Type-2 Diabetes
Don't use DIABETES as a CV risk equivalent
As a pharmacy doctor, you will see more consensus on using statins for diabetes patients. We all know the controversy about the ACC/AHA cholesterol guidelines that abandoned LDL goals and recommended specific statin doses instead. Now the American Diabetes Association is following suit and providing similar guidance on when to use a statin in diabetes patients. …
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Type-2 Diabetes
Finerenone (Kerendia) role for Diabetic Kidney Disease
As a hospital pharmacist, you will hear about a new medication finerenone ( Kerendia ) for patients with chronic kidney disease (CKD) due to type 2 diabetes. It's the first "nonsteroidal mineralocorticoid receptor antagonist", and is approved to slow CKD progression and improve CV outcomes in these patients. Finerenone is thought to limit fibrosis and …
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Type-2 Diabetes
Optimize management of CKD in patients with diabetes
As a clinical pharmacist, you should optimize treatment of chronic kidney disease (CKD) in patients With diabetes. Patients with CKD have a much higher rate of hospitalization, especially if they have diabetes. Use a hospital stay to optimize treatment. Ensure patients are on an ACEI or ARB to manage blood pressure (BP) . Continue to us…
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Weight Loss
Explaining the role of Mounjaro for Type 2 Diabetes
As a pharmacy doctor, you will hear buzz about new injectable Mounjaro (tirzepatide), the first "twincretin" for type 2 diabetes . Think of Mounjaro as similar to a glucagon-like peptide-1 (GLP-1) agonist, BUT it’s also a glucose-dependent insulinotropic polypeptide (GIP) agonist. More twincretins are in the works. GL…
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Weight Loss
Insulin resistance is a BIG problem
Metabolic syndrome is a BIG problem and growing. It affects over 25% of adults and 4% of adolescents. It's also called "insulin resistance syndrome" or "syndrome X" or "dysmetabolic syndrome" and even has its own ICD-9 code (see table 1) . New treatment guidelines will focus even more attention on it... …
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Type-2 Diabetes
Ensure your DIABETIC patients are on statin
Many eligible adults with diabetes aren’t on a statin . We know that statins reduce cardiovascular (CV) risk in patients with type 1 or 2 diabetes , and guidelines recommend use. Plus statin use in patients with diabetes age 40 to 75 is a common quality measure. Follow these steps... Think of statins as "automatic" for most …
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Prediabetes
Best diet for DIABETIC patients
On WORLD DIABETES DAY (14 November), the question is increasing about what is the best diet to improve blood glucose level. Medical nutrition therapy plays an important role in the management of diabetes, it has a significant impact on T2DM patients. Counseling and education sessions for development of an individualized eating plan according to the metabolic needs of…
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Type-2 Diabetes
Using metformin in diabetes patients with kidney disease
M etformin will be used in more diabetes patients with kidney disease as FDA labeling catches up with the evidence. We're used to avoiding metformin if serum creatinine is over 1.5 mg/dL for men or over 1.4 mg/dL in women due to fear of lactic acidosis. But lactic acidosis is EXTREMELY rare, even in kidney disease. And now labeling will base metformin dosing on…
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Pts W/ DM and HF
Consider heart failure when weighing medications for diabetes
HEART FAILURE is a frequent and often fatal complication of type 2 diabetes and there will be more focus on how this affects medication choices. Consider whether your patient also has heart failure when evaluating diabetes medications, since some may help or harm. Medications with potential benefit Continue to recommend metformin first, it's linked to l…
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Type-2 Diabetes
Blood pressure goals and medications for patients with diabetes
All pharmacists hear continued debate about how to manage hypertension in patients with diabetes. The recent American College of Cardiology and American Heart Association guidelines recommend a blood pressure goal of less than 130/80 mmHg in patients across the board. Years ago, many of us were also taught this goal for patients with diabetes . But the American Di…
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Type-2 Diabetes
Management of diabetes mellitus in primary care
SCREENING AND PREVENTION ㅡ Screen asymptomatic patients at increased risk for diabetes mellitus (family history of diabetes in twin, sibling, or parent, obesity, gestational diabetes and history of impaired glucose tolerance). Use fasting glucose determination; fasting test is preferred since it is most sensitive of methods appropriate for asymptomatic adult populati…
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Nephrology and Urology
ACE inhibitors or an ARB for hypertension or diabetic kidney disease
A shift in thinking about the cardiovascular (CV) benefits of angiotensin receptor blockers (ARBs) will lead to more use of angiotensin receptor blockers (ARBs) instead of angiotensin converting enzymes inhibitors (ACEIs). ACEIs are mostly recommended to be used, since they have more CV outcomes data and seemed to have a bigger impact on CV events than ARBs. And low-…
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