In the News.. Amazon Pharmacy automates insulin discounts, A1Cs go down for this group, a wild T2D study, and more!

It’s In the News, a look at the top stories and headlines from the diabetes community happening now. Top stories this week: Amazon Pharmacy will automatically apply insulin coupons, a new study shows A1Cs are going down for people with T1D who have access to technology, pollution and gestational diabetes study and a wild study that looks at how a parasite might help prevent type 2.

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Transcript: 

Hello and welcome to Diabetes Connections In the News! I’m Stacey Simms and these are the top diabetes stories and headlines happening now
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In the news is brought to you by Edgepark simplify your diabetes journey with Edgepark
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Amazon’s online pharmacy will automatically apply manufacturer-sponsored coupons to more than 15 insulin and diabetes medicines to help patients access discounts pledged by the drug industry.
With the new program, patients using Amazon Pharmacy will no longer have to search for and manually enter coupons from the three largest insulin makers, Novo Nordisk (NOVOb.CO), Eli Lilly (LLY.N), and Sanofi (SASY.PA), to lower the cost of their insulin to as little as $35 for a month's supply, the company said.
Novo, Lilly and Sanofi announced in March that they would slash their insulin prices by at least 70% by or in 2024, but many reports some patients were finding it difficult to get already discounted generic insulin from pharmacies at the promised lower price.
Amazon Pharmacy will also automatically apply available discounts to diabetes-related medical devices from manufacturers Dexcom and Insulet, including continuous glucose monitors and pumps, as well as to other cardiometabolic medicines such as Novo's powerful weight-loss drug Wegovy.
https://www.reuters.com/business/retail-consumer/amazon-pharmacy-automates-discounts-help-insulin-patients-get-pledged-prices-2023-08-15/

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New study will look at Liver Targeted Insulin (LTI) in Type 1 diabetes.. Directing insulin action to the liver may help restore normal liver physiology for people with Type 1 diabetes, leading to better glucose control and overall health outcomes. Jeremy Pettus and a team of researchers are working to determine the mechanism of action and evaluate the safety profile of the Liver Targeted Insulin
Pettus lives with type 1 and is an endocrinologist who is also the xx at TCOYD.
“Living with Type 1 diabetes is extremely tough,” said Pettus. “One of the major barriers to helping patients with Type 1 diabetes achieve normal glucose levels is that injected insulin simply does not get to the ‘right’ places. Normal insulin has its main effects in the liver, but patients with Type 1 diabetes must inject insulin into the fat tissue. Doing so makes the insulin act very slowly, can lead to weight gain and can cause deadly low blood sugars. This project seeks to attach a molecule to insulin that can help direct it to the liver. In doing so, much of the normal physiology may be restored and patients may get better results.”

Pettus is working with the company Diasome to conduct a single center clinical study with 14 patients with Type 1 diabetes to test the safety, tolerability and effectiveness of the novel LTI.

If this study finds that the LTI is active and preferentially targeting the liver, the findings could spur research and development efforts in the LTI space, leading to additional clinical trials and eventually a novel insulin available that could help improve clinical outcomes.
https://today.ucsd.edu/story/2m-grant-drives-research-on-novel-insulin-in-type-1-diabetes
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Good news about A1c reduction in people with type 1.. but it’s limited for those with access to technology.
The new findings from a study involving patients at the Barbara Davis Center for Diabetes Adult Clinic between January 1, 2014, and December 31, 2021. They show that as technology use has increased, A1c levels have dropped in parallel. Moreover, progression from use of stand-alone continuous glucose monitors (CGMs) to automated insulin delivery systems (AIDs), which comprise insulin pumps and connected CGMs, furthered that progress.
On the flip side, A1c levels rose significantly over the study period among nonusers of technology. "We cannot rule out provider bias for not prescribing diabetes technology among those with higher A1c or from disadvantaged socioeconomic backgrounds," Karakus and colleagues write.

Also of note, even with use of the most advanced AID systems available during the study period, just under half of patients were still not achieving A1c levels below 7%. "The technology helps, but it's not perfect," Shah observed.

