Diabetes Empowerment

A Mediaplanet Guide to Proactive Diabetes Diagnosis & Care

Diabetes Empowerment

Lauren Cox The first WNBA player with Type 1 diabetes offers inspiration and advice for controlling your T1D

The importance of community and advocacy for women with diabetes The topical treatment easing the pain of peripheral neuropathy

NOVEMBER 2021 | FUTUREOFPERSONALHEALTH.COM

2020

1.6 MILLION AMERICANS LIVE WITH

TYPE 1 DIABETES jdrf.org

An Independent Supplement by Mediaplanet to USA Today

THE NUMBER OF YOUTH WITH

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Protect Your Vision with Regular Eye Exams Receiving in-person, dilated eye exams on a regular basis is crucial to preserving your vision from the effects of diabetes.

Across the country, a high number of patients who come into the optometrist’s office have diabetes. Many of these patients come in with no previous diagnosis of diabetes, instead just complaining of a sudden change in their vision.

In fact, in 2019, Doctors of Optometry detected an estimated 431,000 cases of diabetes in patients who were unaware they had the disease.

A leading cause of blindness Through an eye exam, your Doctor of Optometry can detect a number of diseases that affect your blood vessels, including diabetes. Diabetic retinopathy occurs when tiny blood vessels leak blood and other fluids. This causes the retinal tissue to swell, resulting in cloudy or blurred vision. The condition usually affects both eyes, and the longer a person has diabetes, the more likely they will develop diabetic retinopathy, one of the leading causes of blindness in the United States.

Symptoms of diabetic retinopathy include: • Seeing spots or floaters • Blurred vision • Having a dark or empty spot in the center of your vision • Difficulty seeing well at night Patients with diabetes who can better control their blood sugar levels will slow the onset and progression of diabetic retinopathy. Often, the early stages of diabetic retinopathy have no visual symptoms. That is why the American Optometric Association recommends that everyone has a comprehensive in-person eye examination once a year.

Robert C. Layman, O.D., President, American Optometric Association

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Diabetic retinopathy is the leading cause of blindness among working-age adults, but early diagnosis and treatment can preserve your vision.

Whether you’re newly diagnosed or have been managing Type 1 or Type 2 diabetes for a while, utilizing a team approach can provide the much-needed support to maintain your health.

As a part of your care team, your Doctor of Optometry plays a vital role in helping you preserve your sight. Your optometrist can examine, diagnose, treat, and manage diseases and disorders of the eye.

In addition to providing eye and vision care, they play a major role in an individual’s overall health and well-being by detecting systemic diseases, like diabetes, and diagnosing, treating, and managing how those diseases affect the eyes. They can also provide feedback to your other doctors regarding how your diabetes may be affecting your vision.

Diabetic retinopathy Because diabetes can contribute to eye disease, particularly diabetic retinopathy, the importance of in-person, dilated eye exams cannot be stressed enough. Diabetic retinopathy is a serious, sight-threatening complication of diabetes. Diabetes interferes with the body’s ability to use and store sugar (glucose). The disease is characterized by too much sugar in the blood, which can cause damage throughout the body, including the eyes. Over time, diabetes damages small blood vessels throughout the body, including the retina. Diabetic retinopathy occurs when

Diabetes and Your Eyes these tiny blood vessels leak blood and other fluids. This causes the retinal tissue to swell, resulting in cloudy or blurred vision.

Diabetic retinopathy usually affects both eyes. The longer a person has diabetes, the more likely they will develop diabetic retinopathy, and if left untreated, diabetic retinopathy can cause permanent blindness. Patients with diabetes who can better control their blood sugar levels

will slow the onset and progression of diabetic retinopathy.

The American Optometric Association (AOA) recommends that everyone with diabetes have a comprehensive dilated eye examination at least once a year. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy. To find a Doctor of Optometry near you, visit aoa.org. n American Optometric Association

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Publisher Caroline Dranow Business Developer Katie Konf ino Managing Director Luciana Olson Lead Designer Tiffany Pryor Designer Kayla Mendez Lead Editor Mina Fanous Copy Editor Taylor Rice Director of Content and Production Jordan Hernandez Cover Photo Courtesy of The Los Angeles Sparks and JDRF All photos are credited to Getty Images unless otherwise specified. This section was created by Mediaplanet and did not involve USA Today.

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How One Woman Regained Her Sight After Nearly Losing It to Diabetes P H OTO : C O

Nearly out of options — and hope — after multiple eye procedures for diabetic eye disease, one woman found a treatment that restored her vision. She’s now encouraging other people living with diabetes to be more proactive about getting regular eye exams to stay ahead of potential vision loss.

