WORCESTER MEDICINE
Game Changers No More Finger Sticks Continued The original Libre does not have any low- or high-glucose alert features. The Libre 2 offers customizable high and low alarms. Both the Libre and Libre 2 are flash CGM sensors meaning the data is not continuously sent to the reader or their phone, but rather the patient must scan the sensor with the reader or smartphone to view a blood glucose reading along with the blood sugar trend and graph. The Eversense CGM sensor from Senseonics is the first longterm implantable sensor. The sensor is generally inserted under the bicep muscle and replaced every 90 days at an outpatient visit. Advantages of the implantable sensor include 90 days of continuous wear and the ability to remove the external transmitter without needing to change the sensor. Several studies have demonstrated that use of CGM therapy significantly lowers HbA1c (1,2). Data from 248 patients — 182 with Type 1 diabetes and 66 with Type 2 diabetes — demonstrated a significant decrease in mean HbA1c from 8.2% at baseline to 7.1% at the end of the three-month study (P < 0.001). More than half of those with initial HbA1c values >7% experienced absolute HbA1c reductions of >1%. Additionally, significant reductions in diabetes distress and hypoglycemic concerns were observed (P < 0.001) (1). Few things are truly as rewarding as the improvement in self-management seen after prescribing CGM therapy. In my experience, it is not unusual for patients who have struggled for years with uncontrolled sugars, many with HbA1c values > 10%, to return to the office two weeks after sensor placement with near normal glucose control. I recently asked one of those patients why CGM made the difference for her. She admitted, as a mother of five children, it couldn’t be easier for her to forget to care for herself, which included the arduous task of trying to measure her blood sugars and remember to take her medications. While wearing the CGM sensor, however, she simply couldn’t ignore the high blood sugars. It directly correlated to marked improvements in medication compliance and diet. Diabetes is a chronic complex condition associated with a long list of complications and a high treatment burden. Fortunately, this technology offers patients a non-pharmacological tool to proactively address their glucose level and improve overall glucose control thus reducing their risk of long- term complications while improving their day-to-day quality of life. + references
1. WH;, Gilbert TR;Noar A;Blalock O;Polonsky. “Change in Hemoglobin A1C and Quality of Life with Real-Time Continuous Glucose Monitoring Use by People with Insulin-Treated Diabetes in the Landmark Study.” Diabetes Technology &amp; Therapeutics, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih. gov/33470882/. 2. Wright, Eugene E., et al. Use of Flash Continuous Glucose Monitoring Is Associated With A1C Reduction in People with Type 2 DIABETES Treated with Basal Insulin or Noninsulin Therapy. Diabetes Spectrum, American Diabetes Association, 1 May 2021, spectrum.diabetesjournals.org/content/34/2/184. 12
Herpes Zoster Vaccine: A Breakthrough in Preventing Shingles Anna K. Morin, PharmD
H
erpes zoster, also known as hz or shingles,
is caused by the varicella zoster virus, or VZV, the same virus that causes chickenpox (1). VZV remains dormant in the body within the dorsal root ganglia and can reactivate years later, spreading along a sensory nerve to cause HZ. Not everyone who had chickenpox will develop shingles, but immunity to VZV declines with advancing age and the risk for developing shingles rises sharply after the age of 50. An estimated 1 million people get shingles annually in the United States with approximately one out of every three people developing shingles during their lifetime. The annual incidence for HZ in the U.S. is approximately five cases per 1,000 in adults aged 50-59 years. However, the estimated annual incidence among individuals 80 years and older more than doubles to 11 cases per 1,000 (1,2). Immunocompromised individuals are at greater risk of developing shingles (2). Because the risk of reactivation of vaccine-strain VZV is lower compared with reactivation of wild-type, non-vaccine strain, VZV, children who have been vaccinated against chickenpox have a lower risk of developing HZ (3). There is limited information on the impact of the chickenpox vaccine on the rate of HZ in those who received the vaccine as an adult. The economic and public health impact associated with HZ in the U.S. is significant. Estimated annual direct and indirect costs related to not being vaccinated for HZ in the U.S. are nearly $800 million and the costs associated with HZ in those over the age of 65 is projected to be $4.74 billion by 2030, if the incidence of HZ is not decreased (4). Shingles presents as a painful maculopapular rash that commonly develops in one or two adjacent dermatomes and presents as a single strip on one side of the body, this is localized HZ (1,3). The rash most often appears on the trunk along a thoracic dermatome as blisters or vesicle clusters that typically scab over in seven to 10 days and fully clear within two to four weeks. Less commonly, the rash can be more widespread and affect three or more dermatomes, this is disseminated HZ (1,3). Disseminated zoster generally occurs in those with compromised or suppressed immune systems and can be difficult to distinguish from chickenpox. Symptoms of pain, itching or tingling may precede the onset of an HZ rash by several days. Most individuals experience a single episode of shingles during their lifetime. However, multiple episodes of shingles are possible.
NOVEMBER / DECEMBER 2021
