PHARM - Treatment of Diabetes Mellitus_students.pdf

NON-INSULIN TREATMENT OF TYPE 2 DIABETES KATIE TROTTA, PHARMD, BCACP LEARNING OBJECTIVES Discuss the mechanism of action, indications, therapeutic course, contraindications, drug-drug and drug-food interactions, side effects, and monitoring parameters of the non-insulin pharmacologic agents commonly...

NON-INSULIN TREATMENT OF TYPE 2 DIABETES KATIE TROTTA, PHARMD, BCACP LEARNING OBJECTIVES Discuss the mechanism of action, indications, therapeutic course, contraindications, drug-drug and drug-food interactions, side effects, and monitoring parameters of the non-insulin pharmacologic agents commonly used in the treatment of diabetes mellitus type 2 Discuss the goals of treatment for diabetes mellitus type 2 based on patientspecific factors. Develop an evidence-based treatment plan for a patient with diabetes mellitus type 2 based on patient specific factors. Develop an appropriate monitoring plan for a patient being treated for diabetes mellitus type 2 based on patient specific factors. GUIDELINES ADA Standards of Care in Diabetes https://diabetesjournals.org/care/issue/47/Supplement_1 REVIEW ON YOUR OWN WHAT IS DIABETES MELLITUS (DM)? Diabetes mellitus (DM) describes a group of chronic metabolic disorders characterized by hyperglycemia that may result in long-term microvascular and neuropathic complications, including nephropathy, retinopathy, and neuropathy. Macrovascular complications (coronary artery disease, peripheral vascular disease, and stroke) are also associated with DM. American Diabetes Association: Diabetes mellitus, or simply, diabetes, is a group of diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin. Chisholm-Burns M, Schwinghammer T, Wells B, Malone P, Kolesar J, DiPiro J. Pharmacotherapy – Principles & TYPES OF DM Type 1 Type 2 Gestational diabetes mellitus (GDM) Other Latent Autoimmune Diabetes of Adulthood (LADA) Mature Onset Diabetes of Youth (MODY) Other: Beta cell genetic defects, cystic fibrosis (Type 3c), drug/chemical-induced DIABETES PREVALENCE https://www.cdc.gov/diabetes/data/statistics-report/index.html People who do not meet the criteria for diabetes yet have abnormal carbohydrate metabolism that results in elevated glucose levels Risk factor for developing T2DM If patients are high-risk and they do not yet present with pre-DM, consider drawing a fasting insulin level PRE-DIABETES/ INSULIN RESISTANCE Identify how progressed a patient is with their insulin resistance and how much beta-cell function remains Useful tool that is often underutilized DIABETES SCREENING & DIAGNOSIS REVIEW KAHOOT: DIABETES SCREENING & DIAGNOSIS CASE Hector is a 48 year old Latino male presenting today for his annual physical. He has previously been in good health but lately has been feeling more fatigued and he feels it is due to increased stress at work; has no additional complaints. PMH: HTN FH: mom alive and well at 76 with OA; dad passed away from an MI at 68 + had a hx of HTN, DM, and COPD; one older sister age 54 in remission for cervical cancer SH: drinks 2-3 beers most nights of the week Meds: lisinopril/HCTZ 10/12.5 q daily Vitals: BP 132/78, HR 74, RR 16, T T 37°C (98.6°F), Ht 5’8” Wt 180 lb (up from 172lb one year ago) ROS: (+) fatigue, (+) nocturia, (-) polydipsia/polyphagia, (-) N/V/D, (-) SOB/chest pain CASE What risk factors does Hector have for DM? What symptoms is he displaying consistent with hyperglycemia? What labs should be checked today? PATHOPHYSIOLOGY OF T2DM: CORE DEFICITS Insulin resistance in the muscle/liver (differentiating factor) Body initially compensates by ↑ β-cell activity  β-cells eventually become dysfunctional β-cell failure  hyperglycemia Hepatic glucose overproduction in fasting state ↑ insulin OMINOUS OCTET NON-INSULIN MANAGEMENT OF DIABETES TREATMENT GOALS Prevent (or manage!) long-term microvascular and macrovascular complications Maintain quality of life Preserve β-cell function Avoid weight gain Prevent acute complications from hyperglycemia Minimize hypoglycemic events PATIENT-CENTERED COLLABORATIVE CARE Patient should be an active member of the decision-making process Utilize patient-centered communication, strength-based language, and active listening Assess cultural components of health and health literacy Uncover potential barriers to care Involve an interprofessional team! CONSIDERATIONS WHEN TREATING T2DM Always refer to diabetes self-management education and support (DSMES) Goal setting Lifestyle management Immunizations Comprehensive, holistic diabetes care Evaluate for common co-morbid conditions and diabetes complications ASCVD risk Kidney disease Microvascular complications Obesity NAFLD/NASH OBESITY & WEIGHT MANAGEMENT Diet, physical activity, and behavioral modifications to achieve at least 5% weight loss to improve glycemic control and reduce ASCVD risk Not one diet recommendation No set percentage of carbs/fat/protein Maximize whole grains, legumes, fruits, veggies, nuts, and seeds Minimize refined sugars, processed and packaged foods, and sugar sweetened beverages Physical activity 150 minutes/week with no more than 2 consecutive days without physical activity Combination of cardio and strength training Minimize sedentary time (