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February 2013 Webinar: “Practical Ways to Help Get Our Diabetes Patients to Goal”

February 2013 Webinar: “Practical Ways to Help Get Our Diabetes Patients to Goal”. Controlling the ABC’s Cases. The ‘ABCs’. A 1C B P < 140/90 C holesterol (LDL<100, if CAD <70). Improving Glucose Control. Who Are Your High A1C Patients?. Orals and need second oral? Need insulin?

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February 2013 Webinar: “Practical Ways to Help Get Our Diabetes Patients to Goal”

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  1. February 2013 Webinar:“Practical Ways to Help Get Our Diabetes Patients to Goal” Controlling the ABC’s Cases

  2. The ‘ABCs’ • A1C • BP < 140/90 • Cholesterol (LDL<100, if CAD <70)

  3. Improving Glucose Control

  4. Who Are Your High A1C Patients? • Orals and need second oral? • Need insulin? • On insulin? • There can be inertia at each level • DEPRESSION? • Adherence? • Open-ended ended question: • “Some people find it hard taking their insulin every day, how’s it going for you?”

  5. BP CONTROL

  6. BP Management • <140/90 • Multiple meds • Don’t miss an opportunity to titrate • Standing orders?

  7. Medication Treatment Algorithm? • Start with ACE or ARB and/or HCTZ • Either one • Best might be early combo since all will likely need it • Third agent based on co-morbidity • Beta blocker and/or Ca channel • Add the 4th and hopefully you’ve reached goal - if not call an expert +/- alpha blocker?

  8. 140/80 150/90 140/80 150/90 Tashko and Gabbay, Integrated Blood Pressure Control (2010)

  9. Cholesterol LDL control <100If CVD <70

  10. Getting to Goal on LDL • Most myalgia not from statins! • Stop and observe • Switch to another statin • Mention stroke risk • TITRATE

  11. Evidence Based Interventions That Reduce Morbidity and Mortality • HbA1C < 7 • BP < 130/80 • LDL cholesterol < 100 (or <70 if CAD) • Aspirin age > 50 men, 60 women with 1 risk factor • ACE -age >55 • Statin use- age >40 • Yearly screen for nephropathy, feet, and eye exams

  12. QUESTIONS? Any Cases?

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