New 2019 ADA Standards, From Meds to Technology – January Newsletter

by Coach Beverly
Beverly Thomassian, RN, MPH, CDCES, BC-ADM

January Newsletter now available!

For this newsletter, we provide highlights to the 2019 Standards, discuss our Question of the Week, reveal some study tips for the 2019 CDCES Examination, revisit the cost of insulin and share some of our most popular blog posts. Articles include:

• ADA Standards of Care From Meds to Technology, Compliance to Patient-Centered
• ADA Standard 9: Pharmacologic Management
• New ADA Standard 7: Diabetes Technologies
• CDCES Exam 2019 Updates
• Making a Difference Scholarship
• and more!

Click here to read our newsletter!

---

Our Diabetes Detective Team scans the diabetes news to discover the most relevant info that Diabetes Educators need in their daily practice. We post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

[yikes-mailchimp form=”1″]

Check out our latest Blog Bytes >>

Recent research by the Broad Institute of MIT, Harvard, and Massachusetts General Hospital has shown that there may potentially be five distinct subtypes of type two diabetes based individual genetics.

Three of the subtypes involve insulin resistance where insulin is not used effectively and for the right purpose. The other two subtypes involve a deficiency of insulin where insulin is not being produced in adequate amounts by the beta cells. 

The study included 17,365 subjects from four separate studies with type two diabetes. The genomic data of each individual was analyzed and recorded, only to find the five different variances in DNA that led to insulin resistance/deficiency. Those who were insulin resistant typically had a larger waistline and had a higher risk of obesity. Individuals who were insulin deficient were typically thinner than their counterparts. 

This new data is critical because “there could be a number of processes which lead to high blood glucose levels.” This information also means that there is no one-size-fits-all when it comes to treating type two diabetes with medication therapy.

For more information on the subtypes of type two diabetes, visit subtypes of type 2 diabetes highlighted by genetics study.

---

Learn more about matching medication therapy to the person with diabetes.

Meds Management Update – 1.5 CEs | Live Webinar, Dec 6, 2019 at 11:30

Join Beverly to gain insight into the increasingly complex world of diabetes medications and management.

This webinar will highlight the key elements of the latest Medication Guidelines by AACE and ADA. We will explore clinical factors to consider when determining the best strategy to improve glucose management in people with type 2 diabetes and discuss new medications.

This webinar will discuss how to integrate new medication recommendations into our practice. We will discuss the benefits, considerations and critical information to share with our patients and providers.

• Overview of classes and actions of diabetes medications
• Medication management updates and new recommendations
• Using the ADA/AACE algorithms to improve diabetes care and outcomes

This course is included in: Level 2: Beyond Fundamentals. Purchase this course individually for $29 or the entire bundle and save 70%. 

---

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

[yikes-mailchimp form=”1″]

“Insulin’s High Cost Leads To Lethal Rationing” – NPR

Such a tragic story of a young man’s life cut short because he couldn’t afford his insulin. Sign the ADA Petition to make insulin affordable.

We can make a difference starting today! 

Make Insulin Affordable – what you can do today

The Insulin Wars ( How insurance companies farm out their dirty work to doctors and patients) – The New York Times 

 

According to a statement made recently by Eli Lilly, they have submitted a nasal glucagon treatment to the FDA. The treatment would be for cases of severe hypoglycemia in adults and children with diabetes. This treatment would be the first of it’s kind, a nasal spray, to treat low blood glucose emergencies in those with diabetes.  

“The submissions put us one step closer to bringing this innovative rescue medicine to the diabetes community and filling an important need in the treatment of severe hypoglycemia,” said Thomas Hardy, Senior Medical Director, Lilly Diabetes, told Endocrine Today. 

The way glucagon is currently administered can be a complicated process, requiring the administer to reconstitute the powder and other steps. This can be a confusing process, particularly if you are a caregiver a a child with diabetes. The new nasal glucagon would deliver the medicine in a powder form in an easy, ready to use format. Many people already understand how to use nose spray, making this functional but also realistic in a hypoglycemic emergency. 

 “This is important and different. You don’t want people to get low [blood sugar], but they do. It’s not a pretend problem, and the fact that the science is clear that people don’t know how to treat it makes it a real problem. With this nasal glucagon kit, anyone could rescue them.”

To learn more about the new nasal glucagon – Lilly submits NDA for nasal glucagon by Helio Endocrine Today

 

Updated and now available On Demand in the Online University

This course is included in: Level 2 – Beyond Fundamentals. Purchase this course individually for $29 or the entire bundle and save 70%. 

Diabetes Education Services Online University Courses are an excellent way to study for your exam anytime and anywhere that is convenient for you. You will have immediate access to your courses  for 1 year after your purchase date. Each individual online course includes a: 90 minute video presentation, podcast, practice test and additional resources.

