Speaker: Juan Pablo Frías, M.D., FACE
Diabetes Standards of Care 2020: A Global Update on Medication and Monitoring Guidelines
Webinar Description: In this webinar, Juan Pablo Frías, M.D., FACE, gives a global update on the diabetes standards of care on medication and monitoring guidelines.
Diabetes Standards of Care 2020: A Global Update on Medication and Monitoring Guidelines Q&A
with Juan Pablo Frías, M.D., FACE
1. Could you please elaborate on the GLP-1 and DPP 4 contraindication?
Both GLP-1 RA and DPP4 inhibitors are considered ‘incretin-based therapies.’ GLP-1 RA (or GLP-1 analogs) are administered SQ or orally and mimic the effects of native GLP-1 and provide supraphysiologic concentrations of GLP-1. DPP-4 inhibitors, inhibit the action of DPP-4 to degrade native GLP-1, therapy increasing endogenous GLP-1 concentrations. There is no advantage to giving both agents with respect to glycemic control and there may be an increased risk of side effects, therefore the recommendation is not to administer both classes of agents together.
2. Are the recommendations for intensifying to injectable therapy similar from the inpatient setting. For example, pt on Metformin, A1c > 9%- do you start basal insulin due to simplicity or GLP-1?
If a patient is stable in the hospital and being discharged and there was a need to start an injectable agent, I would first consider a GLP-1 RA as long as there are no contraindications. In the hospital, this will depend on the patient’s condition. Often times the hospitalized patient may need to temporarily discontinue metformin. Also, patients may need faster control of glucose which can be achieved with temporary insulin therapy temporarily. If appropriate monitoring is available, insulin therapy may be preferred in the inpatient setting. This can generally be changed to GLP-1 RA therapy as an outpatient once the patient is stable.
3. To what extent do you think the poor progress in glycemic control in the population has to do with poor access to medications (uninsured or underinsured) in addition to price gouging of insulins?
I think this plays a very important role. Many of these patients do not have options beyond MET and SFUs and find it very difficult to find affordable insulin or programs that provide continued access to insulin. Low dose pioglitazone is an option in appropriate patients and we should have generic DPP-4 inh. relatively soon which will also help.
Speaker: Juan Pablo Frias, M.D., FACE
Diabetes Standards and Guidelines: Medications and Monitoring
Speaker: Jay H. Shubrook DO FACOFP, FAAFP
Building a better base: Revisiting Basal insulin
Webinar Description: Jay H Shubrook, DO, FACOFP, FAAFP is a Board-Certified Family Physician and Diabetologist. He is a Professor in the Primary Care Department at the Touro University California College of Osteopathic Medicine. He also serves as the Director of Clinical Research and Director of Diabetes Services at this institution. He is the Associate Editor at the JAOA and Clinical Diabetes. Jay is on the global advisory board for Springer/Nature's Diabetes Medicine Matters. He is the past Chair of the Primary Care Advisory Group for the American Diabetes Association. His professional goal is to better prepare primary care providers to provide exceptional care for patients with diabetes. His research interests focus on type 2 diabetes prevention and early intervention.
Speaker: Jerry Meece, RPh, CDE, FACA, FAADE
Update on New Basal Insulins and Combinations: Starting, Titrating and Adding to Therapy
Webinar Description: Advances in the pharmacologic management of diabetes continue to evolve. These advancements are changing the paradigm of medication selection and titration of therapy. Jerry Meece, RPh, CDE, FACA, FAADE discusses changes in the landscape of basal insulin and basal insulin combinations.
Speaker: Elaine Cooke, BSc(Pharm), RPh, CDE
Starting and Helping People with Type 2 Diabetes on Insulin
Webinar Description: Starting and Helping People with Type 2 Diabetes on Insulin Lifestyle changes and oral medications are standards of care in type 2 diabetes management, but are unlikely to be permanent solutions because type 2 diabetes is a progressive disease. Most people with type 2 diabetes will eventually require insulin to achieve euglycemia. Elaine Cooke, BSc(Pharm), RPh, CDE shares her experience as a healthcare professional in Canada with insulin initiation and titration in type 2 diabetes.
Starting and Helping Type 2 Diabetes Patients on Insulin
Canadian Diabetes Association. Getting started with insulin, 2013
Insulin pen start checklist help sheet CDA Self-SMBG Frequency & Pattern Tool
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Appendix 4. Can J Diabetes 2013;37(Suppl 1):S197-S212
Canadian Diabetes Association Self-Monitoring of Blood Glucose Interactive Frequency & Pattern Tool
Canadian Diabetes Association. Insulin prescription tool for healthcare providers
FIT forum for injection technique
FIT technique plus technique for all
FITTER for Diabetes
BC Health Guide Sick Day Guidelines for People with Diabetes
Diabetes and Driving: 2015 Canadian Diabetes Association Updated Recommendations for Private and Commercial Drivers
Book on the athlete and diabetes
The Diabetic Athlete by Sheri Colberg published 2000 is the original book a newer version is Diabetic Athlete’s Handbook by Sheri Colberg published 2008 with paperback published 2009