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
Personalize glycemic targets for patients with diabetes
As a clinical pharmacist, people with diabetes will rely on your help to tailor A1c goals and decipher continuous glucose monitoring (CGM) metrics. Continue to emphasize individualizing glycemic goals, explain that a “one-size-fits-all” approach isn’t safe, practical, or recommended... A1c. Rely on A1c to asses…
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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
Reduce insulin if SAXENDA is used for weight loss
As a nutrition support pharmacist, you will hear more about using Saxenda for weight loss in adolescents 12 and up, not just in adults. Saxenda will be the first GLP-1 agonist for obesity, that in addition to stimulating insulin release and inhibiting glucagon secretion, slows gastric emptying and increases satiety after eating, (see our Note about Saxenda for weigh…
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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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Type-2 Diabetes
Lifestyle changes to help PREDIABETIC patients
Patients with type 2 diabetes (T2D) constitute approximately 90%-95% of all patients with diabetes worldwide. In 2013, 382 million adults were diagnosed with diabetes worldwide. This number is expected to grow to 592 million in 2035. About 1 in 3 adults and 1 in 5 adolescents in the U.S. have prediabetes, but most are unaware. Prediabetes is the term used for ind…
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Type-2 Diabetes
Manage diabetes medications during fasting
How should diabetes medications be managed while fasting? Fasting for morning labs usually doesn't require adjustments. But other fasts vary. For example, patients may fast from dawn to dusk during Ramadan or from sundown to sundown during Yom Kippur or 18 hours/day with some intermittent fasting diets. Help individualize a plan based on medications, and fast dur…
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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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Type-2 Diabetes
Preventing and treating hypoglycemia in patients with type 2 diabetes
As a pharmacist, you'll see more emphasis on preventing and treating hypoglycemia in patients with type 2 diabetes, not just type 1. We all know that hypoglycemia can lead to confusion, seizures, and emergency room visits. But it can also impact driving, sleep, or work. Help your diabetes patients prevent and manage hypoglycemia... …
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Type-2 Diabetes
Prevention and treatment of diabetic foot infections
As a pharmacist, you'll see more focus on prevention and treatment of diabetic foot infections. More than half of foot ulcers in diabetes patients develop into diabetic foot infections... Recommend choosing empiric antibiotics based on infection severity and likely pathogens. For mild infections, recommend oral antibiotics that cover strep and S. aureus. Suggest …
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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
Pharmacotherapy of type 2 diabetes
Overview ㅡ Effective treatment of type 2 diabetes is uniquely challenging because it encompasses management of lifestyle factors ( including diet, exercise, and weight control ), use of multiple oral or injectable medications, self-monitoring of blood glucose concentration, and surveillance and treatment for acute and chronic diabetic complications. Goals of Ther…
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