NewNowNext

Janumet can now be used for type 2s who are completely new to diabetes drugs or are currently using a sulfonylurea
Image courtesy of Merck

janumet: aggressive, first-line diabetes therapy

Do you have type 2 diabetes and not take any medication? Is diet and exercise alone failing to keep your blood sugar under control? If so, there is now a new drug option available to you. The drug is called Janumet, and it is taken twice daily. It is a combination of two different drugs: metformin (an older drug that is used as a front-line treatment for diabetes) and Januvia (a newer drug that also lowers blood sugar). See diaTribe #4, New Now Next, to learn more about Janumet and diaTribe #2, Learning Curve, for an in-depth look at Januvia.

Initially, Janumet was only available once other therapies such as metformin or Januvia had failed to adequately control blood sugar. However, on February 28 2008, the Food and Drug Administration approved use of Janumet for people who have never before taken medication for their type 2 diabetes, or who are currently using a sulfonylurea drug such as Amaryl (glimepiride). Because Janumet is a combination of two different drugs, it may be considered an aggressive initial treatment for type 2 diabetes. However, the advantage of aggressively treating diabetes, even early on, is that it may be possible to slow the progression of type 2 diabetes. Dr. Sethu Reddy, U.S. Director for Scientific Affairs for Diabetes and Obesity at Merck (the manufacturer of Janumet), highlighted an important advantage of the combination of Januvia and metformin: “neither of these medications cause much hypoglycemia.” However, he warned that therapies must always “be individualized and left to the professional healthcare provider.” As always, if you are interested, be sure to talk to your healthcare team about whether you fit the criteria of patients that would benefit from Janumet or Januvia.

DexCom SEVEN receiver
Image courtesy of DexCom

dexcom manual calibration – big win for seven users

Big news: All new DexCom continuous glucose monitoring systems have been approved by the FDA to enable manual entry of blood glucose data during calibration. This feature, aptly named Open Choice, will give DexCom users the ability to use any blood glucose meter to calibrate their DexCom SEVEN units. The SEVEN used to rely exclusively on the OneTouch Ultra meter for transmission of calibration information. diaTribe was thoroughly impressed with this new feature and is pleased to see DexCom paying attention to the patient perspective as they develop their technology. For many whose insurance does not cover strips for the Ultra meter, it is easy to see how this comes as a big positive. Plus, this could mean one less meter to lug around with the rest of our diabetes supplies. With all that said, we note that manually entering blood glucose values increases the chances for a mistake in calibration, though it did seem pretty straightforward when we tried it. A big question: what about current users of DexCom? a. We recently learned that current users will receive a software upgrade as soon as the software is approved by the FDA (likely by this summer). The cost of this upgrade? Free!

The Abbott FreeStyle Navigator transmitter (attached to sensor) and receiver.
Image courtesy of Abbott

navigator approval

For anyone interested in continuous glucose monitoring, you now have a third option in addition to the DexCom SEVEN and the Medtronic Guardian or Paradigm. The Abbott FreeStyle Navigator was approved by the FDA in March for use in the U.S., having been approved in the European Union last year. Like the DexCom and Medtronic systems, the FreeStyle Navigator system consists of three parts: a sensor, a transmitter and receiver. An automated inserter places the sensor just beneath the skin where it is worn for up to five days – currently the Medtronic sensors are supposed to be worn for up to three days as compared to seven days for the DexCom sensor, although it is possible to “extend” wear with both. The Navigator gathers glucose data once every minute and wirelessly sends it to the receiver. We think the biggest advantage to the system is the directional arrows that are designed to predict high and low blood sugars before they occur. As with the other continuous glucose monitors, the Navigator does not actually measure glucose levels in the blood, but rather in interstitial fluid, which is a close approximation. Click here to view an interactive tour of the device. Look for the Test Drive in upcoming issues of diaTribe when one of our staff will take the Navigator out for a spin.

iD USB flash drive giveaway

You've read our Test Drive stories; here's a chance to do your own! The iD USB Flash Drive is quite simply a flash drive (a.k.a. thumb/pen/key drive) with a personal information page that jumps up on your screen once plugged into the USB drive on a Windows-based computer. The idea is that if you get in trouble and a paramedic or firefighter plugs this in, it will provide a quick reference in case you are incapable of personally giving your medical history. diaTribe has received word that the developers of the iD USB Flash Drive are giving away 50 of these devices in exchange for some feedback from you! In our view, the most attractive aspect of the device - aside from the obvious potential benefits during emergencies - is the price: ~$11-$15. The downside – which we hear they are working on - is that it is only Windows-compatible. We hope this product continues to improve – with your input- since Kelly’s Medic-Alert bracelet only has room enough for “Don’t take off my insulin pump!” If you are interested in trying one of these devices and are willing to give your feedback, please email Chris Owens or call him on (801) 944 6393 – the first 50 people will be sent a free ID USB flash drive!