Diabetes treatment by the algorithm

Size: px
Start display at page:

Download "Diabetes treatment by the algorithm"

Transcription

1 Diabetes treatment by the algorithm Joseph Dawley, M.D. Southwest Oklahoma Family Medicine Residency Oklahoma University Health Sciences Center Clinical Assistant Professor Objectives By the end of this presentation you should be able to: Understand the principles of Type 2 diabetes management Recognize lifestyle management strategies Know the goals for glycemic control Use the glycemic control algorithm Use the algorithm for adding/intensifying insulin Utilize the pre-diabetes algorithm 1

2 Disclosure I have nothing to disclose. Epidemiology Diabetes affects 8.3% of the U.S. population 25% of these have not been diagnosed 90% of these cases are Type 2 diabetes Another 35% of U.S. adults have pre-diabetes Up to 70% of people with pre-diabetes develop Type 2 diabetes 2

3 Epidemiology Non-Hispanic whites : 7.1% Asian Americans: 8.4% Hispanic Americans: 11.8% African Americans (ie, non-hispanic blacks): 12.6% Native Americans: 16.1% Morbidity and Mortality Relative to people without diabetes: Risk of death from any cause: 2x Risk of death from cardiovascular disease: 2-4x Risk of stroke: 2-4x 3

4 Morbidity and Mortality Diabetes is the: 7th leading cause of death according to death certificate data Leading cause of blindness among adults Leading cause of renal failure More than 60% of non-traumatic lower limb amputations are among diabetics Diabetes doubles the risk of periodontal disease Costs Direct costs: $116 billion Indirect costs: $56 billion 4

5 Principles for the treatment of Type 2 Diabetes 1.Lifestyle therapy 2.Weight loss Behavioral interventions Weight loss medications 3.A1C target 4.Glycemic control targets Principles for the treatment of Type 2 Diabetes 5.Choice of therapy 6.Minimizing risk of hypoglycemia is a priority 7.Minimizing risk of weight gain is a priority 8.Total cost of care 9.Stratified starting point based on A1c 5

6 Principles for the treatment of Type 2 Diabetes 10.Combination therapy is usually required 11.Comprehensive therapy includes BP and lipid control 12.Therapy must be evaluated frequently 13.Therapeutic regimen should be as simple as possible 14.This algorithm includes every FDA-approved class of medications for diabetes Lifestyle modifications and weight loss Nutrition; initial steps Maintain optimal weight Calorie restriction Plant-based diet; high in polyunsaturated and monounsaturated fatty acids 6

7 Lifestyle modifications and weight loss Nutrition; increased intensity of therapy Limit saturated fatty acids Avoid trans fatty acids Nutrition; highest intensity of therapy Structured counseling Meal replacement Lifestyle modifications and weight loss Physical activity; initial steps 150 mins of moderate exertion per week Strength training Increase as tolerated 7

8 Lifestyle modifications and weight loss Physical activity; increased intensity of therapy Structured program Wearable tech Physical activity; highest intensity of therapy Medical evaluation/clearance Medical supervision Lifestyle modifications and weight loss Sleep; initial steps Basic sleep hygiene ~7 hours per night Sleep; increased intensity of therapy Screening for OSA; Home sleep study Sleep; highest intensity of therapy Referral to a sleep lab 8

9 Lifestyle modifications and weight loss Behavioral support; initial steps Community engagement Alcohol moderation Behavioral support; increased intensity of therapy Discuss mood at office appointment Behavioral support; highest intensity of therapy Formal behavioral therapy/psychiatry referral Lifestyle modifications and weight loss Smoking cessation; initial steps No tobacco products Smoking cessation; increased intensity of therapy Nicotine replacement Smoking cessation; highest intensity of therapy Structured program 9

10 Lifestyle modifications and weight loss A1c and glycemic goals 10

11 Choosing Wisely Avoid using medications other than metformin to achieve hemoglobin A1c<7.5% in most older adults; moderate control is generally better. American Geriatrics Society. Choosing Wisely Avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia. Endocrine Society. 11

12 A1c < 7.5 The order of medications suggests a hierarchy of usage. The length of the green (or yellow) line represents the strength of recommendation. 12

13 A1c 7.5 Or no improvement within 3 months Emphasis is still on metformin if tolerable Other 1st line agents if not A1c 7.5 With no improvement from dual therapy at 3 months 13

14 A1c > 9 All depends on symptoms Remember to keep your eye on cost of care 14

15 Starting basal insulin Glycemic goal is <7% for most patients Pre-meal blood glucose <110mg/dl without hypoglycemia Intensifying therapy You may add a GLP-1 RA or an SGLT-2i or DPP-4i 15

16 16

17 Prediabetes algorithm This should also be an important part of diabetes management. ASCVD Risk Factors ABCDE mnemonic 17

18 ASCVD Risk Factors High risk: DM with age < 40 and no other comorbidities Very high risk: DM, age >40 or other major ASCVD risks Extreme risk: DM with established clinical cardiovascular disease Prediabetes algorithm If we can treat early we may be able to defray some of the costs. 18

19 Summary Follow the algorithm, but individualize treatment to your patient Cost of treatment, compliance Maximize your weight loss strategies Manage hypertension, and hyperlipidemia The algorithm can help guide shared decision making DOWNLOAD THE APP! AACE/ACE Comprehensive Type 2 Diabetes Management Alg This algorithm for the comprehensive management of persons This app is available on itunes and Google Play 19

