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 CDCES® 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! 

 

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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.

Want to learn more about this topic?

• Join our Standards of Care Webinar – Jan 19, 2018
• Download our FREE Medication PocketCards
• Join our Meds Update Webinar – Feb 19, 2019
• Download CDCES Coach App – FREE

 

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Main Message from ADA – Individualize approach and focus on eating nutrient dense foods

The ADA Standards of Care, states that there is no ideal percentage of calories from carbs, protein and fat. The key is to individualize nutrition recommendations using a patient centered approach.  Emphasis is on healthy eating patterns which include nutrient dense foods and consumption of less added sugar and processed foods.

The ADA recommends a variety of eating plans based on available research.

Examples of Healthful Choices include:

• Mediterranean Diet
• DASH Diet
• Plant-based Diets
• Diabetes Plate Method

Common theme for the best diets includes more whole grains, fruits, vegetables, beans, nuts, fish and less processed foods and added sugars.

Resources

Best Diets for 2018 – Great NPR article that ranks diets from best to worse.

Joy of Six – Sugar Pledge Resource Page – Great tools and information to support eating less foods with added sugar.

Mediterranean Diet Info – from Oldways Website

Plant based eating resource page – Full of recipes, getting started resources and articles supporting the benefits of plant based eating.

DASH (Dietary Approaches to Stopping Hypertension). Here the NIH DASH Website provides research and links to patient and professional resources.

DASH Diet Info from US News

Oldways Website “inspiring good health through cultural food traditions”.  Oldways is a nonprofit food and nutrition education organization, with a mission to inspire healthy eating through cultural food traditions and lifestyles.  Includes cultural food info on plant based diets, Mediterranean Diet, Asian Diets and more. Lots of handouts and resources for patients and professionals.

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Want more info?

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