When Lauren was diagnosed with Type 2 diabetes at 37, it didn’t come as a shock. The disease runs in her family: several of her immediate family members have it, including her father, who eventually died because of related complications.

“I actually got diagnosed at the same age my dad did,” Lauren said, “so it wasn’t really a surprise to me.”

What Lauren didn’t know — like many of the other 34 million Americans living with diabetes — is that high blood

sugar from diabetes can cause serious damage to the delicate blood vessels in the back of one’s eyes. If untreated, diabetes can ultimately lead to severe vision loss and even blindness.

At 38, Lauren learned she had diabetic macular edema (DME), a severe vision-threatening complication of diabetes.

DME, which advances from an earlier form of the disease called diabetic retinopathy, is one of the leading causes of blindness in adults. African Americans like Lauren are three times more likely than white adults to develop it.

Even though Lauren was being diligent about managing her diabetes before the DME diagnosis — she started eating right and exercising more — the condition still took its toll on her eyes.

Her primary physician told her to see an eye doctor, who diagnosed her with DME and said she was at risk of losing her

sight or even going blind. Over time, Lauren’s vision began to decline, and she said she started seeing “lightning bolts.”

Seeking treatment To stave off the progression of her DME, Lauren was referred to a retina specialist, Dr. Roger Goldberg, who recommended her for a series of procedures, including laser surgery.

Some of the procedures helped, but when one fixed the peripheral vision in her left eye, she became almost completely blind in her right eye. Things began to look grim.

“I started kind of losing hope because I thought I was doing better with my health, and I couldn’t understand why things weren’t going like I wanted them to with my vision,” Lauren said.

Lauren’s outlook changed for the better when her doctor recommended that she try an anti-VEGF injectable treat-

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ment that blocks the growth of new blood vessels in the back of the eye to treat DME. She says she now receives regular treatments, and that the injections have halted the damage to her eye’s blood vessels and restored most of her vision.

Empowering others With 88 million Americans currently classified as prediabetic, the incidence of diabetes is expected to rise and complications like DME will only become more common.

For Lauren, who works as a check processor, seeking treatment for DME helped her regain her vision and critical hand-eye coordination skills, which allowed her to maintain her livelihood. However, she still faces her fair share of daily struggles; for instance, she now has a hard time looking at her computer.

Lauren says she wishes she would have understood earlier

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how diabetes and high blood sugar can affect vision, which is why she’s sharing her story.

Being informed and getting the appropriate treatment at the right time can help avoid complications that can lead to vision loss. She hopes she can encourage the millions of people who have or are at risk of developing diabetes to take charge of their eye health so they can keep their sight.

“If your doctor says this type of treatment is something that is going to work for you, then I would definitely recommend it,” Lauren said. n Dustin Brennan

Sponsored by Genentech, Inc.

To learn more about diabetic eye disease, visit gene.com

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How to Have a Healthy Baby While Managing Gestational Diabetes You are not alone — nearly 10 percent of pregnancies in the United States are affected by gestational diabetes.

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f you are diagnosed with gestational diabetes while you are pregnant, one important thing to remember is that, by working with your doctor, you can still have a healthy pregnancy and a healthy baby.

Most pregnant women have a glucose screening test between 24 and 28 weeks of pregnancy. The test may be done earlier if you have a high glucose level in your urine

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during your routine prenatal visits or if you have a high risk for diabetes. No matter what, know that you have all the support you need for both you and your baby.

We don’t know what causes gestational diabetes, but we know that it affects millions of women. We know the placenta supports the baby as it grows.

Sometimes, these hormones from the placenta also block the effects of the moth-

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er’s insulin — a hormone produced in the pancreas that regulates the amount of glucose in the blood — and it causes a problem called insulin resistance. This insulin resistance makes it hard for the mother’s body to use insulin, and she may require up to three times as much insulin to compensate.

Under control While any pregnancy complication is concerning, there’s

good news. Expectant mothers can help control gestational diabetes by eating healthy foods, exercising, and, if necessary, taking medication. Controlling blood sugar can keep you and your baby healthy and prevent a difficult delivery.

In women with gestational diabetes, blood sugar usually returns to normal soon after delivery. But if you’ve had gestational diabetes, you have a higher risk of developing Type 2 diabetes, and will need to be

tested for changes in blood sugar more often.

Whatever the cause, work with your doctor to come up with a plan and maintain a healthy pregnancy through birth. Ask questions. Ask for help. There are many ways to combat gestational diabetes. n

Dr. Robert Gabbay, Chief Scientific and Medical Officer, American Diabetes Association

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ince the onset of the pandemic, I have seen some of the sickest patients of my career — and these are not patients who are suffering from COVID-19.

