News of the Center
Message from the Director
There is less diabetes news to report this fall because most of the research dollars and attention is focused on battling the coronavirus pandemic. This is leading to delay for new research into treatment for diabetes, although we are still recruiting for some trials.
After years of rapid development over the past few years it is good to take a deep breath and move to a time of
consolidation and dissemination of the breakthroughs that we have seen in the past years.
On the medication front two different drug classes known as SGLT2-I and GLP-1 RA have made most of the headline as trial data generated results leading to a recommendation of use to reduce heart and kidney disease. Even though the medications were developed for glucose control these drugs are now widely used by cardiologists and nephrologists as well as endocrinologists.
Continuous glucose monitor (CGM) use in our patients with type 1 diabetes continues to grow and we are seeing greater use in our patients with pre- and type 2 diabetes. Part of this is because due to the pandemic insurance companies and Medicare are paying for their use in people not on insulin (which was the previous indication.) It lets people continuously monitor their sugars for two weeks before their telemedicine appointment with me and from the data I can calculate a GMI (glucose management indicator) that is similar to an A1C. In some ways the data is much better than an A1C because we can see patterns both before and after eating which lets us make even more informed lifestyle and medication adjustments.
Hybrid closed loop pump systems are becoming the standard of care for our pump patients, who generally prefer the Tandem Control-IQ system or the do-it-yourself (DIY) Loop systems (which are not FDA approved). Insulet also completed their trial of their new Horizon OmniPod closed-loop system and FDA approval is expected early next year. Tidepool is also is also is getting ready to submit their Loop system to the FDA .
For our patients who prefer injecting insulin with a pen there is now a smart pen option from InPen that provides the dosing calculator features that pump patients have used for years. It also integrates with CGMs to provide reports that pair dosing data with glucose tracking that allows for to better understanding as to cause and effect of food and insulin dose timing. The Bluetooth connected InPen was recently purchased by Medtronic and you may see increased marketing of this dosing tool. We can also provide remote training on this device.
As our social patterns have been disrupted it is good to know that there are two new easier to use glucagon options. Prevention of hypoglycemia is now much easier with the nasal administration of Baqsimi or the simple premixed injection of Gvoke.
One of the biggest concerns is many of these breakthroughs are not yet available in some of the lower income populations that are hardest hit with diabetes. These are the same people who are currently the hardest hit with COVID cases and complications.
We have been working to alleviate this through the distribution of Libre sensors through a grant from the Hemsley Charitable Trust and Insulin For Life to provide remote CGM monitoring to our patients on the Eastside who have diabetes and are using insulin. We have been able to more easily manage their diabetes through this pandemic while reducing the risk of in person visits and providing easier access to care without missing time off work and using risky and time-consuming public transportation.
Donations from our Westside patients have also been very useful in helping keep our East Los Angeles programs running, especially since much of research funding that has supported our staff has been diverted to COVID efforts.
No matter what side of town people live there is a danger in delaying medical treatment. Most medical facilities are safe to visit due to careful scheduling. It is important that people come in for an in-person visit if there is a concern about foot ulcers, the need to get blood drawn vaccinations or any other need that requires an in-patient visit.
We are also concerned about people exercising less and losing muscle strength or developing unhealthy eating habits. It is important to maintain a schedule of daily exercise, and to be aware that the added stress of the pandemic and the resulting isolation can increase mental health issues of depression, anxiety disorders and insomnia. It is important to reach out to your healthcare providers to get the support that you need and if the increased stress interferes with your life or function, you need to connect with a mental health professional for guidance and treatment.
COVID-19 related job and insurance loses are impacting many people. Ways to get insulin at a lower cost can be found at https://getinsulin.org/. Remember, even if you lose your insurance you can always reach out to us via email so we can guide you on how to get care. We should all be helping each other during these difficult times.
Have a happy and as safe a holiday season as possible this year. I am very optimistic that we have an increasing ability to combat this pandemic and although the next few months may be problematic, I think things will be much improved by springtime.