Type 2 Diabetes- Treatment Toolbox

by: Karen L. Staples, FNP, ACNP

Where Do I Start?

Disclosures:

NONE…..Nada…..

zilch……

zero!!!!!I

CDC predictions for type 2 diabetes in us by 2050

• In US Currently : ONE in TEN……• In 2050 : ONE in THREE!!!!!!! (if trends

continue linearly……if not…could be more!)• This year, SC reached the 10% Mark!

• Type 2 Diabetes burden on the US by 2050• Based on current trends with more diverse

populations and longer life spans.

http://www.cdc.gov/diabetes/pubs/images/diabetes-infographic.jpg

A1C ≥6.5%OR

Fasting plasma glucose (FPG)≥126 mg/dL (7.0 mmol/L)

OR

2-h plasma glucose ≥200 mg/dL(11.1 mmol/L) during an OGTT

OR

A random plasma glucose ≥200 mg/dL (11.1 mmol/L)

Criteria for the Diagnosis of DiabetesCriteria for the Diagnosis of Diabetes

ADA. I. Classification and Diagnosis. Diabetes Care 2014;37(suppl 1):S15; Table 2

FPG 100–125 mg/dL (5.6–6.9 mmol/L): IFGOR

2-h plasma glucose in the 75-g OGTT140–199 mg/dL (7.8–11.0 mmol/L): IGT

OR

A1C 5.7–6.4%

*For all three tests, risk is continuous, extending below the lower limit of a range and becoming disproportionately greater at higher ends of the range.

ADA. I. Classification and Diagnosis. Diabetes Care 2014;37(suppl 1):S16; Table 3

Categories of Increased Risk for Diabetes (Prediabetes)*Categories of Increased Risk for Diabetes (Prediabetes)*

• Test overweight/obese adults (BMI ≥25 kg/m2) with one or more additional risk factors; in those without risk factors, begin testing at age 45 years

• If tests are normal, repeat testing at least at 3-year intervals is reasonable

• To test for diabetes/prediabetes, the A1C, FPG, or 2-h 75-g OGTT are appropriate

• In those with prediabetes, identify and, if appropriate, treat other CVD risk factors

Recommendations: Testing for Diabetes in Recommendations: Testing for Diabetes in Asymptomatic PatientsAsymptomatic Patients

ADA. II. Testing for Diabetes in Asymptomatic Patients. Diabetes Care 2014;37(suppl 1):S16

Criteria for Testing for Diabetes in Asymptomatic Criteria for Testing for Diabetes in Asymptomatic Adult Individuals (1)Adult Individuals (1)

•Physical inactivity•First-degree relative with diabetes•High-risk race/ethnicity (e.g., African

American, Latino, Native American, Asian American, Pacific Islander)•Women who delivered a baby

weighing >9 lb or were diagnosed with GDM•Hypertension (≥140/90 mmHg or on

therapy for hypertension)

• HDL cholesterol level<35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)

• Women with polycystic ovarian syndrome (PCOS)

• A1C ≥5.7%, IGT, or IFG on previous testing

• Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans)

• History of CVD

*At-risk BMI may be lower in some ethnic groups.

1. Testing should be considered in all adults who are overweight(BMI ≥25 kg/m2*) and have additional risk factors:

ADA. Testing for Diabetes in Asymptomatic Patients. Diabetes Care 2014;37(suppl 1):S17; Table 4

2. In the absence of criteria (risk factors on previous slide), testing for diabetes should begin at age 45 years

3. If results are normal, testing should be repeated at least at 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly), and risk status

ADA. Testing for Diabetes in Asymptomatic Patients. Diabetes Care 2014;37(suppl 1):S17; Table 4

Criteria for Testing for Diabetes in Asymptomatic Criteria for Testing for Diabetes in Asymptomatic Adult Individuals (2)Adult Individuals (2)

• Refer patients with IGT , IFG , or A1C 5.7–6.4% to ongoing support program– Targeting weight loss of 7% of body weight– Increasing physical activity to at least 150 min/week of

moderate activity (eg, walking)

• Follow-up counseling appears to be important for success

• Based on cost-effectiveness of diabetes prevention, such programs should be covered by third-party payers

Recommendations:Recommendations:Prevention/Delay of Type 2 DiabetesPrevention/Delay of Type 2 Diabetes

ADA. IV. Prevention/Delay of Type 2 Diabetes. Diabetes Care 2014;37(suppl 1):S20

• Consider Metformin for prevention of type 2 diabetes if IGT , IFG , or A1C 5.7–6.4% – Especially for those with BMI >35 kg/m2,

age <60 years, and women with prior GDM

• In those with prediabetes, monitor for development of diabetes annually

• Screen for and treat modifiable risk factors for CVD

Recommendations:Recommendations:Prevention/Delay of Type 2 DiabetesPrevention/Delay of Type 2 Diabetes

ADA. IV. Prevention/Delay of Type 2 Diabetes. Diabetes Care 2014;37(suppl 1):S20