These are patients with severe diabetic wounds, gangrene, and even risk of sepsis. These patients are afraid they will contract COVID-19 in a healthcare facility, and as a result, they are avoiding regular care and even ignoring injuries and infections.

Diabetes risks People with diabetes are classified as high risk for COVID-19, and our national healthcare experts have appropriately cautioned high-risk patients to limit their potential exposure. Those cautions do not extend to avoiding regular care for diabetes.

Keep Your Appointment, Keep Your Feet Patients who have been stuck at home have become more sedentary and often have become lax in their diets.

They have neglected to track their A1C levels, and many are risking their feet and, in fact, their lives by putting off routine foot care.

I have patients who were treating wounds on their own at home before finally coming into my office when it was too late to save their feet. Once a wound becomes infected, there is very real risk that the tissue

will die (what we refer to as gangrene), which can lead to an amputation. There is also a risk for sepsis, a deadly systemic infection. And even if a patient does not develop sepsis, the five-year mortality rate after a diabetic limb amputation is higher than the five-year mortality rate for many cancers.

Proper foot care During the pandemic, people with diabetes should stay active and in control by getting proper exercise and nutrition

and tracking blood sugar levels.

They should stay alert by doing daily foot exams (a caregiver or family member can help) and protecting the feet with shoes, even around the house.

And above all, they should stay in contact with their diabetes care team and reach out to their podiatrist if they notice a wound, injury, or other changes to their feet.

Healthcare providers are taking significant precautions to prevent the spread of COVID19 in their offices. I wear a face

shield and mask when treating patients, and I require my patients to wear masks and follow hand hygiene protocols as well. We do temperature checks for all employees, patients, and guests entering the office, and we require social distancing.

Physicians’ offices are limiting the number of patients in the office at any given time and following disinfection guidelines for surfaces and equipment.

Depending on your condition, you may even be able to take advantage of telehealth options.

With the many safeguards and options in place, the risk of seeking medical attention is much lower than the risk of putting it off. Do not neglect your regular care out of fear of COVID-19. Keep your appointment and keep your feet. n Priya Parthasarathy, DPM, Foot and Ankle Specialists of the Mid-Atlantic

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that produces nitric oxide, which plays a critical role in peripheral nerve function.

Easing the Misery of Peripheral Neuropathy

A cream containing L-arginine can reach the damaged nerves in the feet that cause PN because the peripheral nerves lie just below the surface of the skin. I looked for a topical L-arginine formulation and found Neuro One, an L-arginine cream with Vitamin B-12, which is also essential to nerve function. I have used it on my patients suffering from peripheral neuropathy with extremely positive results.

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What alternatives to prescription drugs exist for PN?

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Nerve damage from diabetes frequently results in foot pain. A non-prescription topical cream may be an alternative treatment to conventional drugs.

As many as 30 million people in the United States suffer from peripheral neuropathy (PN), nerve damage that causes pain and other sensations in the extremities. Most PN is

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associated with diabetes. A pioneer in podiatric medicine, Dr. Arlene Hoffman has been treating patients suffering from PN for decades. “I like to get what causes a problem and not just treat the symptoms,” she says.

How do you know if you’re suffering from PN? Do your socks feel like they are bunched in your shoes? Do you

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have numbness or tingling in your feet? These are classic signs of PN. A simple test is to take a toothpick and tap the sharp end several times on the inside of your ankle. Then tap on the underside of your toes.

If you feel less sensation at your toes than at your ankle, you may have peripheral neuropathy.

Consult a health practitioner.

How is PN typically treated?

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It’s often treated with prescription oral medications, which are generally not effective and are associated with unwanted side effects such as drowsiness, dizziness, blurred vision, nausea, diarrhea, and weight gain.

What’s the role of L-arginine and nitric oxide in PN? L-arginine is a naturally occurring amino acid in your body

How does Neuro One work?

When applied to the foot and ankle, the cream is absorbed and nourishes the underlying nerves. There are no associated side effects. Patients should apply it to the entire ankle, foot, and toes. Most patients notice an improvement within days; for some, it may take up to a month. n Dr. Arlene F. Hoffman, DPM, Ph.D.

This has been paid for by Neuro One.

Leveraging Technology to Transform Diabetes Care

Diabetes Doesn’t Have to Define You. I’m Living Proof

PHOTO: COURTESY OF THE LOS ANGELES SPARKS, AND JDRF

A new category of medicine — digital therapeutics — is making it easier for people with diabetes to stay healthy.

Lauren Cox, a WNBA player for the Los Angeles Sparks, details her Type 1 diabetes diagnosis and offers inspiration for others with T1D to follow their dreams.

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will never forget that day. I hadn’t been feeling well, and my parents rushed me to the hospital. I was poked and prodded as doctors ran a series of blood tests.

