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Type 1 diabetes is a relentless disease, according to David Maahs, M.D., M.A., Ph.D., from Stanford University.

The Challenges of Treating Type 1 Diabetes

The rising popularity of the continuous glucose monitor, which is not the same as an insulin pump, has been a huge advance in type 1 diabetes treatment, according to David Maahs, M.D., M.A., Ph.D., from Stanford University. 

Comparing and Contrasting Continuous Glucose Monitors and Insulin Pumps

David Maahs, M.D., M.A., Ph.D., explains why teamwork is the most important part of the 4T diabetes management program. 

4T Program Improves Diabetes Outcomes Through Advocacy and Technological Solutions

David Maahs, M.D., M.A., Ph.D., explains the role that teamwork, targets, technology and tight control plays in type 1 diabetes management and why it’s best to intervene right after diagnosis. 

Personalized Diabetes Care Approach Targets Tight Glucose Control from Diagnosis

Managed Healthcare Executive provides C-suite executives at health plans and provider organizations with news, analysis, insights, and strategies to pursue value-driven solutions.

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He is president of the Wellesley, Mass.-based Disease Management Purchasing Consortium and is an editorial advisor for MHE.

You will never be able to measure wellness and you actually don't want to

BLOG: Why we can't measure wellness outcomes

Reported outcomes from medical homes must be able to discern between true and preceived cost savings, and North Carolina is an example of what can go wrong

Time to challenge ROI of medical homes

Following the FDA’s Mar. 8 decision to approve semaglutide (Wegovy) as a preventive for stroke and heart disease in overweight individuals, the CMS announced last week that it will soon be covered under their Medicare Part D drug program as well, multiple news outlets 

“This patient population has a higher risk of cardiovascular death, heart attack and stroke," John Sharretts, M.D., director of the Division of Diabetes, Lipid Disorders, and Obesity in the FDA’s Center for Drug Evaluation and Research said in an FDA 

. "Providing a treatment option that is proven to lower this cardiovascular risk is a major advance for public health."

 Medicare beneficiaries to undergo step therapy with other drugs before receiving a Wegovy prescription.

Marijane Hynes, M.D. is a clinical professor of Medicine at the George Washington Weight Loss Clinic in Washington, D.C. Almost half of the patients she serves are on Medicare or Medicaid.

“It is excellent that Medicare will cover Wegovy for CVD disease, as it will improve patient outcomes and help decrease cost and hospitalizations overall for patients with heart disease,” Hynes said.“However, this is secondary prevention, and Medicare needs to consider covering these medications for primary prevention when patients have obesity before they get heart disease.”

Without coverage, out of pocout-of-pocketket costs for Wegovy are around $1,400 a month, causing patients to seek cheaper options from Mexico and Canada. Gastric bypass surgeries are also extremely expensive without coverage – nearly $20,000 Hynes said.

Hynes also said that there is no “magic pill” or procedure that will make the weight melt away and stay away. She said there must be behavioral skills and an exercise regimen in place in addition to treatment.

There are also side effects that come along with Wegovy that patients should know about. Wegovy works by making fatty foods taste less appealing and can make patients sick if they decide to eat them after taking a dose.

“They're still injectable medications and someone has to be monitoring the patients and helping them through the side effects,” Hynes said.

 for chronic weight management in adults in June 2021. The approval was later expanded to include children ages 12 and older.

New development comes after the FDA’s Mar. 8 Wegovy approval for patients at risk for heart attack and stroke.

Medicare Part D to Cover Wegovy for Obese Patients at-risk for Heart Disease

 Monday that a new clinical trial called A5374 has begun. The new trial aims to treat HIV patients with a combination of three therapies that include a therapeutic T-cell vaccines, two broadly neutralizing antibodies (3BNC117-LS, 10-1074-LS) and TLR7 agonists to boost the immune response. The goal of the trial is to improve the immune response so that HIV patients can successfully stop relying on ART for treatment.

