New Triple Combo Pill for Type 2 Diabetes

The FDA made history last month by approving the first-ever triple combination pill for type 2 diabetes. This medication can help simplify the medication regimen for people living with type 2 diabetes.

As the director of the diabetes research unit at the University of Texas Health Science Center at San Antonio, Ralph A. DeFronzo, MD, said, “Type 2 diabetes is a complex disease that often requires the use of multiple antidiabetic medications to improve glycemic control. Having three different diabetes medications in a single tablet is an important advance in diabetes treatment.”

Known as Trijardy XR, this medication combines the SGLT2 inhibitor empagliflozin, the DPP-IV inhibitor linagliptin, and metformin extended-release. Both empagliflozin and linagliptin lower blood glucose and empagliflozin has the added benefit of reducing the risk of cardiovascular death and chronic heart failure for those living with cardiovascular disease or chronic heart failure.

Additionally, a trial that was presented at the American Diabetes Association (ADA) Scientific Sessions by Healio found that linagliptin will not increase the risk for a cardiovascular event, nor will it contribute to the progression of renal disease among people with type 2 diabetes. This trial, known as the CARMELINA trial, was conducted over six years, across a group of 6,000 people. The trial demonstrated that no “between-group differences for the incidence of nonfatal myocardial infarction, nonfatal stroke and CV death during a median of 6 years.”

  • Trijardy XR will be available in four dosages:
  • 5 mg empagliflozin/2.5 mg linagliptin/1,000 mg metformin ER
  • 10 mg empagliflozin/5 mg linagliptin/1,000 mg metformin ER
  • 12.5 mg empagliflozin/2.5 mg linagliptin/1,000 mg metformin ER
  • 25 mg empagliflozin/5 mg linagliptin/1,000 mg metformin ER.

There is no information on pricing as of yet. Read more about Trijardy here.

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Happy Friday! As I get older, font sizes seem to be getting smaller. Excited to see the updated Injectables Algorithm, I turned my ADA Book to Standard 9 and quickly realized that in order to read the print, I had to hold the page inches from my nose. And there was no way could I read the footnotes even using my iphone flashlight to illuminate the words.

Thank goodness I collaborate with wonderful staff who boast youthful eyes and 2020 vision.

Robert (our Assistant Director and my high school senior) set to work recreating a draft of the document on Word. Getting the arrows to line up and fitting all the content in little boxes, was challenging, but he persevered. Taryn added the footnotes and I completed the final editing and the creation of the PDF.

We created this readable version because the algorithm is an important document that can be used to promote a collaborative practice.

Coach Beverly

I consider the ADA Standards my clinical “playbook”. The medication algorithms are of particular importance because it provides us with the opportunity to engage in a collaborative practice with our referring providers. “These are the evidence based medication recommendations from the ADA. I use it as a guide to recommend medication additions or changes”.

Enjoy our font enhanced Figure 9.2: Intensifying to Injectable Therapy

Then we can start a conversation exploring if a collaborative practice and medication adjustments using the algorithm is comfortable for the provider and perhaps include into our practice guidelines.

Enjoy this helpful 2 page reference guide, on us!


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Multiple studies have examined metformin for its potential tumor and cancer fighting ability. The National Center for Biotechnology Information (NCBI) published such a study in 2016. Researchers found substantial pre-clinical evidence suggesting anti-cancer properties of metformin based on in-vitro and in-vivo analysis. Their analysis suggested metformin could be used as a radiation sensitizer or immunotherapy drug, besides its direct anti-proliferative properties .

In mice with lung cancer, metformin was used and researchers saw a 72% reduction in tumor burden. Tumors are known to exhibit the Warburg effect, but metformin blunts this and consequently downregulates the growth of cancer stem cells.

Several observational studies showed a correlation between metformin use and lessened cancer incidence. The results demonstrated that metformin users have statistically significant reductions in liver, pancreatic, colorectal and breast cancers.

You can read more details on the study and enjoy their infographics and tables of data here.

Coach Beverly reports no conflict of interest for medication postings.


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October Newsletter Now Available!

Our October Newsletter is brimming with medication updates! From Oral GLP-1 to Semaglutide and pre-filled Glucagon, we’re keeping you up to date AND updating our PocketCards. Did you know you can hire Coach Beverly to come speak in your hometown? Read this month’s Newsletter to find out how to request her time. 

October News Topics Include:

  • Oral GLP-1: Easier to Stomach than Injectables?
  • Canagliflozin Slows Kidney Disease and Protects the Heart
  • Diabetes & Breast Cancer
  • 25% Off Live Webinars
  • Updated DiaBingo
  • 7 Strategies to Survive Halloween

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A post analysis of the SAVOR-TIMI 53 trial and a review of 17 different observational studies showed metformin use is associated with decreased all-cause mortality in people with type 2 diabetes and a high risk of cardiovascular events.

The SAVOR-TIMI 53 trial involved 12,156 people who had baseline biomarker samples: 74% had taken metformin, 13% had prior heart failure, and 11% had at least moderate CKD. The trial found the metformin group had a significant decrease in risk of death from any cause.

In a previous systematic review of 17 observational studies published in the Annals of Internal Medicine in 2017, researchers concluded that metformin use is associated with decreased all-cause mortality in patients with CKD, congestive heart failure, or chronic liver disease with hepatic impairment.