I didn’t understand what was happening, but the look on my parents’ faces told me it was serious.

I had Type 1 diabetes. I was seven years old, and life as I knew it would forever change. Suddenly, I went from being a little girl without a care in the world to having serious responsibilities. And it wasn’t optional. Taking one day off from managing my diabetes was a matter of life or death.

Gaining acceptance I struggled. I didn’t know anyone else with Type 1 diabetes, and I did everything I could to hide my diagnosis, from testing my blood sugar under the table at restaurants to discreetly going to the

bathroom at school to inject insulin. I was embarrassed and barely withheld my tears as I watched my friends look so carefree.

Eventually, I gained acceptance. I was determined to control my diabetes and never allow it to control me. I had discovered my love for playing basketball at a young age, and nothing was going to stop me from pursuing my dreams.

Early detection One night, my family came to my game, and I could tell that something was off with my younger sister, Whitney. She frequently had to use the bathroom during the game and on the drive home.

Recognizing symptoms from my experience years earlier, my parents quickly took her to the hospital. Her diagnosis was what we had all feared; she, too, had Type 1 diabetes.

Finding community Whitney and I cried together when she returned home. We knew it would not be easy, but this life-threatening disease was not going to hinder her either. Thanks to JDRF-funded research, our diabetes technology helps us manage the disease throughout the day and during games. We also found community and inspiration by connecting with others at events like the JDRF One Walk and Children’s Congress.

Today, Whitney is entering her third season as a basketball player at Lubbock University, and I’ll be entering my third season in the WNBA as the first player with T1D. My message to every young person living with T1D is this: with determination, you can do whatever you decide to do. I’m living proof that diabetes doesn’t have to define you. n

More than 100 million Americans are currently living with diabetes or pre-diabetes.

Yet despite the prevalence of this condition, clinical resources can be few and far between, and they can be especially challenging to access for those who are at higher risk for poor outcomes.

The future of healthcare Digital therapeutics (DTx) deliver therapeutic interventions directly to patients using scientifically developed, evidence-based, and clinically evaluated software to treat, manage, and prevent diseases and disorders. DTx products can be used independently, alongside medications, or in tandem with clinician-delivered therapy.

The portability and scalability of DTx products uniquely position them as a transformative option for people with diabetes to better understand their health and gain a sense of control over their condition. Pew Research indicates that a large majority of the U.S. population owns a smartphone, and this number is likely to increase. Since most DTx interventions are delivered at least in part through Android and iOS smartphones or tablets, few technical barriers exist to the implementation and scalability of DTx products in a multitude of settings. As such, digital therapeutics have the ability to provide patients with asynchronous support and therapy when they are actively experiencing symptoms or are unable to immediately access their healthcare providers.

Reducing disparities Given that many individuals with diabetes may not have local clinician support or the educational support necessary to manage their condition, providing wider access to DTx products may empower people with diabetes and reduce the current racial, economic, and geographic disparities in outcomes. We encourage legislators to direct CMS to expand access to DTx products by formally recognizing DTx products and codifying coverage.

Andy Molnar, Chief Executive Officer, Digital Therapeutics Alliance

Lauren Cox

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SPONSORED

Preserving Vision for Diabetic Eye Disease Patients

PHOTO: COURTESY OF ALIMERA SCIENCES, INC.

Worldwide, 21 million people have diabetic macular edema (DME), the major cause of vision loss in people with diabetic retinopathy (DR).

Symptoms can include double or blurred vision, floaters, and decreased vision.

Jessica Salazar, a 38-year-old teacher from Edinburg, Texas, was diagnosed with Type 2 diabetes at age 18. She started losing her vision when she was 28. While teaching at a private school, she began having trouble reading numbers, so she consulted her doctor. Her eye doctor, Dr. Victor Gonzalez, a retina specialist at Valley Retina Institute, diagnosed her with Diabetic Macular Edema (DME).

“It affected my job, affected my social life because now I’m dependent on people driving me around,” says Salazar. She also had to make her home an open space because she worried about falling during the night due to blurry vision.

Like many people with diabetes, Salazar must schedule time every week to see her doctors. For the past two-anda-half years, Salazar has had kidney failure and has been on dialysis three times a week. In addition to DME, she suffers from low blood pressure, anemia, arthritis, nerve damage, and carpal tunnel.

About DME The retina, located at the back of the eye, is a thin layer of cells which provides our ability to see.

The macula, located near the center of the retina, is responsible for central vision. In DME, fluid collects in the macula, causing swelling which leads to blurry vision and vision loss.

People with either Type 1 or Type 2 diabetes are at risk of developing Diabetic Retinopathy (DR), which can lead to DME. Left untreated, DME can cause permanent vision loss.