“Our goal with this study is to demonstrate that enhancing immune responses to HIV will lead to sustained suppression of HIV during treatment interruption,” A5374 Protocol Chair Sharon A. Riddler, M.D., M.P.H., University of Pittsburgh, said in a 

ACTG Chair Judith Currier, M.D., M.Sc., spoke with 

and explained what this trial may change for the future of HIV. Currier is a professor of medicine, Executive Vice Chair for Research and Co-Director of the Center for AIDS Research and Education Center (CARE) in the Department of Medicine at University of California, Los Angeles (UCLA). She has been treating HIV patients for over 30 years.

In the United States, approximately 1.2 million people have HIV. Worldwide, an estimated 39.9 million have have it, according to 

The ACTG is one of the largest HIV clinical trial organizations in the world and was founded in 1987.

Tell us about the new trial. How will it work?

It's for a very unique population of people who were identified right at the time they acquired HIV. There's a window where you can tell if somebody is in the process of developing antibodies to HIV.

It's thought that if you detect HIV and treat it really early, you might control the size of what's called the latent reservoir, so the virus doesn't get to set up housekeeping.

The goal is to see whether this approach delays the return of the virus or improves the immune response compared to what would have happened without it.

The way that we evaluate whether the intervention has done anything to improve the body's immune response is to stop their antiretroviral therapy and look for how long they can remain off treatment before the virus comes back.

If it works, it could be tested on people who had HIV that were identified later, not just in this very early stage.

Is this trial similar or different to previous HIV treatment trials? How so?

Normally, [the trials] test one thing at a time but combining these three things together looked promising in the nonhuman primate model. There are many different approaches to ART-free remission that have been explored to enhance the immune response, but this study is focused on trying to make it so that you can control HIV without medication. These components have all been tested individually in other settings and so it's time to bring them together.

It's putting three things together that are each experimental. I think the extra effort required will pay off because we need to be bold in our approaches and make progress. Taking little steps hasn't gotten us very far.

Where is this trial in the timeline to curing HIV? 

Do you think we’re on course to curing HIV by 2030?

When they say they want to end HIV by 2030, it's ending new infections. There's a whole category of studies that are been focused on trying to “cure HIV.” The word cure has as a lot of connotations, so we use antiretroviral-free remission. We're looking at strategies that might make it possible for people with HIV to be off treatment and control the virus themselves. It's not decades away. I think it could be sooner than that.

Judith Currier, M.D., M.Sc., ACTG Chair, discussed the trial, how it’s different than previous research and the connotations surrounding the “cure” to HIV. 

Clinical

New ACTG Trial Aims to Control HIV Without the use of ART

The Federal Trade Commission (FTC) issued a final rule

 that will ban noncompetes nationwide. The ruling, which was proposed in January 2023, is a cause for celebration for many, and a reason to worry for others. The initial proposal received over 26,000 comments in the 90-day period, 25,000 of which were in support of a noncompete ban, according to the FTC’s website.

“Noncompete clauses keep wages low, suppress new ideas, and rob the American economy of dynamism, including from the more than 8,500 new startups that would be created a year once noncompetes are banned,” FTC Chair Lina M. Khan said in a 

. “The FTC’s final rule to ban noncompetes will ensure Americans have the freedom to pursue a new job, start a new business, or bring a new idea to market.”

The U.S. Chamber of Commerce has since sued the FTC, claiming that the FTC’s decision was an “astonishing power grab” in a 

 and that the ruling opens up the possibility for the FTC to ban or regulate other business practices.

, spoke with Managed Healthcare Executive and provided insights on how the ruling may affect the healthcare world. Hill Ward Henderson is a commercial-focused firm of over 100 attorneys that represent public and private businesses. Brown has been practicing for nearly 30 years and specializes in business partnership disputes such as noncompetes and trade secret protection.

I think universally people assumed that a rule was going to be enacted.

This was clearly a very political move. The commission voted down party lines, three Democrats voted in favor of the rule, and two Republican appointees voted against it.

Who will be most affected by this ruling?

I would say, insurance executives, client facing insurance folks, that's where you're most likely to see the issues. I think [the rule] is kind of poorly drafted and I think what it's intended to do is address a problem that doesn't really exist. If you read some FTC publications associated with the rule, they talk about security guards being subject to enforcement action. If that happens, it happens rarely. The types of folks that tend to see enforcement actions are senior-level executives or client-facing employees like salespeople.

