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2008 Resource Guide. Diabetes Forecast. 61(1): RG1-RG60. January 2008.

This special section of Diabetes Forecast offers the annual guide to diabetes products and services. The guide lists items in seven categories: new diabetes products, type 2 oral medications, insulin, insulin delivery, blood glucose monitoring and data management systems, products for treating low blood glucose, and urine testing. Specific products include human and analog insulin, syringes, injection aids, insulin pens and pen needles, insulin pumps, aids for people who are visually and physically impaired, blood glucose meters, ways to pair the blood glucose meter with software, blood-sampling supplies, meter supplies, glycohemoglobin tests, microalbuminuria testing kits, and over-the-counter products for meal replacement. Each category includes a section of text, bringing readers up to date on the changes in that area, and charts summarizing the products available. The guide includes a list of manufacturers and distributors, arranged alphabetically. 10 figures. 20 tables.

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Diagnosing and Managing Latent Autoimmune Diabetes in Adults. Practical Diabetology. 21(1): 32-37. March 2008.

This article reviews the diagnosis and management of latent autoimmune diabetes in adults (LADA), defined as a slowly progressive form of autoimmune diabetes mellitus characterized by mature age at diagnosis, the presence of pancreatic autoantibodies, and the lack of an insulin requirement at diagnosis. The author notes that patients with LADA present with better-preserved beta-cell function than those with classic type 1 diabetes mellitus, but they usually experience a rapid and progressive loss of beta-cell function and tend to become rapidly unresponsive to intervention with oral medications and parenteral agents such as incretin mimetics. The article discusses the importance of the correct diabetes diagnosis, differentiating autoimmune diabetes from diabetes caused by insulin resistance, the prevalence of LADA, the pathogenesis of LADA, screening and testing that can be done for LADA, and treatment strategies for these patients. The author concludes that, although treatment guidelines for LADA have not been published, intensive management with insulin therapy provides a theoretical advantage by preserving any remaining endogenous pancreatic beta-cell function and minimizing long-term complications. 2 tables. 23 references.

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Non-Insulin Medications for Diabetes. 5th ed. Timonium, MD: Milner-Fenwick. 2008. (DVD).

This DVD program reviews noninsulin medications that may be used to help manage type 2 diabetes. The program focuses on the causes of type 2 diabetes and the role of different oral medications, including combination medications, in keeping blood glucose levels under control. One section describes the use of exenatide (Byetta), an injectable drug used for type 2 diabetes. Safe medication use is emphasized. Viewers are reminded of the importance of a comprehensive self-management plan for keeping diabetes under control. The video depicts a variety of people who share their experiences with diabetes management and oral medications. Simple graphics are used to explain most of the topics covered. Short video segments about the drug classes sulfonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, meglitinides, DPP-IV, and combinations appear at the end of the full presentation. Viewers are referred to the American Association of Diabetes Educators website for more information and to find a local diabetes educator.

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What I Need to Know About Diabetes Medicines. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. 16 p.

This booklet helps readers with diabetes understand how diabetes medicines help keep their blood glucose levels in healthy target ranges. Written in nontechnical language, the booklet describes how these medications work; recommended targets for blood glucose levels, including for before and after meals; how blood glucose levels are affected by the presence of diabetes; medicines that may be used for each of the types of diabetes, including type 1, type 2, and gestational diabetes; and the types of diabetes medications and their forms, including insulin injections and insulin pumps, the side effects of insulin, the different types of insulin, oral medications, and injections other than insulin. Inside the back cover of the booklet is a folder with numerous inserts that provide information about specific drugs. The first insert is a form on which readers and their health care providers can record the medications currently prescribed. A second insert offers a list of questions patients might want to ask about their diabetes medications, and a third insert summarizes the different types of insulin. The remaining inserts provide specific information about the following drugs: the alpha-glucosidase inhibitors Glyset (miglitol) and Precose (acarbose); the biguanides Glucophage (metformin), Glucophage XR (long-acting metformin), and Riomet (liquid metformin); Starlix (nateglinide); the DPP-4 inhibitor Januvia (sitagliptin); a meglitinide called Prandin (repaglinide); sulfonylurea compounds including Amaryl (glimepiride), DiaBeta (glyburide), Diabinese (chlorpropamide), Glucotrol (glipizide), Glucotrol XL (long-acting glipizide), Glynase (glyburide), Micronase (glyburide), and the generics tolazamide and tolbutamide; thiazolidinediones Actos (pioglitazone) and Avandia (rosiglitazone); the combination pill Actoplus Met (pioglitazone and metformin); and the amylin mimetic Symlin (pramlintide). Each drug insert explains what the drug is supposed to do, who should and should not take the drug, and possible side effects. A final insert discusses low blood glucose levels. Blank spaces in different sections of the booklet allow readers to note their own individual prescriptions. The booklet concludes with a list of resources from which readers can get more information and a brief description of the goals and activities of the National Diabetes Information Clearinghouse.

