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

• Controlling the ABC’s• Cases

The ‘ABCs’

•A1C

•BP < 140/90

•Cholesterol (LDL<100, if CAD <70)

Improving Glucose Control

5

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?”

BP CONTROL

BP Management

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

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?

Tashko and Gabbay, Integrated Blood Pressure Control (2010)

150/90 140/80 150/90

140/80

Cholesterol LDL control <100If CVD <70

Getting to Goal on LDL

• Most myalgia not from statins!• Stop and observe• Switch to another statin• Mention stroke risk• TITRATE

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

QUESTIONS?

Any Cases?