New Developments, New Hope, Some New Concerns in 2017

2017 brought with it some new and exciting developments in endocrinology, especially in the management of diabetes. There are new drugs and devices, and some promising new data. On the flip side, there were also some issues that raised concern.

Insulin pump/sensor combination
Although the hybrid semi-closed loop insulin pump/sensor combo (I’m sorry, I will not call it an artificial pancreas) was FDA approved in 2016, it did not become available to patients until mid-2017. Because of supply issues, there are still many patients who have their new pumps but don’t have the sensors, rendering the system no different than older pumps. Having said that, those who have been able to obtain the system appear to be doing quite well. My patients are very happy with it, and their glycemic control has improved. Feedback from most colleagues I’ve spoken to suggests that their patients are doing well on it too. I have heard of a couple of endocrinologists who aren’t as satisfied though. I do wish there was a way to lower the target glucose so that pregnant women could use it.

Continuous glucose sensor
A new continuous glucose sensor that does not require fingersticks just recently became available. Patients have been asking about it ever since it was approved by the FDA a few months ago. I don’t think it compares with the previously available sensor systems, since there are no alerts if the patient is becoming hypo- or hyperglycemic, but for routine monitoring, it is certainly convenient. Patients often tell me that the worst part of managing their diabetes is pricking their fingers-even worse than taking injections.

GLP-1/basal insulin combinations
Two new glucagon-like peptide 1 (GLP-1)/basal insulin combinations became available this year. These allow patients to have the benefits of both types of drugs while still taking only one injection a day. Now if only more plans would cover them, it would be great.

Drug costs
Which brings me to one of the big issues of 2017-the cost of medication, especially insulin. It is obscene how much drugs cost, and the fact that companies can give some of them away for free with their savings cards is proof that there is no need for them to cost as much as they do. The biggest victims of this travesty are Medicare patients. They cannot use the savings cards, AND they end up in a ridiculous “donut hole” by mid-year. Then they are either asking for samples, asking to be switched or, worse, rationing their meds. It is my sincere hope that something is done about this price gouging in the new year.

Reduced cardiovascular risk
On a brighter note, for the first time, medications used for diabetes have been shown to decrease the risk of cardiovascular events. Even the studies whose primary outcomes were somewhat unimpressive had data that showed more substantial secondary prevention. On the flip side, there were some concerning data about lower extremity amputations, so one must choose patients carefully.

I don’t know what the new year will bring. I am certain there will be new breakthroughs. I hope that more patients will have access to lifesaving medications and devices. And I wish everyone a wonderful holiday season and a happy and healthy new year.