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Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults With Type 2 Diabetes. Executive Summary. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ). 2007. 16 p.

This fact sheet compares the effectiveness and safety of oral diabetes medications for adults with type 2 diabetes. The author notes that as new classes of medications have become available, clinicians and patients have faced an array of oral medications with different mechanisms of action. The fact sheet explores how oral diabetes medications for the treatment of adults with type 2 diabetes differ in their ability to affect the following proximal clinical outcomes: glycated hemoglobin, weight, blood pressure, serum lipid levels, and 2-hour postprandial glucose (PPG) levels; considers how these medications differ in their ability to affect distal diabetes-related complications, including mortality, coronary artery disease, myocardial infarction, stroke, transient ischemic attack, arrhythmia, coronary artery stenosis and in-stent restenosis, retinopathy, nephropathy, neuropathy, and peripheral arterial disease (PAD); discusses the impact of these medications on other health outcomes, including quality of life and functional status; reviews the life-threatening and less serious adverse events that are associated with each of these medications; and considers whether the safety and effectiveness of these medications vary across particular adult populations such as those based on demographic factors or comorbid conditions. Specific drugs discussed are thiazolidinediones, second-generation sulfonylureas, metformin, repaglinide, acarbose, rosiglitazone, alpha-glucosidase inhibitors, pioglitazone, and glyburide. A summary table presents the main conclusions from published evidence regarding the comparative effectiveness of oral diabetes medications, organized by key question and type of outcome. A second table presents a summary of the comparative effectiveness of the oral diabetes medications. The fact sheet is from a series called the Effective Health Care Program, established to provide valid evidence about the comparative effectiveness of different medical interventions. The goal is to help consumers, health care providers, and others in making informed choices among treatment alternatives. 2 tables.

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Comparing Oral Medications for Adults With Type 2 Diabetes: Clinician’s Guide. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ). 2007. 4 p.

This guide helps clinicians understand the current thinking on oral hypoglycemia agents used for adult patients with type 2 diabetes. The guide summarizes evidence from both observational studies and controlled trials that compare the effectiveness and safety of oral hypoglycemia agents. Standard oral hypoglycemic regimens include single drugs and combinations of two or three drugs from different classes, such as metformin and a sulfonylurea. Choosing among available oral hypoglycemia agents requires consideration of their benefits as well as their adverse effects and cost. The dose and prices of the drugs reviewed in the comparative studies are listed on the back page. As single agents, all second-generation sulfonylureas, thiazolidinediones, metformin, and repaglinide work well to reduce hemoglobin A1C levels by about 1 percentage point on average. Combination therapies reduce HbA1c levels about 1 percentage point more than single drug therapies. People taking sulfonylureas, thiazolidinediones, and repaglinide gain about 2 to 10 pounds. Metformin does not cause weight gain. This guide does not address insulin, combining oral medications with insulin, older first-generation sulfonylureas, or the new class of DPP-4 inhibitors. Readers are encouraged to consult the Agency for Healthcare Research and Quality’s website at www.effectivehealthcare.ahrq.gov for more information.

