Our “Question of the Week” is created weekly by Coach Beverly to cover a variety of Diabetes related topics. The questions are designed to keep you current and prepare you for the CDE® Exam.
This week’s Rationale: Question of the Week – January 3rd – test your knowledge before seeing answer below!
What a perfect way to information share and bring new concepts to light. We appreciate our community of diabetes educators and the opportunity to keep learning together!
The 2018 ADA Standards of Care includes updates to the Pharmacologic Algorithm to manage hyperglycemia for individuals with type 2 diabetes. Which of the following accurately reflects updates to the algorithm?
a. Start insulin therapy if A1c is 9% or greater (26% guessed)
b. Try Lifestyle Management for 3 months before starting metformin (10% guessed)
c. When adding a second agent, consider a medication proven to reduce cardiovascular mortality (61% guessed)
d. Avoid use of all injectables and oral meds that contribute to hypoglycemia (15% guessed)
Correct Answer: c. When adding a second agent, consider a medication proven to reduce cardiovascular mortality
Stepwise Approach to Pharmacologic Management of Type 2 Diabetes – 2018
According to the ADA 2018 Standards, section 8, Metformin therapy should be started along with lifestyle Management at diagnosis of type 2 Diabetes (unless contraindicated).
Metformin is effective, safe, inexpensive and may reduce risk of CV events and death.
If A1c target is not achieved after 3 months, consider metformin and any one of the six preferred treatment options based on drug specific effects and patient factors.
If A1c target is still not achieved after 3 months on metformin, and the patient has CV Disease, consider adding a second agent with evidence of cardiovascular risk reduction (based on drug specific effects and patient factors).
If A1c target is still not achieved after 3 months, combine metformin plus two other agents for a three-drug combination.
If A1c target is still not achieved after 3 months, add combination injectable therapy to the three-drug combination.
For all steps, consider including medications with evidence of CV risk reduction, based on drug specific effects and patient factors.
Medication Therapy Based on A1c
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