20 Thank you. 1. Endocr Pract.2017,doi: /EP CS 2. Handelsman Y, Bloomgarden ZT, Grunberger G, et al. American Association of Clinical Endocrinologists and American College of Endocrinology: clinical practice guidelines for developing a diabetes mellitus comprehensive care plan Endocr Pract. 2015;21: Balducci S, Alessi E, Cardelli P, Cavallo S, Fallucca F, Pugliese G. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis: response to Snowling and Hopkins. Diabetes Care. 2007;30:e25; author reply e Wadden TA, West DS, Neiberg RH, et al. One-year weight losses in the Look AHEAD study: factors associated with success. Obesity (Silver Spring). 2009;17: Diabetes Prevention Program Research Group, Ratner R, Goldberg R, et al. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Diabetes care. 2005;28: Keogh JB, Clifton PM. Meal replacements for weight loss in type 2 diabetes in a community setting. J Nutr Metab. 2012;2012: American Diabetes Association. Standards of medical care in diabetes Diabetes Care. 2014;37(suppl 1):S14 S George C, Bruijn L, Will K, Howard-Thompson A, Management of Blood Glucose with Noninsulin Therapies in Type 2 Diabetes. Am Fam Physician Jul 1;92(1):

CASE A2 Managing Between-meal Hypoglycemia

CASE A2 Managing Between-meal Hypoglycemia Managing Between-meal Hypoglycemia 1 I would like to discuss this case of a patient who, overall, was doing well on her therapy until she made an important lifestyle change to lose weight. This is a common

More information

American Diabetes Association Standards of Medical Care in Diabetes 2018: Latest Updates

American Diabetes Association Standards of Medical Care in Diabetes 2018: Latest Updates American Diabetes Association Standards of Medical Care in Diabetes 2018: Latest Updates Juan Pablo Frias, MD President and CEO, National Research Institute, Los Angeles, CA Clinical Faculty, University

More information

AACE COMPREHENSIVE DIABETES MANAGEMENT ALGORITHM

AACE COMPREHENSIVE DIABETES MANAGEMENT ALGORITHM AACE COMPREHENSIVE DIABETES MANAGEMENT ALGORITHM 2013 TASK FORCE Alan J. Garber, MD, PhD, FACE, Chair Martin J. Abrahamson, MD Joshua I. Barzilay, MD, FACE Lawrence Blonde, MD, FACP, FACE Zachary T. Bloomgarden,

More information

Reviewing Diabetes Guidelines. Newsletter compiled by Danny Jaek, Pharm.D. Candidate

Reviewing Diabetes Guidelines. Newsletter compiled by Danny Jaek, Pharm.D. Candidate Reviewing Diabetes Guidelines Newsletter compiled by Danny Jaek, Pharm.D. Candidate AL AS KA N AT IV E DI AB ET ES TE A M Volume 6, Issue 1 Spring 2011 Dia bet es Dis pat ch There are nearly 24 million

More information

Welcome and Introduction

Welcome and Introduction Welcome and Introduction This presentation will: Define obesity, prediabetes, and diabetes Discuss the diagnoses and management of obesity, prediabetes, and diabetes Explain the early risk factors for

More information

Obesity, Insulin Resistance, Metabolic Syndrome, and the Natural History of Type 2 Diabetes

Obesity, Insulin Resistance, Metabolic Syndrome, and the Natural History of Type 2 Diabetes Obesity, Insulin Resistance, Metabolic Syndrome, and the Natural History of Type 2 Diabetes Genetics, environment, and lifestyle (obesity, inactivity, poor diet) Impaired fasting glucose Decreased β-cell

More information

Objectives. Objectives. Alejandro J. de la Torre, MD Cook Children s Hospital May 30, 2015

Objectives. Objectives. Alejandro J. de la Torre, MD Cook Children s Hospital May 30, 2015 Alejandro J. de la Torre, MD Cook Children s Hospital May 30, 2015 Presentation downloaded from http://ce.unthsc.edu Objectives Understand that the obesity epidemic is also affecting children and adolescents

More information

Diabetes Day for Primary Care Clinicians Advances in Diabetes Care

Diabetes Day for Primary Care Clinicians Advances in Diabetes Care Diabetes Day for Primary Care Clinicians Advances in Diabetes Care Elliot Sternthal, MD, FACP, FACE Chair New England AACE Diabetes Day Planning Committee Welcome and Introduction This presentation will:

More information

Metabolic Syndrome. Shon Meek MD, PhD Mayo Clinic Florida Endocrinology

Metabolic Syndrome. Shon Meek MD, PhD Mayo Clinic Florida Endocrinology Metabolic Syndrome Shon Meek MD, PhD Mayo Clinic Florida Endocrinology Disclosure No conflict of interest No financial disclosure Does This Patient Have Metabolic Syndrome? 1. Yes 2. No Does This Patient

More information

Individualizing Type 2 Diabetes Management. Cynthia Gerstenlauer, ANP-BC, GCNS-BC, CDE, CCD

Individualizing Type 2 Diabetes Management. Cynthia Gerstenlauer, ANP-BC, GCNS-BC, CDE, CCD Individualizing Type 2 Diabetes Management Cynthia Gerstenlauer, ANP-BC, GCNS-BC, CDE, CCD Harsh Statistics 30.3 million (9.4% of population) in US had DM in 2015 The percent of population with DM increases

