Today at MEDS
Clinician Reviews and the Primary Care Metabolic Group welcomed more than 300 NPs, PAs, RNs, CDEs, and other clinicians involved in the diagnosis and management of metabolic and endocrine disorders from across the United States and abroad to the 2018 Metabolic and Endocrine Disease Summit (MEDS). This annual conference, headed by Meeting Chair Scott Urquhart, PA-C, DFAAPA, and Co-Chair Christine Kessler, MN, ANP-BC, CNS, BC-ADM, FAANP, was held August 1-4, 2018, at the Wyndham San Diego Bayside in San Diego, California, providing the opportunity for attendees to earn up to 24.25 CE/CME credits.
View summaries from the event on the following pages.
Morning session
Case Studies in Type 2 Diabetes: Achieving Goals Together—A Gluco-Patient Centric Approach
Scott Urquhart, PA-C, DFAAPA, James Madison University and George Washington University, and Lucia M. Novak, MSN, ANP-BC, BC-ADM, CDTC, The Uniformed Services University of the Health Sciences
Using case studies, Urquhart and Novak first reviewed how each case would be managed according to the latest American Diabetes Association and American Association of Clinical Endocrinologists guidelines and recommendations and then explained how management might be altered by assuming a more gluco-patient centric approach. The latter, they noted, engages patients as partners in choosing medications and pays special attention to the individual’s concerns and priorities in order to empower patients and optimize outcomes. “Patients come with their own terms/non-negotiables that will ultimately determine therapeutic choices, as well as overall success.” While metformin is a safe and effective first-line therapy choice, it is often necessary and appropriate to consider other agents that address the glycemic goals of the individual patient, possess secondary (nonglycemic) benefits, and are better suited to the patient’s lifestyle, fears, and/or preferences.
Diabetes Medications: Making Co$$tly Decisions
Scott Urquhart, PA-C, DFAAPA, James Madison University and George Washington University, and Lucia M. Novak, MSN, ANP-BC, BC-ADM, CDTC, The Uniformed Services University of the Health Sciences
Urquhart and Novak discussed the financial and clinical impact of barriers that interfere with optimal pharmacologic management of type 2 diabetes mellitus (T2DM) and the importance of evaluating the nonglycemic benefits, such as cardiovascular and renal protection, of diabetes medications when making treatment adjustments. When calculating cost, it is not enough to consider the face price of a drug and the patient’s insurance coverage; the cost equation must factor in the cost (risk to the patient) of complacency and the cost of not maximizing nonglycemic benefits. Complacency, on the part of the clinician, may be caused by clinical inertia; insufficient time, resources, or training; and being overwhelmed with information or confusing guidelines. Complacency on the part of the patient may stem from disease denial, burnout, or distress, or comorbidities. Urquhart and Novak also identified resources available to assist patients with managing medication costs.
Insulin Overview: Which Type and Why?
Davida F. Kruger, MSN, APRN-BC, BC-ADM, Wayne State University and Michigan State University
In reviewing the differences between the basal, prandial, and premixed/biphasic insulin products currently available for the treatment of T2DM in the United States, Kruger emphasized the importance of understanding differences in potency between available products and being able to identify the insulin contained in vials vs pens. Also included in the discussion were differences in physiologic action, pharmacokinetics, dosing, and their pros and cons in various patient populations. Kruger concluded with a look at insulin products on the horizon.
Case Studies continued: Moving Beyond your Comfort Zone
Donna Jornsay, MS, BSN, CPNP, BC-ADM, CDE, CDTC, Mills Peninsula Medical Center, and Davida F. Kruger, MSN, APRN-BC, BC-ADM, Wayne State University and Michigan State University
Using case studies, Jornsay and Kruger reviewed how to choose from among the various insulins available, when and how to initiate and titrate insulin, and the step-wise, trial insulin strategies used for each case before arriving at a treatment approach that worked. They emphasized the importance of recognizing potential barriers to starting insulin and the support and education patients require to be successful. Roadblocks to health care providers providing timely insulin initiation may include concerns about patient adherence, hypoglycemia, pain from glucose monitoring and/or insulin injections, and patient age. Patient roadblocks may include the belief that their T2DM is not sufficiently severe or that insulin will not help.
Continue to: Afternoon session