Find out more details about the Harvard Medical School study here.


Want more great medication information? Download our Medication PocketCard for free! We also have these great 8-cards-in-1, laminated, accordion fold PocketCards for sale with bulk discounts.

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Xeris Pharmaceuticals new pre-filled glucagon pen, Gvoke, just received FDA’s stamp of approval to treat severely low blood sugar levels in people with diabetes.

The Gvoke glucagon pen is filled with a liquid stable form of glucagon and is approved for use in people with diabetes, age 2 and above. Xeris will have the pre-filled syringe version available in 4-6 weeks and the auto-injector version available in 2020.

The Xeris glucagon pen was created to simplify glucagon injections. This new Gvoke pen does not require any mixing, since it is filled with liquid stable glucagon.

Availability of a glucagon delivery device is critical to treat severe hypoglycemia and prevent serious consequences of untreated severe hypoglycemia such as cardiovascular events, seizure, coma, or even death.

Read more about the Gvoke Glucagon Pen and auto-injector here .


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Continuous glucose monitoring (CGM) uses interstitial fluid to provide real time glucose readings. Some CGMs have a nonadjunctive dosing indication, which means that users can base treatment decisions on the CGM reading.

Most recently, Eversense CGM received the nonadjunctive indication from the FDA. This means that Eversense users will not have to check fingersticks to make treatment decisions in the near future.

Photo 2018 FDA Website

However, users will still need to calibrate the Eversense CGM twice daily and will need to download a new app before they can base treatment on the CGM readings.

The Eversense is the first long-term implantable CGM device that can be used for up to 90 days before replacing. The sensor is inserted via an in-office procedure in the upper arm by a trained physician. A fluorescent chemical coating on the outside of the sensor generates a small amount of light in response to the amount of sugar that is present in fluid under the skin (interstitial glucose). This light signal is converted into a glucose reading and transmitted wirelessly every five minutes to a compatible mobile device.

Read more in Endrocrine Today – FDA approves nonadjunctive indication for Eversense CGM.

For more information visit the Eversense Website


Want more practice for the exam? Try our new Technology Toolkit, meant to assist with studying based on the updated CDCES content outline!

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Two Online Courses are included in this Technology Toolkit:

  • Tech 101 – Pumps and Sensors Update and Overview and 
  • Tech 102 – Insulin Pump Calculations: From Basal to Square Bolus 

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In a randomized phase 3a study published in Diabetes Care, those taking oral semaglutide monotherapy experienced superior and clinically significant improvements in A1c and weight loss compared to those taking a placebo.

Semaglutide (Ozempic) is currently only available as a once a week injectable, belonging to the GLP-1 Receptor Agonists classification. This class of medications is referred to as “Incretin Mimetics” since they imitate the action of gut hormones, causing satiation, post prandial glucose lowering and slowed gastric emptying. They have the added benefit of associated weight loss.

One drawback for people starting on semaglutide and all GLP-1 RAs, is that they currently can only be administered via injection.

Download FREE Diabetes Injectables PocketCard for more info on GLP-1 RAs.

The findings, based on the Peptide Innovation for Early Diabetes Treatment, or PIONEER, study, found that those who took either oral semaglutide 3 mg, 7 mg or 14 mg once a day for 26 weeks had significantly lower A1C and improved body weight, compared with those on placebo.

This phase 3a trial involving 703 people with type 2 diabetes provides hope that this medication class may be effective when administered orally.

The findings also showed that mild to moderate transient gastrointestinal incidents were the most common adverse events with the oral form of this GLP-1 receptor agonist.

Download FREE Diabetes Injectables PocketCard for more info on GLP-1 RAs. Join our Diabetes Educator Course for a 3 Day Review of Medications and More!


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August Newsletter Now Available!

In our August Newsletter, we highlight several exciting new releases! Nasal Glucagon has been approved, generic Dapagliflozin has been released, and Cleveland Clinic has synthesized a chart of supplements and their efficacy for people with diabetes!

Come to the San Diego Live Seminar for 39 CEs and NEW Networking Night!

Read this month’s newsletter before August 16 to see how you could get a $50 discount.

August Newsletter Topics Include:

  • Nasal Glucagon Approved
  • Nutritional Supplement Chart for People With Diabetes
  • 5 Steps to Stop Sitting & Increase Longevity
  • Diabetes Educator Conference “Making a Difference” Scholarship Awarded
  • Generic SGLT-2 Inhibitor Approved
  • New Technology Course & Networking Mixer at San Diego Live Seminar
  • Women Leaders Conference Save the Date – December 6
  • CDCES Coach App® Rated by DANA | $50 Discount for App Survey

Click here to read our newsletter


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The marketing application for a generic version of Farxiga, or dapagliflozin has received tentative approval from the US Food and Drug Administration (USFDA). Alembic Pharmaceuticals received a nod for its abbreviated new drug application for Dapagliflozin Tablets in 5 mg and 10 mg strength.

The approved product is therapeutically equivalent to the reference listed drug product Farxiga Tablets.

No information on pricing has been posted yet, but the hope is that as patents expire, more affordable generic diabetes medications will be made available.

Dapagliflozin belongs to the SGLT-2 Inhibitor class of diabetes medications. To read more, download our FREE Diabetes Medication Pocket Cards.


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