Question of the Week Rationale – Jan 5th

Question of the Week & Rationale 

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.

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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! 

 


Question:

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

Rationale: 

Stepwise Approach to Pharmacologic Management of Type 2 Diabetes – 2018

Step 1

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.

Step 2

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).

These include:

  • SGLT-2 Inhibitors – empalgliflozin (Jardiance) and canagliflozin (Invokana)
  • GLP-1 Receptor Agonist – liraglutide (Victoza)

Step 3

If A1c target is still not achieved after 3 months, combine metformin plus two other agents for a three-drug combination.

Step 4  

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

  • If A1c is less than 9%, consider monotherapy
  • If A1c is greater than or equal to 9% consider dual therapy
  • If A1c is greater or equal to 10%, or if BG 300 or more, or pt is markedly symptomatic, consider insulin and injectable therapy.

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