More information

A Practical Approach to the Use of Diabetes Medications

A Practical Approach to the Use of Diabetes Medications A Practical Approach to the Use of Diabetes Medications Juan Pablo Frias, M.D., FACE President, National Research Institute, Los Angles, CA Clinical Faculty, University of California, San Diego, CA OUTLINE

More information

Diabetes Mellitus: A Cardiovascular Disease

Diabetes Mellitus: A Cardiovascular Disease Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular

More information

Special thanks to the EJC Foundation for their support of Sanford Center Geriatric Specialty Clinic

Special thanks to the EJC Foundation for their support of Sanford Center Geriatric Specialty Clinic Special thanks to the EJC Foundation for their support of Sanford Center Geriatric Specialty Clinic Sanford Center for Aging 775-784-4744 med.unr.edu/aging Diabetes Management Series: From Selfmanagement

More information

Chief of Endocrinology East Orange General Hospital

Chief of Endocrinology East Orange General Hospital Targeting the Incretins System: Can it Improve Our Ability to Treat Type 2 Diabetes? Darshi Sunderam, MD Darshi Sunderam, MD Chief of Endocrinology East Orange General Hospital Age-adjusted Percentage

More information

Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable?

Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable? Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable? Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of

More information

Initiation and Titration of Insulin in Diabetes Mellitus Type 2

Initiation and Titration of Insulin in Diabetes Mellitus Type 2 Initiation and Titration of Insulin in Diabetes Mellitus Type 2 Greg Doelle MD, MS April 6, 2016 Disclosure I have no actual or potential conflicts of interest in relation to the content of this lecture.

More information

Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease

Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures

More information

Brigham and Women s Hospital Type 2 Diabetes Management Program Physician Pharmacist Collaborative Drug Therapy Management Protocol

Brigham and Women s Hospital Type 2 Diabetes Management Program Physician Pharmacist Collaborative Drug Therapy Management Protocol Brigham and Women s Hospital Type 2 Diabetes Management Program Physician Pharmacist Collaborative Drug Therapy Management Protocol *Please note that this guideline may not be appropriate for all patients

More information

Wayne Gravois, MD August 6, 2017

Wayne Gravois, MD August 6, 2017 Wayne Gravois, MD August 6, 2017 Americans with Diabetes (Millions) 40 30 Source: National Diabetes Statistics Report, 2011, 2017 Millions 20 10 0 1980 2009 2015 2007 - $174 Billion 2015 - $245 Billion

More information

Insulin Pumps - External

Insulin Pumps - External Insulin Pumps - External Policy Number: Original Effective Date: MM.01.004 04/01/2011 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 04/01/20174/1/2018 Section: DME Place(s) of

More information

Standards of Medical Care in Diabetes Adult/Pediatric Inpatient/Ambulatory Clinical Practice Guideline

Standards of Medical Care in Diabetes Adult/Pediatric Inpatient/Ambulatory Clinical Practice Guideline Standards of Medical Care in Diabetes Adult/Pediatric Inpatient/Ambulatory Clinical Practice Guideline Note: Active Table of Contents Click to follow link EXECUTIVE SUMMARY... 2 SCOPE... 3 METHODOLOGY...

More information

Diabetes. Health Care Disparities: Medical Evidence. A Constellation of Complications. Every 24 hours.

Diabetes. Health Care Disparities: Medical Evidence. A Constellation of Complications. Every 24 hours. Health Care Disparities: Medical Evidence Diabetes Effects 2.8 Million People in US 7% of the US Population Sixth Leading Cause of Death Kenneth J. Steier, DO, MBA, MPH, MHA, MGH Dean of Clinical Education

More information

GLP-1 (glucagon-like peptide-1) Agonists (Byetta, Bydureon, Tanzeum, Trulicity, Victoza ) Step Therapy and Quantity Limit Criteria Program Summary

GLP-1 (glucagon-like peptide-1) Agonists (Byetta, Bydureon, Tanzeum, Trulicity, Victoza ) Step Therapy and Quantity Limit Criteria Program Summary OBJECTIVE The intent of the GLP-1 (glucagon-like peptide-1) s (Byetta/exenatide, Bydureon/ exenatide extended-release, Tanzeum/albiglutide, Trulicity/dulaglutide, and Victoza/liraglutide) Step Therapy

More information

Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Prior Authorization Protocol

Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Prior Authorization Protocol Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed

More information

Disclosures of Interest. Publications Diabetologia Key points to emphasize

Disclosures of Interest. Publications Diabetologia   Key points to emphasize Disclosures of Interest No conflicts or disclosures How to Use the American Diabetes Association s Type 2 Diabetes Treatment Algorithm Rashida Downing, MD, FAAFP Primary Care Physician JenCare Medical

More information

Jennifer Loh, MD, FACE Chief of Endocrinology KP Hawaii AAMD of Medical Education, KP Hawaii

Jennifer Loh, MD, FACE Chief of Endocrinology KP Hawaii AAMD of Medical Education, KP Hawaii Individualized Diabetes Treatment for the Elderly Jennifer Loh, MD, FACE Chief of Endocrinology KP Hawaii AAMD of Medical Education, KP Hawaii Extremely Relevant Baby Boomers are aging! ¼ of people age

More information

5/21/2018. Type 2 Diabetes. Clinical inertia in type 2 diabetes patients based on recent real-world data

5/21/2018. Type 2 Diabetes. Clinical inertia in type 2 diabetes patients based on recent real-world data Clinical inertia in type 2 diabetes patients based on recent real-world data Andrea DeSantis, DO Department of Family Practice Rohan Mahabaleshwarkar, PhD Center for Outcomes Research and Evaluation Type

