Diabetes Update: 2018 Standards of Care

Diabetes Update: 2018 Standards of Care

Diabetes Update: 2018 Standards of Care Veronica J. Brady, PhD, FNP-BC, BC-ADM, CDE NAPNAMarch 3, 2018 Objectives Review latest diabetes statistics

Discuss latest recommendations for diabetes management Case study Terminology No longer using the term diabetic. Diabetes does not define people.

People with diabetes are individuals with diabetes, not diabetics. Diabetic will continue to be used related to complications, e.g., diabetic retinopathy. ADA, Diabetes Care,2016;

STATISTICS Lifetime risk of DM & Years Lost After age 20 years life time risk 40.2% for men and 39.6% for women (highest Hispanic men/women; non Hispanic black women highest >50%)

Years lost when diagnosed at age 40 is 5.8years G r e gg, e t, a l, 2 014 . Lan c e t D iabe t e s & E n do c r in ol ogy As many as 1 in 3 US adults

could have diabetes by 2050 CDC.gov/diabetes Diabetes United States 30.3 million in US ( 9.4% of population) 1/3 unaware that they

have diabetes Seniors (65+) 25.2% (12 million dx & undx) 84 million adults with pre-diabetes 7 t h leading cause of death in the US 252,806 death certificates list diabetes as underlying contributing cause in 2015 Medical expenditures for persons with DM 2.3x higher than

those without DM cdc.gov/diabetes 2018 Diabetes Nevada 12.4% (281,355)of adult population have diabetes 75,000 dont know they have diabetes

Every year 10,000 Nevadans are diagnosed with diabetes 38.5% (787,000) have pre-diabetes Direct care cost of diabetes in Nevada was an estimated $1.9billion in 2012 Diabetes.org accessed 2/2018

Case S.B. is a 40 year old female with a 10 year h/o T2DM. She has not attended DSME since diagnosis. Since her last visit she has experienced multiple episodes of hypoglycemia with BG ranging 42-70mg/dL. She currently test 3x/ day with BG ranging 42-347mg/dL at all

times of the day. Current medications: Basaglar 45 units at hs Humalog 15 units TIDac Lisinopril 20mg daily Simvastatin 10mg daily

Case (cont) PMH-HTN, T2DM, Anemia (heavy periods), hyperlipidemia FH-mother and sister with DM, father deceased heart attack age 54 Labs- A1c 9.7%, cholesterol-240, LDL120, HDL- 42, GFR-111, micro/alb-45 PE- BP 160/90, 86, BMI 30.4 weight- 90kg

WHAT DO THE LATEST STANDARDS SUGGEST FOR MANAGEMENT OF S.B.? ADA 2018 Standards of Medical Care NEW

RECOMMENDATIONS Screening Testing for diabetes/pre-diabetes is recommended for children < 18 who are overweight/obese with one or more risk factors

Maternal diabetes/GDM Signs of insulin resistance 1st or 2nd degree relative with DM Race/ethnicity ADA standards of care, 2018, diabetes.org

Use of A1c Consider alternate method of testing in persons whose A1c does not match with SMBG readings Consider age, ethnicity, pregnancy, sickle cell disease, etc. when interpreting A1c

ADA standards of care, 2018, diabetes.org Comprehensiv e Exam ADA standards of care, 2018, diabetes.org

Comprehensive Exam (cont) ADA standards of care, 2018, diabetes.org MANAGEMENT

Diabetes Self-Management Education DSME should be offered to patients at time of diagnosis, annually, when complications arise and when there are transitions in care. Education can be offered in group

setting, individually or using technology ADA standards of care, 2018, diabetes.org Use of Technology CGM helps to improve glycemic

control in patients with T1DM starting at 18 years of age. Newest CGM--FreeStyle Libre ADA standards of care, 2018, diabetes.org

Cardiovascular Disease & DM In patients with DM and atherosclerotic cardiovascular disease, diabetes management should begin with metformin and

lifestyle changes and then include an agent that reduces major cardiovascular events (empagliflozin & liraglutide) ADA standards of care, 2018, diabetes.org

ADA standards of care, 2018, diabetes.org Blood pressure Current target 140/90 All patients with HTN should monitor BP at home

ADA standards of care, 2018, diabetes.org ADA standards of care, 2018, diabetes.org

Special Populations Pregnant women Recommend low dose ASA at end of 1st trimester Older adults Decrease risk of hypoglycemia Avoid overtreatment

Simplify regimens Personalize targets ADA standards of care, 2018, diabetes.org Management of S.B. in 2018

Due to her anemia A1c not the best measurement of BG control. She needs to be referred for DSME She would likely benefit from use of CGM to guard against hypoglycemic events Due to HTN, hyperlipidemia, and family history, as well as

being obese she would likely benefit from use of liraglutide (if no contraindications) May require additional BP medication Prescribing a home BP monitor is recommended [email protected]

THANK YOU!! Questions???

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