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Educating Patients With Type 2 Diabetes on a New Class of Drug, Dipeptidyl Peptidase 4 Inhibitors. Diabetes Educator. 33(Suppl 5):111S-113S. May - June 2007.

New and innovative antihyperglycemic therapies for people with type 2 diabetes have recently become available. This article is from a special supplement about an American Association of Diabetes Educators’ continuing education program called a Multidisciplinary Approach in Addressing Novel Mechanisms in the Management of Type 2 Diabetes, held in Los Angeles in August 2006. In this article, the author considers patient education approaches for people with type 2 diabetes who are being treated with dipeptidyl peptidase 4 (DPP-4) inhibitors. DPP-4 inhibitors, including sitagliptin and vildagliptin, can be given orally once a day and are not associated with an increased risk for hypoglycemia or weight gain. Patient adherence to any drug regimen remains a problem; reports show that adherence to oral medications ranges from 65 to 85 percent. The author briefly reviews some of the reasons for patient nonadherence and offers suggestions about how diabetes educators can be an active part of the diabetes patient care team. The patient with a good health care team, appropriate support, and adequate diabetes self-management education (DSME) is more likely to comply with drug regimens and prevent complications. 1 figure. 1 table. 8 references.

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Overcoming Barriers to the Initiation of Insulin Therapy. Clinical Diabetes. 25(1): 36-38. Winter 2007.

This article explores some of the barriers to the initiation of insulin therapy in patients with type 2 diabetes, noting that new recommendations for these patients call for more rapid use of both oral medications and insulin therapy. Although most health care providers agree that insulin is an effective therapy for the management of type 2 diabetes, many still consider insulin therapy as the last resort and indicate that their patients are hesitant to take insulin. The author of this article recommends physicians first assess the patient‘s perspective regarding insulin therapy; many barriers can be identified from this discussion. The author briefly discusses some of these barriers, which include beliefs that the insulin use demonstrates personal failure, insulin is not effective, insulin injections are painful, insulin causes complications or death, fear of hypoglycemia, insulin causes weight gain, and insulin use will have a negative impact on lifestyle. The next section considers provider-identified barriers to insulin therapy and how to address each of them. These suggestions include referring patients for diabetes self-management education and medical nutrition therapy (MNT), providing ongoing self-management support, using strategies already proven successful, and addressing emotional issues. 4 references.

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What's New in Diabetes Care?. Diabetes Wellness News. 13(4): 1-2. April 2007.

This article briefly summarizes some new medications, new ways to deliver insulin, and new ways to monitor blood glucose levels for people with diabetes. The author discusses inhaled insulin, Exubera; two new injectable medications: Byetta and Symlin, which have effects in addition to lowering blood glucose levels, notably in reducing hunger and helping patients to lose weight; a new class of oral medications, the DPP–4 inhibitors: Januvia and Galvus, which lower blood glucose levels but also help control blood glucose levels after meals when they tend to be highest; the use of the oral medication Avandia to prevent or delay type 2 diabetes; the use of continuous blood glucose monitoring; and work on islet transplants. 1 figure.

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American Diabetes Association 2006 Resource Guide. Diabetes Forecast. 59(1): RG4- RG69. January 2006.

This special section of Diabetes Forecast offers the annual guide to diabetes products and services. The guide lists items in seven categories: new diabetes products, type 2 oral medications, insulin, insulin delivery, blood glucose meters and data management systems, products for treating low blood glucose, and urine testing. Specific products include human and analog insulin, syringes, injection aids, insulin pens and pen needles, insulin pumps, aids for people who are visually and physically impaired, pairing the blood glucose meter with software, blood-sampling supplies, meter supplies, glycohemoglobin tests, microalbuminuria testing kits, and over-the-counter products for meal replacement, blood glucose stabilization, and preventing low blood glucose. Each category includes a section of text, bringing readers up to date on the changes in that area, and charts summarizing the products available. The guide includes a list of manufacturers and distributors. 8 figures. 16 tables.

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