Friday , September 22 2017

From the Editor

September, 2017

  • 19 September

    Sept. 19, 2017

    dave

    On most Saturday mornings I go out at 8 AM with our local bike club for a 30 to 40 mile ride. I usually wake up about 6 AM, and will turn on my local NPR station and tune into the People’s Pharmacy. Joe and Terry Graedon have been hosting the show ...

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September, 2017

Test Your Knowledge

Treatment Changes

A 42-year-old patient was diagnosed with type 2 diabetes approximately one year ago and is currently taking metformin, a DPP-4 inhibitor, and a basal insulin dose (current daily dose .9 U/kg/day). Despite good compliance with her diet, exercise, and medication regimen, she reports postprandial glucose measurements of usually about 190 mg/dL. Her current A1C is 7.6%. Which of the following changes in her management do you consider most important?

Correct

Answer is C. Add a pre-meal rapid-acting insulin

Educational Critique: While the ADA/EASD’s implementation strategies to pharmacologically achieve glycemic targets while minimizing side-effects need to be individualized for each patient, a general progression exists. Assuming there are no contraindications, metformin is the optimal first-line medication. Individualized A1c goals are assessed approximately every 3-6 months with additional drugs being added/adjusted as needed to achieve the A1C goal (1-drug monotherapy, 2-drug combo therapy, 3-drug combo therapy, complex insulin strategies). After a patient starts a basal insulin regimen, they can self-titrate their insulin dosing to their pre-agreed fasting glucose goals. The American Diabetes Association recommends the following glycemic recommendations for most adult, nonpregnant individuals with type 2 diabetes. Fasting glucose <130, postprandial glucose<180, mean plasma glucose<150-160, A1C=7%. When fasting glucose is at target, but postprandial glucose levels (PPG>180 mg/dL) and A1C remain above target, the addition of prandial insulin should be considered.

Reference: American Diabetes Association

Incorrect

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September, 2017