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Monthly Archives: May 2018

May 26, 2018

Regardless of your political leanings, there is no doubt that there is a lot of miscommunication and false truths concerning the new drug pricing reform plan. The biggest message seems to be “it is a work in progress”! This week Kennen Munoz Munoz, our current Pharm. D. Candidate from LECOM …

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Those Pesky Facts About Insulin Costs

Guest Post by David Kliff, Editor, Diabetic Investor

The so-called “high” cost of insulin continues to get lots of attention. But as I’ve noted before, little perspective has been given to this debate and far too many facts are missing. Yes, I know facts are pesky things, but they are facts nonetheless. Allow me for a moment to provide some examples.

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Double Therapy

Would you treat a new patient with a family history of heart disease, diagnosis of type 2 diabetes, and an A1c of 8% with the double therapy of a GLP-1 plus an SGLT-2 inhibitor? Follow the link to share your response.

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Clinical Case Vignette Follow-up: Two Steps Back

Mrs. Hunter is 36-year-old African-American who comes to your office for her annual wellness exam. She has excessive weight (BMI 27 kg/m2), but is otherwise healthy. She jokes that she, “just can’t seem to lose that extra baby weight” after giving birth 3 years ago. However, her daughter recently started preschool so she has been able to go to her new gym several times per week. In fact, one of the added bonuses of her membership is that she has been participating in their free, weekly nutrition and exercise support groups. In addition to her routine labs, you order an A1C, which comes back elevated at 7.1%. You and Mrs. Hunter set a goal for A1C<6.5%. She returns 3 months later for a follow-up visit and her office labs show an A1C 6.8%. You congratulate her on her progress and ask her to return in another 3–4 months. When she does, she is above her goal with an A1C 8.1%. She explains that she has gone back to full-time work and just doesn’t have the time to get to the gym anymore. At this time, what would your next step be and what would her individualized glycemic targets be?

A. Encourage lifestyle modifications and start metformin with a target A1C less than 6.5%
B. Encourage lifestyle modifications and start metformin with a target A1C less than 7.5%
C. Encourage lifestyle modifications and start a 2-drug combination target A1C target less than 7%
D. Encourage lifestyle modifications and do not initiate drug therapy at this time

Follow the link for the answer.

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