A Nurse's Perspective: Martha M. Funnell, MS, RN, CDE
In our practice we spend time in the community and encounter patients who are seeing primary care physicians and are on minimal therapy as well as patients from our clinic who are managed more aggressively....
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The community patients have typically been put on multiple oral medications as their prescribers are trying to avoid the use of injectables. In these settings we offer the patients information about GLP-1 agonist therapy that they can take back to the prescriber.
When it comes to starting GLP-1 agonist therapy we often find that the biggest hurdle is insurance and so one of the first things we look to do is insure that the patients will be able to continue on the medication after the sample or coupon is gone.
We have found the best way to have success is to lay out the realistic expectations and help the patient know what to look for as markers of success. We know that the medication decreases appetite and this often means that we do not have to give our patients strict food guidelines but we do let them know that it might be a good idea to decrease their fat intake at the same time to help reduce gastric problems.
It might be interesting to note that many of us think that decreased appetite is a good thing, but in reality many of our patients feel that losing their appetite is a sign of weakness and perhaps the feeling of being sick and then they will be less likely to remain on the drug.
This is a medication for diabetes and not a weight loss miracle drug and our patients need to know this up front. We are more concerned about the lowering of A1c's than the lowering of the weight and for a lot of patients there is no weight loss at first but a slowing of weight gain. A lot of times this weight plateau is related to the dosing levels as we find that in the community many patients never get up to the maximum dose.
We have found that although the risk of hypoglycemia is low when using the GLP-1 agonists we tend to increase monitoring when the medication is started and often this helps the patient see that the medication is working which increases persistence. After a few weeks of readings we usually decrease the frequency and the patients seem to be very appreciative of this.
We also discuss the use of GLP-1 analogs versus insulin and how they differ. I often find that letting them know the differences make them feel more comfortable about using the GLP-1 analogs and they feel that using these analogs may prolong the time to insulin.
I would have to say that if you get all the issues out on the table and let the patient get all their questions answered then your patients should have a high degree of success using these analogs.
Martha M. Funnell, MS, RN, CDE, is a Research Investigator at the Department of Medical Education, Michigan Diabetes Research and Training Center, University of Michigan.
Interviewed by Dave Joffe, Editor-in-chief, Diabetes In Control
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