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?