Those with diabetes may delay or prevent the development of DR and DME by keeping their A1C as close to normal as possible. Risk factors for developing DME

include having diabetes for 10 or more years, poor control of blood sugar levels in the past, hypertension, hyperglycemia, kidney disease, or tobacco use.

Treating DME It’s important for people with diabetes to see an eye doctor for regular eye exams. An eye doctor needs to perform an eye exam in order to diagnose DME. There are three common treatments for DME: vascular endothelial growth factor (VEGF) inhibitor therapy which treats DME by targeting the protein, VEGF, with monthly or everyother-month treatments, corticosteroid treatment options, and laser treatments that cauterize blood vessels in the retinal tissue.

One of those corticosteroid treatments is an implant that delivers medication over a few months. In clinical trials, the effect of this corticosteroid on vision has been shown to last approximately four months and diminishes after that time.

Another treatment, the ILUVIEN microimplant, consistently and continuously delivers a very low dose of a corticosteroid called fluocinolone acetonide or FAc. The single injection provides CONTINUOUS MICRODOSING™ delivery to release the drug for up to three years.

Clinical studies have shown that ILUVIEN significantly reduced the overall number of injections for DME patients.

Indication ILUVIEN® (f luocinolone acetonide intravitreal implant) 0.19 mg is indicated for the treatment of diabetic macular edema (DME) in patients who have been previously treated with a course of corticosteroids and did not have a clinically significant rise in intraocular pressure.

Important Safety Information • Do not use ILUVIEN if you have or think you might have an infection in or around the eye.

• I LUVIEN should not be used if you have advanced glaucoma.

• You should not use ILUVIEN if you are allergic to any ingredients of ILUVIEN. • Injections into the vitreous

in the eye are associated with a serious eye infection (endophthalmitis), eye inf lammation, increased eye pressure, glaucoma, and retinal detachments.

Your eye doctor should monitor you regularly after the injection.

• U se of corticosteroids including ILUVIEN may produce cataracts (ILU-

VIEN 82%; sham 50%), increased eye pressure (ILUVIEN 34%; sham 10%), glaucoma, and may increase secondary eye infections due to bacteria, fungi, or viruses. Let your doctor know if you have a history of herpes viral infections of the eye.

• I f the posterior capsule of the lens of your eye is

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Jessica Salazar receiving an eye exam from her ophthalmologist.

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ILUVIEN, produced by Alimera Sciences, Inc., may be an option for people who have been treated for DME with a prior course of corticosteroid without a clinically significant rise in intraocular pressure.

Patients with DME should talk to their eye doctor to see if ILUVIEN is right for them.

Feeling grateful Dr. Gonzalez prescribed ILUVIEN to treat Salazar’s DME. Now, she doesn’t have to see him as often, which is very convenient for her busy life.

Salazar’s vision is now 20/25, a huge improvement — before taking the medication, she was legally blind in one eye and partially blind in the other.

“I would recommend to any patient that suffers from DME to seek this medication — ILUVIEN — to help them reduce the edema in their eyes,” she concludes. “Our vision is the most important thing that we have, and we should not take that for granted.” n Kristen Castillo

Get more information on how ILUVIEN can help treat diabetic macular edema iluvien.com/iluviendiabetic-macular-edema/.

This is one patient’s experience; patient results may vary.

missing or torn the ILUVIEN implant may move to the front chamber of the eye.

• T he most common side effects reported in patients with diabetic macular edema who were treated with ILUVIEN include cataracts (ILUVIEN 82%; sham 50%) and increased eye pressure (ILUVIEN 34%; sham 10%).

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Patient Information ILUVIEN® (ih-LOO-vee-in) (fluocinolone acetonide intravitreal implant) 0.19 mg This information is not comprehensive and does not take the place of talking to your doctor about your medical condition or treatment. If you have any questions about ILUVIEN® (fluocinolone acetonide intravitreal implant) 0.19 mg, ask your doctor. Only your doctor can determine if ILUVIEN is right for you. Visit www.iluvien.com to obtain the FDA-approved product labeling. ..............................................................................................................

What is ILUVIEN and what is it used for?

• ILUVIEN is a prescription medicine used to treat diabetic macular edema (DME) in patients who have been treated with corticosteroids previously and did not have a significant increase in eye pressure. DME is a swelling of the light-sensitive layer at the back of the eye (macula) and is a condition that may occur in people with diabetes.

• ILUVIEN is a tiny implant that is injected by your doctor into the back of the eye where it releases a continuous low dose of medicine directly to the retina for up to 36 months. The medicine in ILUVIEN is called fluocinolone acetonide which is a type of steroid called a corticosteroid.

• It is not known if ILUVIEN is safe and effective in children less than 18 years of age.