This advanced level course is designed to help participants determine the best medication choice based on the patient’s unique characteristics. The content incorporates the management guidelines published by the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) Algorithms. We will discuss the role of lifestyle changes and review the pros and cons of available diabetes medications using a patient centered approach. In addition, we discuss the medication algorithms in detail. Participants not familiar with the basics of diabetes medication, may benefit from first enrolling in our “Meds for Type 2” and “Insulin 101 Course.”  90-minute course.

Topics include:

• The importance of patient assessment in determining a realistic meds management plan.
• Gain insights into developing an individualized plan to treat hyperglycemia in collaboration with the person with diabetes
• Strategies on adjusting meds plus lifestyle to achieve glucose targets

Intended Audience:  A great course for health care professionals seeking to enhance their knowledge of hyperglycemia management for those living with type 2 diabetes.

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.

Fee: $29.00 (Group Discounts Available)

Course Level: 2 (included in Level 2 – Beyond Fundamentals)

All hours earned count toward your CDCES Accreditation Information

Earn 1.5 CEs

Video presentation and podcast available now On Demand.

*Certified Diabetes Care and Education Specialist^® and CDCES^® are registered marks owned by NCBDE. The use of DES products do not guarantee successful passage of the CDCES^® exam. NCBDE does not endorse any preparatory or review materials for the CDCES^® exam, except for those published by NCBDE.”

New & Update Medication Update Webinar is now available! 

Feeling overwhelmed by all the new recently approved diabetes medications? Two bio-similiar insulins are now available and another GLP-1 RA was just approved. Plus, 2 new combo oral meds are now available.

Are you wondering how to apply the new 2018 ADA and AACE Medication Management Guidelines into practice?

We are here to help out with our newly recorded Medication Update 2018!

This webinar will discuss how to integrate these new medications into our practice. We will discuss the benefits and limitations and critical information to share with our patients and providers. If you want cutting edge information on the latest pharmacology and hospital glucose management, we highly recommend this Meds Update.

 

Testimonial: “I want to let you know your online program rocks! I’d say it is the best one out there!”  – Marsha

Fee: $29.00 (Group Discounts Available)

All hours earned count toward your CDCES Accreditation Information

All video presentations and podcasts available now On Demand. Includes both courses, free podcasts, handouts, resources and CE Certificates.  

Standards of Care Section 8 – Approaches to Glycemic Treatment

Insulin Therapy for Type 1
This updated version of Meds Management includes more detailed information on insulin therapy for Type 1s. They note that sensor-augmented insulin pump therapy with the threshold suspend feature reduced nocturnal hypoglycemia without increasing A1c (for type 1s in a 3 month randomized trial). The FDA approved the first hybrid closed-loop pump system, since the literature supports its safety and efficacy.

Investigational Agents for Type 1s

• Add on Metformin for Type 1 – In several trials, adding metformin to insulin for type 1s, reduced insulin requirements 6.6 units a day and led to small reductions in weight and LDL cholesterol. However, it did not significantly reduce A1c. Metformin in not FDA Approved for use in patients with type 1 diabetes.
• SGLT-2 Inhibitors – these “glucoretics” lower glucose by decreasing renal reabsorption of glucose in the proximal tubules. Since this class works independent of endogenous insulin, SGLT-2 Inhibitors may benefit patients with type 1 or type 2 (not FDA Approved for use in patients with type 1 diabetes).  However, the FDA has issued a warning of the risk of ketoacidosis occurring in the absence of significant hyperglycemia. There are many reported cases of euglycemic ketoacidosis in patients with type 1 or type 2 diabetes. If patients are experiencing signs of ketosis, instruct them to immediately stop taking the SGLT-2 and seek immediate care.

Type 2 Management Strategies – 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, 2018
• Download CDCES Coach App – FREE

 

---

 

 

New SGLT-2 Inhibitor – Ertugliflozin

The Food and Drug Administration (FDA) has approved Ertugliflozin (Steglatro), a new SGLT-2 Inhibitor to treat adults with type 2 diabetes. Also approved are two new combination medications with ertugliflozin.  These include Segluromet (ertugliflozin plus metformin) and Steglujan (ertugliflozin plus sitagliptin). See box below for available combination doses (in mgs).

Dosing range: 5 -15 mg daily.  Monitor GFR before starting. Don’t start med if GFR is less than 60 and stop if GFR is less than 30.

Considerations: Ertugliflozin has the same warnings as other SGLT-2s: Watch for hypotension, UTI’s, increased urination, genital infections, ketoacidosis.

Benefits: no hypoglyecmia or weight gain.
Lowers A1c 1.0% – 2.0%. Lowers wt 1-3 lbs.

Download our FREE Updated Insulin PocketCard

---

Medication Update Webinar – Feb 19, 2018 11:30 to 1pm (PST)