How to Use ADA’s Type 2 Diabetes Treatment Algorithm
[Pages:29]How to Use ADA's Type 2 Diabetes Treatment Algorithm
Carlos Mendez, MD, FACP
Presenter Disclosure Information
In compliance with the accrediting board policies, the American Diabetes Association requires the following disclosure to the participants: Carlos Mendez, MD, FACP Disclosed no conflict of interest
Management of Hyperglycemia in T2DM
1. Patient-centered care 2. Anti-hyperglycemic therapy 3. Implementation strategies 4. Other considerations
American Diabetes Association. 8. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes. Diabetes Care 2018; 41 (Suppl. 1): S73-S85
Learning Objectives
? Recognize drug-specific and patient factors of antihyperglycemic agents to support patientprovider shared decision making
? Demonstrate when and how to intensify therapy ? Identify opportunities to refer patients to
Diabetes Self-Management Education
Impact of Intensive Therapy for Diabetes: Summary of Major Clinical Trials
Study Microvasc
CVD
Mortality
UKPDS
DCCT / EDIC*
ACCORD
ADVANCE
VADT
Kendall DM, Bergenstal RM. ? International Diabetes Center 2009 UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:854.
* in T1DM
Holman RR et al. N Engl J Med. 2008;359:1577. DCCT Research Group. N Engl J Med 1993;329;977.
Nathan DM et al. N Engl J Med. 2005;353:2643. Gerstein HC et al. N Engl J Med. 2008;358:2545.
Patel A et al. N Engl J Med 2008;358:2560. Duckworth W et al. N Engl J Med 2009;360:129. (erratum:
Moritz T. N Engl J Med 2009;361:1024) . Writing Group for the DCCT/EDIC Research Group. JAMA. 2015;313(1):45-53.
Initial Trial Long Term Follow-up
Multiple, Complex Pathophysiological Abnormalities in T2DM
Adapted from: Inzucchi SE, Sherwin RS in: Cecil Medicine 2011
Multiple, Complex Pathophysiological Abnormalities in T2DM
SGLT-2 inhibitors
Adapted from: Inzucchi SE, Sherwin RS in: Cecil Medicine 2011
Patient-Centered Approach
"...providing care that is respectful of and responsive to individual patient preferences, needs, and values ensuring that patient values guide all clinical decisions."
? Gauge patient's preferred level of involvement ? Explore therapeutic choices ? Consider using decision aids ? "Shared decision making" ? Lifestyle choices ultimately lie with the patient
Diabetes Care 2012;35:1364?1379; Diabetologia 2012;55:1577.?1596
Glycemic Recommendations: Individualized Treatment
A1C ? ................
................
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