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Clinical Issues™

Clinical Issues in Type 2 Diabetes

Consensus and Controversies Around Intensifying Noninsulin Therapy

Meeting Slides

Guidelines

Standards of medical care in diabetes—2016.

The ADA’s Standards of Care provide clinicians, patients, researchers, payers, and other interested individuals with the components of good diabetes management, general treatment goals, and tools to evaluate the quality of care. Importantly, these recommendations should be adjusted based on individual preferences, comorbidities, and other patient-related factors.
American Diabetes Association.  Diabetes Care. 2015;38(suppl 1):S1-S94.

AACE/ACE comprehensive diabetes management algorithm 2016.

This algorithm from the AACE addresses evaluating the whole patient, potential risks and complications, and evidence-based treatment approaches for diabetes. The document contains sections on obesity, prediabetes, hyperglycemia therapy (lifestyle modifications, pharmacotherapy, and insulin), hypertension management, hyperlipidemia treatment, and other risk-reduction strategies.
Garber AJ, Abrahamson MJ, Barzilay JI, et al. Endocr Pract. 2015;21(4):438-447.

Patient Resources

Diabetes HealthSense 

Provides easy access to resources to help patients live well and meet their goals—whether they have diabetes or are at risk for the disease.

Decision Aids for T2DM

To facilitate shared decision making, these examples of medication choice decision aids from the Mayo Clinic are organized into 7 issues that may be of interest to patients with T2DM. A video demonstrating the use of these cards can be found at: https://www.youtube.com/watch?v=SYTPqceFgSw.

Suggested Readings

From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus

Defronzo RA. Diabetes. 2009;58(4):773-795.

Glucagon-like peptide 1 receptor agonist or bolus insulin with optimized basal insulin in type 2 diabetes.

Diamant M, Nauck MA, Shaginian R, et al. Diabetes Care. 2014;37(10):2763-2773.

Dapagliflozin compared with other oral anti-diabetes treatments when added to metformin monotherapy: a systematic review and network meta-analysis

Goring S, Hawkins N, Wygant G, et al. Diabetes Obes Metab. 2014;16(5):433-442.

Glycemic variability and diabetes complications: Does it matter? Of course it does!

Hirsch IB. Diabetes Care. 2015;38(8):1610-1614.

Minimizing hypoglycemia in diabetes

International Hypoglycemia Study Group. Diabetes Care. 2015;38(8):1583-1591.

Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes

Inzucchi SE, Bergenstal RM, Buse JB, et al. Diabetes Care. 2015;38(1):140-149.

The safety of dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium-glucose cotransporter 2 (SGLT-2) inhibitors added to metformin background therapy in patients with type 2 diabetes mellitus: a systematic review and meta-analysis.

Kawalec P, Mikrut A, Łopuch S. Diabetes Metab Res Rev. 2014;30(4):269-283.

Combination therapy for the improvement of long-term macrovascular and microvascular outcomes in type 2 diabetes: rationale and evidence for early initiation.

Milligan S. J Diabetes Complications. 2016 Mar 15 [Epub ahead of print].

Early combination therapy for the treatment of type 2 diabetes mellitus: systematic review and meta-analysis

Phung OJ, Sobieraj DM, Engel SS, Rajpathak SN. Diabetes Obes Metab. 2014;16(5):410-417.

GLP-1 receptor agonists: Practical considerations for clinical practice.

Triplitt C, Solis-Herrera C. Diabetes Educ. 2015;41(1 Suppl):32S-46S.

Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes.

Zinman B, Wanner C, Lachin JM, et al. N Engl J Med. 2015;373(22):2117-2128.

Activity
Clinical Issues in Type 2 Diabetes

Consensus and Controversies Around Intensifying Noninsulin Therapy

Relevant Resources

Incretin-Based Therapies for Type 2 Diabetes

Mechanism-Based Strategies to Achieve Patient-Centered Care

Insulin Replacement Therapy for Type 2 Diabetes

Patient-Centered Management of Hyperglycemia in Primary Care

Improving Outcomes in Type 2 Diabetes

Integrating GLP-1 Receptor Agonists Into Multimodal Treatment Regimens

A Focus on Bipolar Depression

Overcoming Diagnostic Barriers and Optimizing Long-Term Patient Outcomes

Clinical Issues in Type 2 Diabetes

Discussions and Debates Around GLP-1 Receptor Agonists

Clinical Issues in Type 2 Diabetes

Evolving Roles of GLP-1 Receptor Agonists

Improving Outcomes for Women with Type 2 Diabetes

Individualizing Evidence-Based Care

Noninsulin Approaches to Managing Type 2 Diabetes

Best Practices in Combination Therapy

Hitting the Target in Type 2 Diabetes

Evolving Approaches to Insulin Based Therapy

Improving Outcomes in Congenital and Acquired Lipodystrophy

Best Practices in Diagnosis and Management

Clinical Updates in Type 2 Diabetes

New Strategies for Insulin Replacement Therapy

How Low Do You Go?