• Tell your doctor if the eye becomes red, sensitive to light, painful or develops a change in vision after ILUVIEN. ..............................................................................................................

secondary eye infections due to bacteria, fungi, or viruses.

• the implant may move from the back of the eye to the front of the eye if the lens capsule is not intact.

• Tell your doctor if the eye becomes red, sensitive to light, painful or develops a change in vision after ILUVIEN. The most common eye-associated (ocular) side effects reported in patients with DME who were treated with ILUVIEN include: • cataracts. If a cataract occurs, your vision will decrease and you will need cataract surgery to restore your vision.

• increased eye pressure, which may progress to glaucoma, if untreated. For this reason, your doctor will monitor you regularly after the injection. Increase in eye pressure can be treated with eye pressure-lowering medications (usually eye drops). However, some people may require eye surgery to treat their increased eye pressure.

The most common side effects not associated with the eye (non-ocular) reported in patients with DME who were treated with ILUVIEN include: • decrease in the amount of red blood cells or hemoglobin in the blood (anemia).

• headache.

• kidney (renal) failure.

Who should not use ILUVIEN?

• pneumonia.

• Do not use ILUVIEN if you have or think you might have an infection in or around the eye.

These are not all the possible side effects with ILUVIEN. Tell your doctor about any side effect that bothers you or does not go away. You are encouraged to report side effects to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. ..............................................................................................................

• ILUVIEN should not be used if you have severe glaucoma (high pressure in the eye).

• You should not use ILUVIEN if you are allergic to any ingredients of ILUVIEN (see complete list below). ..............................................................................................................

What should I tell my doctor before using ILUVIEN? Tell your doctor if you: • have had a history of herpes viral infection of the eye (an ulcer or sores on the eye) • are pregnant or plan to become pregnant. It is not known if ILUVIEN can harm your unborn baby.

General information about ILUVIEN • Medicines are sometimes prescribed for purposes other than those listed in their package inserts. This is a Brief Summary of important information about ILUVIEN. Ask your doctor or pharmacist for more complete product information or visit www.ILUVIEN.com, or call 1-844-445-8843.

What are the ingredients in ILUVIEN? • Active ingredient: 0.19 mg fluocinolone acetonide.

• are breastfeeding or plan to breastfeed. It is not known if ILUVIEN passes into your breast milk. ..............................................................................................................

• Inactive ingredients: polyimide tube, polyvinyl alcohol, silicone adhesive, and water for injection. ..............................................................................................................

How should ILUVIEN be used?

ILUVIEN (fluocinolone acetonide intravitreal implant) 0.19 mg

• A retina specialist will insert a single ILUVIEN implant in your eye during an in-office procedure. The eye is numbed prior to the procedure, and then the implant is delivered to the back of the eye through a tiny needle within the applicator.

Following ILUVIEN treatment, your doctor will schedule periodic appointments to monitor your condition. ..............................................................................................................

Manufactured for: Alimera Sciences, Inc. 6120 Windward Parkway Alpharetta, GA 30005 See: www.alimerasciences.com

What are some of the possible side effects of ILUVIEN? The use of ILUVIEN may cause serious side effects including: • serious eye infection (endophthalmitis), eye inflammation, increased eye pressure, and retinal detachments.

• cataracts (clouding of the lens), glaucoma and increased

All Rights Reserved. ILUVIEN is a registered trademark of Alimera Sciences, Inc. Copyright ©2021 Alimera Sciences, Inc. All Rights Reserved.

1-844-445-8843. Printed in USA. US-ILV-REF-0073.

US-ILV-MMM-0970-01 10/2021 04/2019

Being a Woman with Diabetes: The Importance of Community and Advocacy

to learn how to manage this stage in life.

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What are some of the barriers faced by women living with diabetes?

What inspired you to join DiabetesSisters? What was it like growing up as a woman living with diabetes?

I was diagnosed with Type 1 diabetes in August 1993, two weeks before beginning college at University of Florida. I was lucky that I had advocacy instilled in me from such a young age, because I knew which questions to ask my school infirmary doctor. I owe much of this gumption to my mom, who had spent countless hours with medical teams, as my sister was born with special needs and required constant medical care. I didn’t realize the value of knowing how to advocate for myself until I received my own health diagnosis, and even then, it took me nearly seven years to fully grasp what it meant to have diabetes, to have to focus time and energy on blood sugar management, when all I wanted was to be a young woman who was enjoying college life and the excitement that is built around it.

DiabetesSisters came to be thanks to Brandy Barnes, a woman also living with diabetes, who saw a need for peer support while she was pregnant with her daughter.

Brandy shared the isolation she felt during pregnancy and never wanted anyone to feel that way again. In 2008, she founded DiabetesSisters.org, a place for women living with any kind of diabetes to find support through one another.