More information

Non-insulin treatment in Type 1 DM Sang Yong Kim

Non-insulin treatment in Type 1 DM Sang Yong Kim Non-insulin treatment in Type 1 DM Sang Yong Kim Chosun University Hospital Conflict of interest disclosure None Committee of Scientific Affairs Committee of Scientific Affairs Insulin therapy is the mainstay

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Single Technology Appraisal. Canagliflozin in combination therapy for treating type 2 diabetes

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Single Technology Appraisal. Canagliflozin in combination therapy for treating type 2 diabetes NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Single Technology Appraisal Canagliflozin in combination therapy for Final scope Remit/appraisal objective To appraise the clinical and cost effectiveness

More information

Cardiovascular disease and diabetes Vascular harmony

Cardiovascular disease and diabetes Vascular harmony Cardiovascular disease and diabetes 2018 Vascular harmony Robert Chilton Professor of Medicine University of Texas Health Science Center Director of Cardiac Catheterization labs Director of clinical proteomics

More information

Laboratory analysis of the obese child recommendations and discussion. MacKenzi Hillard May 4, 2011

Laboratory analysis of the obese child recommendations and discussion. MacKenzi Hillard May 4, 2011 Laboratory analysis of the obese child recommendations and discussion MacKenzi Hillard May 4, 2011 aka: What to do with Fasting Labs The Obesity Epidemic The prevalence of obesity in adolescents has tripled

More information

OBESITY IN TYPE 2 DIABETES

OBESITY IN TYPE 2 DIABETES OBESITY IN TYPE 2 DIABETES Ashley Crowl, PharmD, BCACP Assistant Professor University of Kansas Objectives Review how to manage obesity in patients with type-2 diabetes mellitus Compare antiobesity agents

More information

Objectives 2/13/2013. Figuring out the dose. Sub Optimal Glycemic Control: Moving to the Appropriate Treatment

Objectives 2/13/2013. Figuring out the dose. Sub Optimal Glycemic Control: Moving to the Appropriate Treatment Sub Optimal Glycemic Control: Moving to the Appropriate Treatment Judy Thomas, MSN, FNP-BC Holt and Walton, Rheumatology and Endocrinology Objectives Upon completion of this session you will be better

More information

Sodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors Drug Class Prior Authorization Protocol

Sodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors Drug Class Prior Authorization Protocol Sodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has

More information

Helpful Hints for Taking Care of Your Diabetes. Farahnaz Joarder, MD and Don Kain, MA, RD,CDE Harold Schnitzer Diabetes Health Center

Helpful Hints for Taking Care of Your Diabetes. Farahnaz Joarder, MD and Don Kain, MA, RD,CDE Harold Schnitzer Diabetes Health Center Helpful Hints for Taking Care of Your Diabetes Farahnaz Joarder, MD and Don Kain, MA, RD,CDE Harold Schnitzer Diabetes Health Center Objectives How big of a problem is diabetes? What is diabetes? How is

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Proposed Health Technology Appraisal

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Proposed Health Technology Appraisal NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Proposed Health Technology Appraisal Dapagliflozin in combination therapy for the Final scope Remit/appraisal objective To appraise the clinical and

More information

Why do we care? 20.8 million people. 70% of people with diabetes will die of cardiovascular disease. What is Diabetes?

Why do we care? 20.8 million people. 70% of people with diabetes will die of cardiovascular disease. What is Diabetes? What is Diabetes? Diabetes 101 Ginny Burns RN MEd CDE Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action

More information

Optimizing Postpartum Maternal Health to Prevent Chronic Diseases

Optimizing Postpartum Maternal Health to Prevent Chronic Diseases Optimizing Postpartum Maternal Health to Prevent Chronic Diseases Amy Loden, MD, FACP, NCMP Disclosures Research: None Financial: none applicable to this presentation PRIUM QEssentials Market Research

More information

Diabetes Mellitus in Older Adults. Presenter Disclosure Information

Diabetes Mellitus in Older Adults. Presenter Disclosure Information Diabetes Mellitus in Older Adults Medha Munshi, M.D. Joslin Diabetes Center Beth Israel Deaconess Medical Center Harvard Medical School Presenter Disclosure Information Medha Munshi Research grant from

More information

LOW SUGAR: CAUSES, COMPLICATIONS AND MANAGEMENT OF HYPOGLYCEMIA

LOW SUGAR: CAUSES, COMPLICATIONS AND MANAGEMENT OF HYPOGLYCEMIA LOW SUGAR: CAUSES, COMPLICATIONS AND MANAGEMENT OF HYPOGLYCEMIA Anne Leake, PhD, APRN-Rx, BC-ADM ECHO Diabetes Learning Group 3/28/2018 Objectives 1. Identify common preventable causes of hypoglycemia

More information

Diabetes Mellitus. Medical Management and Latest Developments Dr Ahmad Abou-Saleh

Diabetes Mellitus. Medical Management and Latest Developments Dr Ahmad Abou-Saleh Diabetes Mellitus Medical Management and Latest Developments Dr Ahmad Abou-Saleh What is Diabetes Mellitus? A disease characterised by a state of chronic elevation of blood glucose levels due to: - The

More information

Diabetes: Use of Adjunctive Therapy ACEs, ARBs, ASA & STATINs --Oh My! Veronica J. Brady, PhD, FNP-BC, BC-ADM, CDE Project ECHO April 19, 2018

