Search form

Topics:

ubmslateCL-logo-ubm

CL Mobile Menu

T2DM: Intensifying Rx When Diet, Lifestyle and OADs Aren't Enough

T2DM: Intensifying Rx When Diet, Lifestyle and OADs Aren't Enough


  • Remember Mrs Davis. She has type 2 diabetes, hypertension, hyperlipidemia, obesity.

  • Patient history review: Over the course of 6 months, A1c, blood pressure, and LDL have gotten progressively worse; she lost then regained weight. Could any of this have been prevented...

  • Guidelines: AACE / ACE 2017 Diabetes Treatment Algorithm Slides summarize how to individualize T2DM treatment as well as BP and LDL treatment.

  • Essential elements of lifestyle therapy: Nutrition, physical activity, sleep, behavioral support.

  • AACE/ACE Lifestyle therapy algorithm. Intensity stratified by burden of obesity and related complications. CLICK HERE TO ENLARGE.

  • AACE Pre-diabetes Algorithm. Risk stratification based on IFG, IGT; medication recommendations based on range of pre-diabetes criteria; includes medically-assisted weight loss therapy.

  • AACE/ACE Pre-diabetes Algorithm. CLICK HERE TO ENLARGE.
  • AACE/ACE ASCVD Risk Factor Modification Algorithm. Addresses dyslipidemia, hypertension based on disease severity.
  • AACE/ACE ASCVD Risk Factor Modification Algorithm. CLICK HERE TO ENLARGE.

  • AACE/ACE ASCVD Glycemic Control Algorithm. Provides "nuts and bolts" of initiating and intensifying medical blood sugar management based on A1c at "entry" to therapy; does not replace clinical judgement regarding individual patient needs.

  • AACE/ACE ASCVD Glycemic Control Algorithm. CLICK HERE TO ENLARGE.

  • Profiles of Antidiabetic Medications. Includes impact of drugs on hypoglycemia, weight, renal/GU, GI, cardiac, bone, and ketoacidosis.

  • Profiles of Antidiabetic Medications. Includes all currently FDA-approved medications for T2DM. CLICK HERE TO ENLARGE.

  • When it's Time to Start Insulin. T2DM is progressive and eventually all patients will require insulin to manage blood glucose as beta-cell function diminishes.

  • AACE/ACE Algorithm for Adding/Intensifying Insulin. CLICK HERE TO ENLARGE.

  • When it's Time to Talk Insulin. Discuss at length with your patient! Listen, address issues, acknowledge resistance; all they will be thinking about is "the needle." Select pen/syringe carefully with consideration for age, manual dexterity, vision.

  • Pharmacokinetics of Insulin. CLICK HERE TO ENLARGE.

  • Insulin Delivery Options. There is a very wide range of choice when considering an insulin delivery device for a specific patient.

  • Insulin Calculations. Consider initiating insulin therapy with a single injection of basal insulin.

  • Basal Insulin Dose Adjustments. One of the most effective approaches is to teach patient how to increase dose based on morning FPG values obtained via SMBG.

  • Adding Meal-time (Prandial) Insulin. One approach: start with a prandial insulin dosed at 10% of the current basal dose, given before the largest meal of the day.

  • What are the Goals for Mrs Davis' Next Appointment? Mrs Davis (A1c = 8.4) Insulin begins at 0.2 x 97.3 = 19.4 units; rounded to 20 units TDD

  • Hypoglycemia. Teach your patients the same day you prescribe diabetes medication how to recognize it, safely treat it and avoid over-treating it.

  • Symptoms of Hypoglycemia.

  • The 15:15 Rule for Treatment of Hypoglycemia.

  • SUMMARY of The Principles of the AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm. CLICK HERE TO ENLARGE.

    Click here for the Type 2 Diabets: Back to Basics Post-test.

In this portion of our Type 2 Diabetes: Back to Basics Special Report, author Dr Susan Williams summarizes the essential principles of T2DM management when diet and lifestyle changes and the addition of 1 or more antihyperglycemic agents have not lowered A1c to the goal set for an individual patient. Included are sections on initiating and intensifying insulin and on precautions to help avoid hypoglycemia.

These slides are based on—and incorporate—slides from the AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm 2017 which is available on the AACE website. The algorithm spends equal time on management of T2DM comorbidities/ASCVD risk factors. The presentation summarizes the AACE/ACE 2017 Consensus Statement on comprehensive T2DM management.

PLEASE NOTE: TO ENLARGE TABLES ON SLIDES 6, 8, 10, 12, 14, 16, AND 27, PLEASE CLICK ON THE LINK PROVIDED IN THE CAPTION; see example below.

Comments

Brilliant summary, very clear. Love the charts. Thanks

Elizabeth @

table too small

BHANUKUMAR @

Included tables to small to read

Samuel @

@Samuel, click on the link in the caption to enlarge the tables.

Jason @

Included tables to small to read

Samuel @

Add new comment

 
Loading comments...

By clicking Accept, you agree to become a member of the UBM Medica Community.