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Type 2 Diabetes: Current Challenges for Treatment

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Modest and controlled by diet and exercise. Also controlled when insulin is used with metformin ... to solve problems and adjust emotionally to diabetes ... – PowerPoint PPT presentation

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Title: Type 2 Diabetes: Current Challenges for Treatment


1
Type 2 Diabetes Current Challenges for Treatment
2
Diabetes in the United States
  • 20.8 million people affected
  • In 2002, total costs were 132 billion
  • Sixth most frequent disease-specific cause of
    death
  • Number 1 cause of
  • Kidney failure
  • Adult blindness
  • Nontraumatic limb amputation

American Diabetes Association (ADA). At
http//www.diabetes.org/about-diabetes.jsp.
3
Risk Reduction With Intensive Treatment UKPDS
A1C 7.0 for intensive treatment vs 7.9 for
conventional treatment
P0.029
P0.05 (NS)
P0.046
P0.0099
P0.0031
UK Prospective Diabetes Study Group. Lancet.
1998352837-853.
4
Recommended Targets for Patients With T2DM
Referenced to a nondiabetic range of 4.0-6.0
using a DCCT assay Postprandial glucose
measurements should be made 1-2h after the
beginning for the meal, generally peak levels in
patients with diabetes Current NCEP/ATP III
guidelines suggest that in patients with
triglycerides ?200 mg/dL, the non-HDL
cholesterol (total cholesterol minus HDL) be
utilized The goal is ?130 mg/dL.
Adapted with permission from ADA. Diabetes Care.
200730(suppl 1)S4-S41. AACE, ACE. Endocr
Pract. 20028(suppl 1)40-82.
5
Are Patients Meeting ADA Clinical Practice
Recommendations?
NHANES, 1999-2002 (n998)
49.8 3.6
Meeting Recommended Goals ()
39.8 2.7
36.0 4.0
27.4 2.0
NHANES National Health and Nutrition
Examination Survey. HDL gt45 mg/dL low
risk. Resnick HE et al. Diabetes Care.
200629531-537.
6
Patient Barriers to Initiating Insulin Therapy
Barriers
Communicate to Patient
  • Failing oral therapy 58 patients believe
    using insulin means they have failed OAD therapy
  • Needle phobia Fear associated with
    early experiences
  • Fear of complications Casual association of
    insulin with diabetic complications

Meece J. Diabetes Educ. 2006329S-18S Peyrot M
et al. Diabet Med. 2005221379-1385.
7
Clinician Concerns About Insulin Therapy in T2DM
  • Hypoglycemia
  • Worsening
  • atherosclerosis
  • Weight gain
  • Patients negative perception of insulin therapy

Romano G et al. Diabetes. 1997461601-1606
Douek IF et al. Diabet Med. 200522634-640
Malmberg K et al. J Am Coll Cardiol.
19952657-65 Malmberg K et al. BMJ
19973141512-15 UK Prospective Diabetes Study
Group. Lancet. 1998352837-853.
8
Diabetes Education Diabetes Self-Management
Training
  • CDEs provide comprehensive care
  • Assist patients in understanding their
    medications
  • Instruct patients in self-monitoring of blood
    glucose
  • Empower patients to solve problems and adjust
    emotionally to diabetes
  • CDEs focus on the patient
  • Assist in creating self-management plans for the
    patients specific needs
  • Age-based, school, daily activities, family
    demands, eating habits, health problems
  • National listing of CDEs available from AADE
    www.diabeteseducator.org

AADE American Association of Diabetes
Educators. At www.diabeteseducator.org
9
Summary
  • Diabetes is a growing epidemic in the US
  • Diabetes is associated with the risk of
    developing long-term morbidities
  • We are not meeting the recommended clinical goals
    for glycemic control
  • Specific barriers exist for the patient and
    clinician when initiating or advancing care of
    diabetes
  • Patient education can be key in achieving
    treatment goals
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