Diabetes: Use of Adjunctive Therapy ACEs, ARBs, ASA & STATINs --Oh My! Veronica J. Brady, PhD, FNP-BC, BC-ADM, CDE Project ECHO April 19, 2018 Diabetes: Use of Adjunctive Therapy ACEs, ARBs, ASA & STATINs --Oh My! Veronica J. Brady, PhD, FNP-BC, BC-ADM, CDE Project ECHO April 19, 2018 Points to Ponder ASCVD is the leading cause of morbidity

More information

Adult Diabetes Clinician Guide NOVEMBER 2017

Adult Diabetes Clinician Guide NOVEMBER 2017 Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Adult Diabetes Clinician Guide Introduction NOVEMBER 2017 This evidence-based guideline summary is based on the 2017 KP National Diabetes Guideline.

More information

American Diabetes Association 2018 Guidelines Important Notable Points

American Diabetes Association 2018 Guidelines Important Notable Points American Diabetes Association 2018 Guidelines Important Notable Points The Standards of Medical Care in Diabetes-2018 by ADA include the most current evidencebased recommendations for diagnosing and treating

More information

Inpatient Management of Diabetes Mellitus. Jessica Garza, Pharm.D. PGY-1 Pharmacotherapy Resident TTUHSC School of Pharmacy

Inpatient Management of Diabetes Mellitus. Jessica Garza, Pharm.D. PGY-1 Pharmacotherapy Resident TTUHSC School of Pharmacy Inpatient Management of Diabetes Mellitus Jessica Garza, Pharm.D. PGY-1 Pharmacotherapy Resident TTUHSC School of Pharmacy 2 Disclosure Jessica Garza does not have any actual or potential conflicts of

More information

Objectives. Kidney Complications With Diabetes. Case 10/21/2015

Objectives. Kidney Complications With Diabetes. Case 10/21/2015 Objectives Kidney Complications With Diabetes Brian Boerner, MD Diabetes, Endocrinology, and Metabolism University of Nebraska Medical Center Review screening for, and management of, albuminuria Review

More information

Standards of Care in Diabetes What's New? Veronica Brady, FNP-BC, PhD, BC-ADM,CDE Karmella Thomas, RD, LD,CDE

Standards of Care in Diabetes What's New? Veronica Brady, FNP-BC, PhD, BC-ADM,CDE Karmella Thomas, RD, LD,CDE Standards of Care in Diabetes 2016-- What's New? Veronica Brady, FNP-BC, PhD, BC-ADM,CDE Karmella Thomas, RD, LD,CDE Terminology No longer using the term diabetic. Diabetes does not define people. People

More information

OLD AND NEW DRUGS FOR CONTROLING DIABETES THERAPEUTIC CLASSES AND MECHANISM OF ACTION

OLD AND NEW DRUGS FOR CONTROLING DIABETES THERAPEUTIC CLASSES AND MECHANISM OF ACTION OLD AND NEW DRUGS FOR CONTROLING DIABETES THERAPEUTIC CLASSES AND MECHANISM OF ACTION Biljana Parapid, MD, PhD, FESC Belgrade University School of Medicine, Belgrade (Serbia) @biljana_parapid COI International

More information

IMPROVED DIAGNOSIS OF TYPE 2 DIABETES AND TAILORING MEDICATIONS

IMPROVED DIAGNOSIS OF TYPE 2 DIABETES AND TAILORING MEDICATIONS IMPROVED DIAGNOSIS OF TYPE 2 DIABETES AND TAILORING MEDICATIONS Dr Bidhu Mohapatra, MBBS, MD, FRACP Consultant Physician Endocrinology and General Medicine Introduction 382 million people affected by diabetes

More information

Baptist Health Nassau Community Health Needs Assessment Priorities Implementation Plans

Baptist Health Nassau Community Health Needs Assessment Priorities Implementation Plans Baptist Health Nassau Community Health Needs Assessment Priorities Implementation Plans Health Disparities Heart Disease Stroke Hypertension Diabetes Adult Type II Preventive Health Care Smoking and Smokeless

More information

NEW DIABETES CARE MEDICATIONS

NEW DIABETES CARE MEDICATIONS NEW DIABETES CARE MEDICATIONS James Bonucchi DO, ECNU, FACE Adult Medicine and Endocrinology Specialists Disclosures Speakers bureau Sanofi AZ BI Diabetes Diabetes cost ADA 2017 data Ever increasing disorder.

More information

Application of the Diabetes Algorithm to a Patient

Application of the Diabetes Algorithm to a Patient Application of the Diabetes Algorithm to a Patient Apply knowledge gained from this activity to improve disease management and outcomes for patients with T2DM and obesity Note: The cases in this deck represent

More information

Nutrition and Medicine, 2006 Tufts University School of Medicine Nutrition and Type 2 Diabetes: Learning Objectives

Nutrition and Medicine, 2006 Tufts University School of Medicine Nutrition and Type 2 Diabetes: Learning Objectives Nutrition and Medicine, 2006 Tufts University School of Medicine Nutrition and Type 2 Diabetes: Learning Objectives Margo N. Woods, D.Sc. 1. Discuss the increase in the incidence and prevalence of type

More information

Fixed dose combination for Trusted Diabetes Control Lobna Farag Eltooy Head of Internal Medicine Department Assiut University

Fixed dose combination for Trusted Diabetes Control Lobna Farag Eltooy Head of Internal Medicine Department Assiut University Fixed dose combination for Trusted Diabetes Control By Lobna Farag Eltooy Head of Internal Medicine Department 1 Assiut University 3/18/2018 3/18/2018 3/18/2018 Diabetes Complications with Increasing HbA1c

More information

Baptist Health Jacksonville Community Health Needs Assessment Implementation Plans. Health Disparities. Preventive Health Care.

