agonist, lixisenatide, has been in development for a while.  In a recent study, it was compared to exenatide twice daily among patients poorly controlled with metformin.  As expected, due to its once-daily formulation, lixisenatide had a slightly lower weight loss, better tolerance from the gastrointestinal side effects, and a lower incidence of hypoglycemia.  The results are similar to liragluatide (VICTOZA) compared to exenatide, which is taken twice daily.  If lixisenatide is approved, then it will be another option. But, it will have to compete with three other products and would be expensive.

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