For last week’s practice question, we quizzed test takers on which medications are needed. you all did great, since 81% of respondents chose the best answer. We want to share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: LS is 43 with type 2 diabetes, with an A1C of 8.8%, UACR is 32 mg/g, GFR is 48, and blood pressure is 146/84 or greater on 2 different occasions.  Current medications include metformin 1000mg BID, lovastatin 20mg, glipizide 20mg.  

Based on the ADA standards of care, in addition to lifestyle encouragement, adding which medications would most improve outcomes?

Answer Choices:

• GLP-1 RA and low dose aspirin
• ACE and ARB for blood pressure management
• Basal insulin and a diuretic
• SGLT-2 and ACE or ARB

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As shown above, the most common choice was option 4, the second most common answer was option 1, then option 2, and then finally option 3.

Getting to the Best Answer

Answer 1 is incorrect. 7.61% chose this answer, “GLP-1 RA and low dose aspirin.” Since LS is under the age of 50 and their CV risk status isn’t revealed in this case study, we don’t have enough information to start LS on aspirin. We could consider adding a GLP-1 RA, since it is known to lower glucose, decrease CV risk and offer some renal protection. However, since one part of the answer is wrong, the whole answer is wrong, even though adding a GLP-1 to LS’s plan would be helpful.

Answer 2 is incorrect. 6.58% of you chose this answer, “ACE and ARB for blood pressure management.” LS does have hypertension and elevated albumin levels and is not taking any medication for blood pressure. Given those two risk factors, LS needs to take EITHER an ACE Inhibitor or ARB for blood pressure management, but NOT both. We would recommend starting LS on an ACE or ARB first and adjusting the dose based on home blood pressure reading. If LS needs an additional blood pressure medication, we could add a diuretic, calcium channel blocker or beta-blocker, or another agent. See our Hypertension & Lipids, Cheat Sheet for more info.

Answer 3 is incorrect. 4.94% of respondents chose this answer, “Basal insulin and a diuretic.” With an A1c of 8.8%, LS isn’t quite ready for insulin since there are 2 other medications we could try first (SGLT-2 or GLP-1) to get glucose to goal. The ADS Standards recommend trying a GLP-1 before basal insulin if possible to avoid the risk of hypoglycemia and to decrease weight gain. In addition, because LS has hypertension and albuminuria, a diuretic would not be the medication of choice to lower blood pressure. The preferred medications for blood pressure in the presence of albuminuria include either an ACE or ARB.

Finally, Answer 4 is correct. 80.86% chose this answer, “SGLT-2 and ACE or ARB.” GREAT JOB! Most of you chose this BEST answer. In the presence of hyperglycemia, albuminuria, and diminishing renal function, adding a SGLT-2 Inhibitor is the best choice based on ADA Standards. SGLT-2s have been shown to not only lower glucose and protect kidneys, they can also lower blood pressure due to their “glucoretic” properties. To manage LS’s hypertension, the preferred medications for blood pressure in the presence of albuminuria include either an ACE or ARB.

We hope you appreciate this week’s rationale! For more information on this topic, check out the ADA Standards of Care. Or, join our 3 day DiabetesEd Specialist Virtual Conference next week. It’s not to late to register!

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Join us for our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

 Download Course Schedule |  Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

 Download Course Schedule |  Download Course Flyer

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Two Registration Options

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Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

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Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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All hours earned count toward your CDCES Accreditation Information

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