Baptist Health Jacksonville Community Health Needs Assessment Implementation Plans. Health Disparities. Preventive Health Care. Baptist Health Jacksonville Community Health Needs Assessment Implementation Plans Health Disparities Infant Mortality Prostate Cancer Heart Disease and Stroke Hypertension Diabetes Behavioral Health Preventive

More information

Baptist Health Beaches Community Health Needs Assessment Priorities Implementation Plans

Baptist Health Beaches Community Health Needs Assessment Priorities Implementation Plans Baptist Health Beaches Community Health Needs Assessment Priorities Implementation Plans Health Disparities Heart Disease Stroke Hypertension Diabetes Adult Type II Preventive Health Care Smoking and Smokeless

More information

Type 2 Diabetes Prevention. By: Montano Labadia And Mary Rose Cairel

Type 2 Diabetes Prevention. By: Montano Labadia And Mary Rose Cairel Type 2 Diabetes Prevention By: Montano Labadia And Mary Rose Cairel Diabetes is the abnormally high occurrence of sugar in your blood, which is known as having a high blood glucose level The insulin in

More information

National Diabetes Fact Sheet, 2011

National Diabetes Fact Sheet, 2011 National Diabetes Fact Sheet, 2011 FAST FACTS ON DIABETES Diabetes affects 25.8 million people 8.3% of the U.S. population DIAGNOSED 18.8 million people UNDIAGNOSED 7.0 million people All ages, 2010 Citation

More information

Glucagon-like peptide-1 (GLP-1) Agonists Drug Class Prior Authorization Protocol

Glucagon-like peptide-1 (GLP-1) Agonists Drug Class Prior Authorization Protocol Glucagon-like peptide-1 (GLP-1) Agonists Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed

More information

Management of DM in Older Adults: It s not all about sugar! Who needs treatment for DM? Peggy Odegard, Pharm.D., BCPS, CDE

Management of DM in Older Adults: It s not all about sugar! Who needs treatment for DM? Peggy Odegard, Pharm.D., BCPS, CDE Management of DM in Older Adults: It s not all about sugar! Peggy Odegard, Pharm.D., BCPS, CDE Who needs treatment for DM? 87 year old, frail male with moderately severe dementia living in NH with persistent

More information

Diabetes Prevention (Managing Prediabetes)

Diabetes Prevention (Managing Prediabetes) IMPORTANCE OF FOCUS Although Prediabetes is not viewed as a clinical entity in its own right, it is a risk factor for diabetes and cardiovascular disease. It is estimated that approximately 1 in 3 U.S.

More information

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus You should be offering psychosocial care to all patients with diabetes, says the ADA. Here are the specific recommendations. Summary Recommendation

More information

If DSME* were a pill, would you prescribe it?

If DSME* were a pill, would you prescribe it? If DSME* were a pill, would you prescribe it? *Diabetes Self-Management Education/Training Jan Kincaid Rystrom, RD CDE MEd Manager, Diabetes Education EvergreenHealth Goals Evaluate DSME as part of ADA

More information

Diabetes and the Heart

Diabetes and the Heart Diabetes and the Heart Jeffrey Boord, MD, MPH Advances in Cardiovascular Medicine Kingston, Jamaica December 6, 2012 Outline Screening for diabetes in patients with CAD Screening for CAD in patients with

More information

HEALTH SERVICES POLICY & PROCEDURE MANUAL

HEALTH SERVICES POLICY & PROCEDURE MANUAL PAGE 1 of 5 PURPOSE To assure that DOP inmates with Diabetes are receiving high quality Primary Care for their condition. POLICY All DOP Primary Care Providers are to follow these guidelines when treating

More information

Deepika Reddy MD Department of Endocrinology

Deepika Reddy MD Department of Endocrinology Deepika Reddy MD Department of Endocrinology Management of hyperglycemic crisis Review need for inpatient glycemic control Brief overview of relevant trials Case based review of diabetes management strategies/review

More information

Approximately one third of the 15.7 million Americans who are estimated to have diabetes

Approximately one third of the 15.7 million Americans who are estimated to have diabetes Diabetes is a very serious illness and too many people are neglecting their condition. Approximately one third of the 15.7 million Americans who are estimated to have diabetes are unaware of their condition.

More information

Chronic Disease Management when Resources are Limited

Chronic Disease Management when Resources are Limited Chronic Disease Management when Resources are Limited Paul R. Larson MD, MS, DIM&PH Director, Global Health Education UPMC St. Margaret Family Medicine Residency Pittsburgh, PA larsonpr@upmc.edu Disclosures

More information

DEMYSTIFYING INSULIN THERAPY

DEMYSTIFYING INSULIN THERAPY DEMYSTIFYING INSULIN THERAPY ASHLYN SMITH, PA-C ENDOCRINOLOGY ASSOCIATES SCOTTSDALE, AZ SECRETARY, AMERICAN SOCIETY OF ENDOCRINE PHYSICIAN ASSISTANTS ARIZONA STATE ASSOCIATION OF PHYSICIAN ASSISTANTS SPRING

More information

8/5/2017. Disclosure to Participants. Learning Outcomes. Terry Compton MS, APRN, CDE. Seniors with Diabetes: Why Are They Different?