This study is the first to examine the relationship of A1c with technology use over time, in contrast to prior cross-sectional studies. "The intention here was to look at the landscape over a decade," Shah said.
https://www.medscape.com/viewarticle/995738
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Can a parasite help with type 2 diabetes? This is kind of gross but very true.. In the first clinical trial of its kind, a team led by scientists from James Cook University in Australia inoculated volunteers with human hookworm larvae (Necator americanus) to see if these parasites can improve their metabolic health. The two-year study included 24 participants, each of whom showed heightened insulin resistance at the start of the trial.
By the end of the investigation, researchers found those who were infected with hookworms showed a significant reduction in their insulin resistance scores compared to those who were given a placebo.
In recent decades, scientists have noticed that in places where parasitic worms are endemic, people report fewer metabolic and inflammatory diseases. I’m sure I don’t have to say this – but more study is needed. No one is recommending you try to get a parasitic infection
https://www.sciencealert.com/radical-trial-shows-hookworms-may-protect-people-from-type-2-diabetes
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https://www.medicalnewstoday.com/articles/simple-blood-test-may-predict-future-heart-kidney-risk-for-people-with-type-2-diabetes
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Exposure to air pollution early in pregnancy—and even shortly before conception—increases a woman's risk of developing gestational diabetes, according to a new USC study out in The Lancet Regional Health—Americas.
"Interestingly, we found gestational diabetes risk wasn't associated with long-term air pollution exposure but was associated with air pollution in a relatively short but critical periconceptional window, from five weeks before to five weeks after conception," said first author Zhongzheng "Jason" Niu, a postdoctoral fellow in population and public health science at the Keck School of Medicine of USC.
The researchers also found the association between air pollution and gestational diabetes was more pronounced among study participants experiencing prenatal depression.
The mechanism connecting ambient air pollution and gestational diabetes remains unclear, researchers say, but an interplay among impaired glucose metabolism, inflammation and hormonal changes could be to blame. Prenatal depression, with disrupted immune and hormonal functions, could make the case worse.
https://news.usc.edu/209509/exposure-to-air-pollution-early-in-pregnancy-increases-risk-of-gestational-diabetes-study-finds/
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Commercial – Edgepark
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A look at Tandem’s bolus by phone feature shows it seems to be helping people with “low bolus frequency” give insulin more. Last year, the t:connect app was updated to allow people with the tslim x2 pump to initiate bolusing from a smart phone or the pump itself. This study looked at those who gave less than three boluses per day prior to the smartphone bolus update – the media number was 2.2. After the smartphone option, that number rose to 2.7.
https://journals.sagepub.com/eprint/QYVHSJUZKND8JJAKRUTG/full
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Great story from Diabetes Daily about two brothers with type 1 who are creating a low or almost no sugar beer. This is in Ireland and I don’t know exactly how to explain it quickly..
“Normally, the reason that the beers have sugar in them – which is what will mess with your blood sugar levels – is that there are unfermentable sugars that remain in the beer, sugars that the yeast isn’t able to convert into alcohol. It’s just a byproduct of how you make it. But this enzyme glucoamylase actually breaks down these unfermentable sugars and makes them into fermentable sugars, so the yeast can convert all of the sugar into alcohol, and there will be no sugar left in the beer at all.
Brut beers are usually done in a clean, bitter, highly fizzy IPA style, almost like a beery champagne, but Seán has tried the glucoamylase in other recipes as well.

“Normally it’s only a pale ale or IPA that people put this enzyme into. But I really like German wheat beers. So I decided I’d try and make a wheat beer with this enzyme as well.”

“It did exactly what it was supposed to do. You end up with no sugar at the end, and a really tasty beer. So I’ve been doing it with a few others – a rye, and a Kolsch, and all the sugars completely ferment out.”

“We’ve had some fun in naming them as well. The first one, the IPA style, we call it Insulin, because it keeps the levels down. The wheat that I like to make we have now called Diawheaties.”

And his non-diabetic friends approve:

“Everyone seems to like it. They tend to be quite nice, easy-drinking beers. We wouldn’t make them just for the zero sugar if they were no good. They’re as good as the normal beers.”
https://www.diabetesdaily.com/blog/how-two-irish-brothers-with-type-1-diabetes-brew-their-own-zero-sugar-beer-689869/
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MNO update
On the podcast next week.. tandem diabetes celebrity panel from friends for life – Hollywood, the NFL and NASCAR. Last week’s episode was Benny off to college

That’s In the News for this week.. if you like it, please share it! Thanks for joining me! See you back here soon.