News in brief: Children with diabetes now eligible for Pfizer vaccine; HbA1C values unreliable after drug or alcohol use; PCSK9 inhibitor gets PBS listing for lipid lowering; Drug use by young people with T1D may affect glycaemia measures

Wednesday, 4 Aug 2021

ATAGI recommends Pfizer vaccine for children with diabetes

Children aged 12–15 with chronic conditions such as diabetes or obesity are among the high risk groups for COVID-19 that should prioritised for vaccination using the Comirnaty (Pfizer) vaccine, according to the Australian Technical Advisory Group on Immunisation (ATAGI)

Following the recent TGA approval of Pfizer vaccine to be extended from people aged 16 years and over to include children aged 12–15 years, ATAGI has recommended that children with specified medical conditions should be first to receive the vaccine, along with Aboriginal and Torres Strait Islander children and children living in remote communities.

However in its advice, ATAGI acknowledges that myocarditis and/or pericarditis have recently been reported overseas in adolescents aged 12 and older following mRNA COVID-19 vaccines including Comirnaty.

It said the risk of these conditions appears higher in adolescents compared to adults, and that follow up is ongoing to understand the potential longer-term implications of myocarditis following COVID-19 vaccination.

HbA1c less predictive of glucose levels after drug or alcohol use

Young adults with type 1 diabetes should be told to monitor their glucose more closely when consuming illicit drugs or alcohol, Australian clinicians warn.

Researchers at St Vincent’s Hospital, Melbourne saw no difference in hypoglycaemia rates on substance-using days versus non-substance using days, but they did find HbA1c was a less reliable predictor of glucose patterns in the 24 hours post drug or alcohol consumption.

Published in Endocrinology, Diabetes & Metabolism, the study assessed daily glucometrics in twenty type 1 diabetes patients aged 18–35 for six weeks using flash glucose monitoring.

“As alcohol and illicit drug use are common in this age group, clinicians need to be aware of the potential impact of substance use on glucose parameters in young adults with type 1 diabetes,” the authors wrote.

“Even those young adults with adequate glucose control need to engage in harm reduction measures, including closer monitoring of their glucose levels, should they choose to consume alcohol or illicit drugs,” they concluded.

PCSK9 inhibitor gets PBS listing for lipid lowering

The PCSK9 inhibitor alirocumab (Praluent) has been listed on the PBS from 1 August for treatment of adults with Non-Familial and Heterozygous Familial Hypercholesterolaemia.

The injection is available on the PBS for patients with Non-Familial Hypercholesterolaemia who have symptomatic atherosclerotic cardiovascular disease (ASCVD), additional high-risk factors and LDL-C above 2.6 mmol/L despite the maximum tolerated dose of a statin and ezetimibe for more than12 weeks.

Alirocumab is also available for  patients with Heterozygous Familial Hypercholesterolaemia with symptomatic ASCVD and LDL-C above 2.6 mmol/L, or without symptomatic ASCVD and LDL-C above 5 mmol/L despite the maximum tolerated dose of a statin and ezetimibe for more than 12 weeks.

According to sponsor Sanofi, alirocumab  has been shown to lower LDL-C by more than 50% on top of optimised statin with or without other lipid-lowering therapy, and to reduce the risk of repeat events in patients with a recent history of ACS and LDL-C that remains above the guideline recommended target of 1.8mmol/L.

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