8/5/2017. Disclosure to Participants. Learning Outcomes. Terry Compton MS, APRN, CDE. Seniors with Diabetes: Why Are They Different? Terry Compton MS, APRN, CDE Diabetes Education Program Manager St. Tammany Parish Hospital Covington, LA Sara (Mandy) Reece PharmD, CDE, BC-ADM, FAADE Diabetes Educator Vice Chair and Associate Professor,

More information

Diabetes and the Heart

Diabetes and the Heart Diabetes and the Heart Kathleen M. Dungan, MD Division of Endocrinology, Diabetes & Metabolism The Ohio State University Disclosures I serve on advisory boards or perform consulting activities with Eli

More information

Standards of Medical Care in Diabetes 2016

Standards of Medical Care in Diabetes 2016 Standards of Medical Care in Diabetes 2016 Care Delivery Systems 33-49% of patients still do not meet targets for A1C, blood pressure, or lipids. 14% meet targets for all A1C, BP, lipids, and nonsmoking

More information

Continuous Glucose Monitoring System

Continuous Glucose Monitoring System Continuous Glucose Monitoring System Policy Number: Original Effective Date: MM.02.003 03/13/2001 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 04/01/2016 Section: DME Place(s)

More information

UNDERSTANDING TYPE 2 DIABETES

UNDERSTANDING TYPE 2 DIABETES 1 UNDERSTANDING TYPE 2 DIABETES PUTTING IT INTO REMISSION WITH A LOW-CARB HIGH-FAT DIET Jacqueline A. Eberstein, R.N. Director of Protocol, HEALcare The Scope of the Challenge 2 The People The Scope of

More information

Disclosure. I have no relevant financial relationships with commercial interests to disclose American Medical Association. All rights reserved.

Disclosure. I have no relevant financial relationships with commercial interests to disclose American Medical Association. All rights reserved. Disclosure I have no relevant financial relationships with commercial interests to disclose. 2 Objectives Describe the trends in type 2 diabetes and implications for clinical practice Review the evidence

More information

A Guidance Statement from the American College of Physicians

A Guidance Statement from the American College of Physicians Hemoglobin A1c Targets for Glycemic Control with Pharmacologic Therapy in Non-Pregnant Adults with Type 2 Diabetes Mellitus: A Guidance Statement from the American College of Physicians Timothy J. Wilt,

More information

Disclosures OBESITY. Overview. Obesity: Definition. Prevalence of Obesity is Rising. Obesity as a Risk Factor. None

Disclosures OBESITY. Overview. Obesity: Definition. Prevalence of Obesity is Rising. Obesity as a Risk Factor. None Disclosures None OBESITY Florencia Halperin, M.D. Medical Director, Program for Management Brigham and Women s Hospital Instructor in Medicine, Harvard Medical School Overview Obesity: Definition Definition

More information

Peripheral Arterial Disease (PAD): Presentation, Diagnosis, and Treatment

Peripheral Arterial Disease (PAD): Presentation, Diagnosis, and Treatment Peripheral Arterial Disease (PAD): Presentation, Diagnosis, and Treatment Prepared and Presented by Jon Manocchio, Pharm D Blanchard Valley Hospital October 2011 Introduction PAD is a condition that is

More information

Diabetes Overview. Basics of Diabetes

Diabetes Overview. Basics of Diabetes Diabetes Overview Basics of Diabetes Objectives Review the prevalence of diabetes, how it develops and the risk of developing diabetes Review diabetes diagnosis Identify the key areas of medically managing

More information

Obesity Management in Patients with Diabetes Jamy D. Ard, MD Sunday, February 11, :15 a.m. 11:00 a.m.

Obesity Management in Patients with Diabetes Jamy D. Ard, MD Sunday, February 11, :15 a.m. 11:00 a.m. Obesity Management in Patients with Diabetes Jamy D. Ard, MD Sunday, February 11, 2018 10:15 a.m. 11:00 a.m. Type 2 diabetes mellitus (T2DM) is closely associated with obesity, primarily through the link

More information

PREVALENCE OF NAFLD & NASH

PREVALENCE OF NAFLD & NASH - - PREVALENCE OF & USA Prevalence in Middle Age Patients San Antonio, Texas (Williams et al., Gastroenterology 2011; 140:124-31) Dallas Heart Study Prevalence Numbers (Browning et al., Hepatology 2004;40:1387-95)

More information

A Population Health Approach to Diabetes in the Young. Jeff Powell Jill Moses

A Population Health Approach to Diabetes in the Young. Jeff Powell Jill Moses A Population Health Approach to Diabetes in the Young Jeff Powell Jill Moses Presenters Jeff Powell, MD, MPH Jill Moses, MD, MPH Pediatrician Community Health Division, Shiprock SU Principal Investigator,

More information

Quick Reference Guide

Quick Reference Guide 2013 Clinical Practice Guidelines Quick Reference Guide (Updated November 2016) 416569-16 guidelines.diabetes.ca diabetes.ca 1-800-BANTING (226-8464) Copyright 2016 Canadian Diabetes Association SCREENING

More information

Diabetes Mellitus case studies. Jana Vinklerová

Diabetes Mellitus case studies. Jana Vinklerová Diabetes Mellitus case studies Jana Vinklerová Definition of diabetes (metabolic disorder) Chronically raised blood glucose (hyperglycaemia) Insulin/Glucagon Insulin is responsible for lowering glucose

More information

Insulin Initiation and Intensification. Disclosure. Objectives

Insulin Initiation and Intensification. Disclosure. Objectives Insulin Initiation and Intensification Neil Skolnik, M.D. Associate Director Family Medicine Residency Program Abington Memorial Hospital Professor of Family and Community Medicine Temple University School

More information

Diabetes: Staying Two Steps Ahead. The prevalence of diabetes is increasing. What causes Type 2 diabetes?