It didn’t take long for the organization to become a safe space for women of all ages to talk about their successes and challenges, to ask questions about treatment, and to find referrals for specialists. It was one of the first organizations of its kind to offer peer support, always without judgement or stigma.

Since then, it has grown to become a leading diabetes nonprofit in the United States.

Our meetup program — PODS Meetups — allows women to meet monthly to share their experiences with diabetes in a safe and judgement-free space. The meetups focus on

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Anna Norton, CEO of DiabetesSisters, explains the importance of being an advocate for yourself and others in the fight for better and more equitable diabetes healthcare.

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a monthly topic, then leaders open the circle for discussion, sharing, and support.

In 2016, we introduced an outreach program for underserved communities, specifically African American, Hispanic Latinas, and South Asian women. The program focuses on grassroots efforts to educate women in ways that they can prevent diabetes, better manage their health, and make attainable goals to live a healthier life. We even now have gatherings in Spanish!

As a Hispanic woman myself, I am immensely proud of this program and how it reaches women that could be my family.

We also have a great website and newsletter full of articles and links to resources.

You can check us out at www.diabetessisters.org.

How are women living with diabetes particularly vulnerable today, and what can we do to increase the standard of care for them?

We need focus on how women balance so many things. Often,

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we manage our personal lives, work lives, family life, and our physical and mental health.

We need to train our medical teams to ask more questions about the way we live, about our hustle and bustle, and then have them offer ways to alleviate the stressors and find healthy ways to maintain proper mental health.

We also need more research, studies, and learnings on women’s reproductive health. Oftentimes, we hear about diabetes and pregnancy, but it’s typically Type 1 diabetes. What about gestational diabetes? There is an increased possibility of developing Type 2 diabetes after gestational diabetes, and many women are unaware of this. Additionally, other life changes such as menopause are rarely discussed with healthcare providers and women with diabetes. This is such an extremely important life event for women living with diabetes. It’s uncharted territory for so many, and there are so few studies that we are relying on each other

One of the biggest barriers for women living with diabetes and insulin use is lack of education. When our healthcare teams prescribe insulin, we are too often not taught about titration, dosing, or hypoglycemia. I know I wasn’t taught those things when I was diagnosed. When we fill our prescriptions, we may not receive guidance or education from our pharmacists. That’s a big challenge for anyone who uses insulin.

Regarding access, we live in a country where access is not necessarily a challenge. Most of the time, the best diabetes treatments are available to us. But affordability, that’s a different story. I know many personal stories of the struggle of being able to afford the newest insulins. It’s heartbreaking to hear these stories, and there needs to be a solution to this crisis. Diabetes has come a long way, but there is still so much work to be done to ensure we are living the healthiest and best lives we deserve.

What does health equity mean to you?

Health equity means that I have the right to be healthy, despite being a woman, a minority, or a person with diabetes. For women, this includes women’s health and pediatric health for our children. We must continue to demand access and affordability in our care, timely routine examinations, and answers to our health questions. n

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The Importance of Insulin Accessibility and Affordability More than 1.6 million Americans live with Type 1 diabetes (T1D), and this number continues to grow.

They need insulin several times a day, every day, just to survive.

Despite the life-saving nature of this drug and studies showing the health impact of affordable insulin, the cost has nearly tripled over the last decade. It’s no coincidence that the rise in price coincides with more people rationing their insulin — a potentially life-threatening practice. No one should suffer or die because they cannot afford insulin.

JDRF, as a leader in the fight to end T1D, has spent years advocating to policymakers, insulin manufacturers, health insurers, pharmacy benefit managers (PBMs), and employers, demanding action to lower insulin costs for everyone, regardless of insurance status.

Insulin access Insulin should be available to people with diabetes at a low, predictable out-of-pocket cost. Immediate steps can ensure greater access for those with insurance through adoption of caps on monthly out-of-pocket costs for insulin and passing savings from rebates directly to the consumer at the pharmacy counter. Insulin manufacturers should also take immediate steps to lower their prices and expand patient assistance programs for those who are uninsured or need assistance with costs.

Insulin choice T1D is a unique disease that affects everyone differently. The same is true for how insulins work. Health plans and PBMs should allow people access to the insulin that works best for them.

Next-generation therapies We need better therapies that will make managing T1D less burdensome. JDRF is a significant funder of research to advance new, innovative therapies, including insulins. We call for health policies that encourage the research and development of new innovations and make them available to everyone.

Aaron Turner-Phifer, JDRF Director of Health Policy

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Know These 5 Numbers If You Have Diabetes

that is used to help determine if you’re overweight or obese. A normal BMI usually ranges from 18.6 to 24.9 and can be calculated in a doctor’s office or at home using a BMI calculator.