If they can’t use noncompetes, what legal steps might employers take to protect themselves?

A noncompete comes in a bundle of restrictive covenants. Typically, you will have a noncompete, a nonsolicitation, antipiracy and confidentiality provisions. If this rule holds up, I think you're going to see health-related organizations trying to enforce a nonsolicitation policy as opposed to a noncompete agreement. The rule doesn't speak to nonsolicitations and anti-piracy.

We're ready for a little bit of chaos associated with interpreting this. There's going to be a lot of healthcare organizations and hospital doctor groups that are trying to figure out what their obligations are and what their restrictive covenants can look like with their physicians.

It kind of remains to be seen how everything will shake out.

Gregory P. Brown, J.D., partner at Hill Ward Henderson, a law firm based in Tampa, talked about potential upcoming complications for healthcare employers and employees. 

Healthcare Employers May Soon Focus on Nonsolicitation Agreements in Wake of FTC Announcement

 from The Ohio State University Wexner Medical Center showed  that nearly 1 in 3 Americans are unaware of the risks associated with eye damage while viewing the upcoming total solar eclipse set to occur on April 8 at 3:20 p.m. ET.

Nearly 32 million Americans will be along the “path of totality” where they will be able to experience an eerie, dawnlike darkness during the height of the eclipse, which will last about 4 minutes.

It is never safe to look directly at the sun, even when the moon is blocking much of it as happens during a solar eclipse, because the brightness can potentially permanent damage that can occur to the retina and cornea.

“The best way you can enjoy yourself is to be prepared,” Nicholas Kman, M.D., emergency medicine physician at The Ohio State University Wexner Medical Center said in an interview with 

today. “The safest way to view the eclipse is with certified eclipse glasses. There are also different types of welder’s goggles that are designed to protect the eyes from bright flashes of light. Other than that, normal sunglasses would not be adequate for this, even if they seem very dark.”

Eclipse glasses, which are ISO-certified, are available online and may be given out for free at community spaces such as local libraries.

The last eclipse, a partial solar eclipse, happened in 2017. The upcoming total eclipse is much rarer and won’t be seen again in the United States for another 20 years, according to 

. The path of totality will also be much broader than the one in 2017.

“We learned a lot of lessons from the eclipse in 2017 - the traffic jams were incredible," Kman said. "One of the things that we're worried about as a hospital is ‘can we get our staff to work?’ It’s almost like a severe weather event.”

In Ohio, where Kman is based, people within a 124-mile wide band will experience the total eclipse. The zone falls between Toledo and Cleveland and then slices south and west through the state. 

“If the weather's good, there's been estimates of about three times the normal amount of people in each of the counties that are in the eclipse path,” Kman said. “In our smaller counties, three times the number of people would put a large stress on gas stations, cell towers, law enforcement and EMS providers."

"Keep in mind that after totality, traffic will be massive," Gary Kader, director of the Burrell Observatory at Baldwin Wallace University in northern Ohio said in a recently 

 story. "Think of the Browns, Cavaliers and Guardians all letting out during rush hour."

Before traveling for the eclipse, Kman recommends that in addition to the right eye protection, people should have a full tank of gas, snacks, cellphone chargers and a plan if the group gets separated.

“We want people to enjoy themselves, but the best way you can enjoy yourself is to be prepared.”

Experts say ordinary sunglasses aren't protective enough for viewers of the solar eclipse on Monday. You need those certified eclipse glasses. Ten-packs were selling on Amazon today for $12.99.

Don't Be Blinded by the Sight of the Eclipse

Engagys LLC, the leading healthcare consumer engagement consulting and advisory firm, has released the results of its highly anticipated Ninth Annual State of Healthcare Consumer Engagement Survey. Drawing on responses from healthcare payer organizations, this year’s survey sheds light on the most critical trends shaping healthcare consumer engagement, focusing on financial constraints, AI integration, and the continued importance of both traditional and digital communication strategies.

Al Lewis

Articles

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