Diabetes: Staying Two Steps Ahead. The prevalence of diabetes is increasing. What causes Type 2 diabetes? Focus on CME at the University of University Manitoba of Manitoba : Staying Two Steps Ahead By Shagufta Khan, MD; and Liam J. Murphy, MD The prevalence of diabetes is increasing worldwide and will double

More information

Diabetes Mellitus and the Dental Healthcare Professional

Diabetes Mellitus and the Dental Healthcare Professional Diabetes Mellitus and the Dental Healthcare Professional Jerry A. Brown DMD, CDE University of South Florida Department of Internal Medicine jabrown7@health.usf.edu Learning Objectives Diabetes- The Disease

More information

Diabetes Mellitus II CPG

Diabetes Mellitus II CPG 1 Diabetes Mellitus II CPG Candidates for Screening Integrated Complex Care Patients: Check Yearly Prediabetes: Check Yearly No Diabetes Mellitus (DM) Risk Factors: Check at Age 45, Repeat Every 3 Years

More information

Continuous Glucose Monitoring System

Continuous Glucose Monitoring System Continuous Glucose Monitoring System Policy Number: Original Effective Date: MM.02.003 03/13/2001 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 04/01/2017 Section: DME Place(s)

More information

Diabetes Complications Guideline Based Screening, Management, and Referral

Diabetes Complications Guideline Based Screening, Management, and Referral Diabetes Complications Guideline Based Screening, Management, and Referral Eric L. Johnson, M.D. Associate Professor Department of Family and Community Medicine Assistant Medical Director Altru Diabetes

More information

Continuous Glucose Monitoring System

Continuous Glucose Monitoring System Continuous Glucose Monitoring System Policy Number: Original Effective Date: MM.02.003 03/13/2001 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 4/1/2018 Section: DME Place(s)

More information

A Summary Report: 2003

A Summary Report: 2003 D iabetes in Idaho A Summary Report: 2003 Idaho Department of Health and Welfare Division of Health Bureau of Community and Environmental Health This publication was supported by Grant No. U32/CCU022691-02

More information

The Many Faces of T2DM in Long-term Care Facilities

The Many Faces of T2DM in Long-term Care Facilities The Many Faces of T2DM in Long-term Care Facilities Question #1 Which of the following is a risk factor for increased hypoglycemia in older patients that may suggest the need to relax hyperglycemia treatment

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Afrezza Page 1 of 7 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Afrezza (human insulin) Prime Therapeutics will review Prior Authorization requests Prior Authorization

More information

UKPDS: Over Time, Need for Exogenous Insulin Increases

UKPDS: Over Time, Need for Exogenous Insulin Increases UKPDS: Over Time, Need for Exogenous Insulin Increases Patients Requiring Additional Insulin (%) 60 40 20 Oral agents By 6 Chlorpropamide years, Glyburide more than 50% of UKPDS patients required insulin

More information

Clinical Practice Guideline

Clinical Practice Guideline Clinical Practice Guideline Secondary Prevention for Patients with Coronary and Other Vascular Disease Since the 2001 update of the American Heart Association (AHA)/American College of Cardiology (ACC)

More information

Donna Tomky, MSN, C-ANP, CDE, FAADE Albuquerque, New Mexico

Donna Tomky, MSN, C-ANP, CDE, FAADE Albuquerque, New Mexico Donna Tomky, MSN, C-ANP, CDE, FAADE Albuquerque, New Mexico Presented in Collaboration with New Mexico Health Care Takes On Diabetes Discuss the burden and challenges prediabetes presents in New Mexico.

More information

Type 2 Diabetes in Adolescents

Type 2 Diabetes in Adolescents Type 2 Diabetes in Adolescents Disclosures Paid consultant, Eli Lilly, Inc, Pediatric Type 2 Diabetes Clinical Trials Outline The burden of diabetes Treatment and Prevention Youth Diabetes Prevention Clinic

More information

Type 2 DM in Adolescents: Use of GLP-1 RA. Objectives. Scope of Problem: Obesity. Background. Pathophysiology of T2DM

Type 2 DM in Adolescents: Use of GLP-1 RA. Objectives. Scope of Problem: Obesity. Background. Pathophysiology of T2DM Type 2 DM in Adolescents: Use of GLP-1 RA Objectives Identify patients in the pediatric population with T2DM that would potentially benefit from the use of GLP-1 RA Discuss changes in glycemic outcomes

More information

Barriers to Achieving A1C Targets: Clinical Inertia and Hypoglycemia. KM Pantalone Endocrinology

Barriers to Achieving A1C Targets: Clinical Inertia and Hypoglycemia. KM Pantalone Endocrinology Barriers to Achieving A1C Targets: Clinical Inertia and Hypoglycemia KM Pantalone Endocrinology Disclosures Speaker Bureau AstraZeneca, Merck, Novo Nordisk, Sanofi Consultant Novo Nordisk, Eli Lilly, Merck

More information