Clinical Updates in LDL-C Management

Incretin-Based Therapies For Type 2 Diabetes

Improving Comprehensive Patient Care

Clinical Updates in Type 2 Diabetes

An Evolving Role for Combinations of Injectable Antihyperglycemic Therapies

Raising the Bar by Lowering the Target

Integrating PCSK9 Inhibitors Into Hypercholesterolemia Management

Injecting New Ideas into Managing Type 2 Diabetes

Evolving Roles of GLP-1 Receptor Agonists

Multidimensional Issues in Type 2 Diabetes

Looking Beyond Hemoglobin A1c

GLP-1 Receptors Agonists in Type 2 Diabetes

Mechanistic Insights and Evolving Treatment Options

Pharmaceutical Economics and LDL-C Management

Implications for PCSK9 Inhibitors in Clinical Practice

Assimilating the Evidence in T2DM

Cardiovascular and Renal Outcomes With SGLT2 Inhibitors

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0.000259
2
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000305
3
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
0.000256
4
SHOW COLUMNS FROM `resources`
0.001603
5
SHOW CREATE TABLE `resources`
0.000431
6
SELECT * FROM `resources` `t` WHERE `t`.`id`=49 LIMIT 1
0.000310
7
SHOW COLUMNS FROM `interactions`
0.001149
8
SHOW CREATE TABLE `interactions`
0.000283
9
SHOW COLUMNS FROM `resource_videos`
0.001009
10
SHOW CREATE TABLE `resource_videos`
0.000350
11
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
0.000389
12
SHOW COLUMNS FROM `activities`
0.001303
13
SHOW CREATE TABLE `activities`
0.000303
14
SHOW COLUMNS FROM `users`
0.001185
15
SHOW CREATE TABLE `users`
0.000324
16
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000622
17
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
0.003918
18
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.001152
19
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2539896
0.013812
20
SELECT `activities`.`id` AS `t1_c0`, `activities`.`group_id` AS `t1_c1`, `activities`.`resource_id` AS `t1_c2`, `activities`.`title` AS `t1_c3`, `activities`.`type` AS `t1_c4`, `activities`.`facultyNames` AS `t1_c5`, `activities`.`shortDescription` AS `t1_c6`, `activities`.`fullDescription` AS `t1_c7`, `activities`.`creditAmount` AS `t1_c8`, `activities`.`shortAddress` AS `t1_c9`, `activities`.`creditType` AS `t1_c10`, `activities`.`startDate` AS `t1_c11`, `activities`.`finishDate` AS `t1_c12`, `activities`.`sponsors` AS `t1_c13`, `activities`.`status` AS `t1_c14`, `activities`.`createDate` AS `t1_c15`, `activities`.`image` AS `t1_c16`, `activities`.`image_featured` AS `t1_c17`, `activities`.`archived` AS `t1_c18`, `activities`.`managers_list` AS `t1_c19`, `activities`.`is_send_pp_email` AS `t1_c20`, `activities`.`muvi_sync_date` AS `t1_c21`, `activities`.`expert_questions` AS `t1_c22` FROM `activities` `activities` WHERE (`activities`.`resource_id`=:ypl0)
0.000329
21
SELECT r.id, COUNT(r.id) relevance FROM resources r join `resource_topics` rtj on rtj.`resource_id`=r.id WHERE rtj.`topic_id` in (SELECT topic_id from `resource_topics` rt where rt.`resource_id`=:rid AND rt.topic_id>0) AND r.id <> :rid AND r.status = 'active' Group by r.id order by relevance DESC, r.`createDate` DESC
0.000320
22
SELECT * FROM `resources` `t` WHERE `t`.`id` IN (143, 132, 129, 122, 118, 109, 89, 81, 73, 51, 50, 48, 45, 42, 38, 33, 30, 29, 20, 18, 16, 14, 13, 9, 11, 4)
0.002087
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