2. Blood pressure Blood pressure is how strongly the blood pumps through your body when your heart beats, and it’s a sign of heart health.

A healthy blood pressure for most people is less than 120/80, but your doctor may give you a different goal based on your diabetes. Blood pressure can be measured in a doctor’s office or at home if you have a blood pressure monitor.

3. A1C Your A1C is a measure of average blood glucose levels for the past two to three months. A healthy A1C for someone with diabetes is 7 percent or less. A1C is measured by a blood test and should be checked at least every six months if you have diabetes.

Although Hispanic/Latino Americans are at significant risk for developing diabetes and suffering from its devastating complications, those living with diabetes can thrive. The path to a longer, healthier life starts with managing some basic health numbers.

“My message for others living with diabetes is that we have control and choices,” says Lupe Barraza, who lives with Type 2 diabetes.

She is a spokesperson for Know Diabetes by Heart, an initiative of the American Heart Association and the American Diabetes Association. “Managing key health numbers can help you prevent complications from diabetes, like heart failure and kidney disease.”

Paying attention to blood pressure, cholesterol, and weight are especially important for anyone living with diabetes, since having diabetes doubles your chances of developing cardiovascular diseases like heart disease, strokes, or heart failure.

“You don’t have to wait until you get sick to go to the doctor.

You, your doctor, and your family should work together now to keep you from getting sick,” Barraza says.

The American Heart Association and the American Diabetes Association share five key measurements all people living with diabetes should track regularly.

1. BMI (body mass index) Your BMI is an estimate of body size based on height and weight

4. Cholesterol Cholesterol is a waxy substance in the blood. If cholesterol levels are too high, they can cause fatty deposits in blood vessels that can lead to a heart attack or stroke.

Cholesterol is measured by a fasting blood test in a doctor’s office.

5. Kidney function Early detection of chronic kidney disease (CKD) can make a huge difference. An often-overlooked test is the UACR (urine albumin to creatinine ratio) which can detect early signs of trouble.

Kidney function is measured in a doctor’s office and should be done every year. Visit www.

KnowDiabetesbyHeart.org for more information. n Jayme Sandberg, Know Diabetes by Heart

Bringing Type 1 Diabetes Screening to All

Approximately 40-60 percent of people in the United States present with life-threatening diabetic ketoacidosis (DKA) at the time of a Type 1 diabetes (T1D) diagnosis. There is a way to change that, however. T1D screening can identify at-risk individuals prior to a T1D diagnosis.

DKA is scary. It is a major and life-threatening complication due to a shortage of insulin, causing symptoms like dehydration, nausea, vomiting, confusion, or, in extreme cases, coma or death. Luckily, JDRF-funded scientists have discovered how to identify at-risk individuals prior to a T1D diagnosis.

Scientists have discovered that having two or more specific autoantibodies — antibodies that are directed toward your own body — means that you have

an almost 100 percent chance of developing T1D in your lifetime. Doctors can screen for these autoantibodies, and JDRF-funded studies have shown that screening followed by close monitoring can help significantly decrease the risk of DKA and produce other beneficial health outcomes. It also opens the opportunity to participate in clinical trials to potentially delay or prevent this disease from occurring at all.

Delaying T1D There are therapies in the pipeline, like teplizumab, that can delay the onset of T1D for nearly three years in people with two or more autoantibodies. This drug was the first ever to delay T1D onset in humans and is now being considered by the FDA for approval.

For many years, programs have helped screen and monitor T1D family

members and helped them enroll in clinical trials, which is still a great way to get screened if you have a family history of the disease. However, such programs don’t capture the 93 percent of people who do not have a family history of T1D. Without having access to T1D risk screening and knowledge of their risk status, these people won’t have the time to prepare for a T1D diagnosis and prevent the risk of dangerous DKA events or enroll in a potentially life-changing clinical trial.

JDRF launched T1Detect to equip the public with knowledge about the benefits of screening, provide a new avenue to get screened, and offer personal support to those determined to be at risk.

How you can help If you or someone you know doesn’t have T1D and hasn’t been screened,

then visit jdrf.org/t1detect. You can learn more about T1D screening, order an in-home test kit from the testing lab, collect a blood sample, and return it. It’s that easy.

The testing lab will provide the autoantibody results in a few weeks, as well as explanations of what the results mean and important next steps if the results are positive. If you want to share your results with JDRF, you will receive personal support, additional education, and resources to help you navigate your next steps.

If T1Detect helps even just one person avoid DKA — as well as the risk, hospital costs, and worry that it brings — then we have done our job to improve outcomes and eliminate DKA at diagnosis. n Frank J. Martin, Ph.D., Senior Director of Research, JDRF

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