DOCSLIB.ORG

What You Need to Know: Centers for Medicare & Medicaid Services Part D Measure — Statin Use in Persons with Diabetes

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
What You Need to Know: Centers for Medicare & Medicaid Services Part D Measure — Statin Use in Persons with Diabetes T:8.5” What You Need to Know: Centers for Medicare & Medicaid Services Part D Measure — Statin Use in Persons With Diabetes UnitedHealthcare recognizes the time and effort you put into managing the health of your patients with diabetes. To help you be as efficient as possible, we’re offering this guide with detailed information about the Statin Use in Persons With Diabetes (SUPD) Part D measure from the Centers for Medicare & Medicaid Services (CMS). Defining the SUPD measure CMS defines this measure as the percentage of Medicare members with diabetes ages 40–75 who receive at least one fill of a statin medication in the measurement year. Members with diabetes are defined as those who have at least two fills of diabetes medications during the measurement year. Only pharmacy claims are used to identify and close care opportunities for this measure. Members who have end-stage renal disease (ESRD) and/or are in hospice care are excluded from the SUPD measure. Understanding measure rationale The SUPD measure is based on cholesterol guidelines from the American College of Cardiology/American Heart T:11” Association (ACC/AHA). The guidelines recommend moderate- to high-intensity statin therapy for patients ages 40–75 with diabetes to help prevent atherosclerotic cardiovascular disease (ASCVD).1,2 The guidelines: • Recognize patients ages 40–75 with diabetes are at a substantially higher lifetime risk for ASCVD events and experience greater morbidity and worse survival rates following the start of clinical ASCVD. • Indicate statins have been shown to be effective in reducing the risk for cardiovascular events. • Align with the American Diabetes Association in recommending statin therapy for patients ages 40–75 with diabetes to help prevent ASCVD.3 Reaching the SUPD target goal To successfully meet CMS requirements, men and women who fit the measure definition must be on a statin medication for the prevention of ASCVD, if clinically appropriate. The care opportunity is addressed when a member with diabetes has at least one prescription fill for a statin or statin combination using their Part D benefit during the measurement year. PATH 1 Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PWF. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 00:000–000. Accessed 12/11/2018. http://circ.ahajournals.org/content/circulationaha/ early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf 2 Grundy, S., Stone, N., Bailey, A., Beam, C., Birtcher, K., Blumenthal, R., Braun, L., de Ferranti, S., Faiella-Tommasino, J., Forman, D., Goldberg, R., Heidenreich, P., Hlatky, M., Jones, D., Lloyd-Jones, D., Lopez-Pajares, N., Ndumele, C., Orringer, C., Peralta, C., Saseen, J., Smith, S., Sperling, L., Virani, S. and Yeboah, J. (2018). 2018 AHA/ACC/AACVPR/ AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. [online] http://www.onlinejacc.org/content/early/2018/11/02/j. jacc.2018.11.003?_ga=2.254610568.1420954589.1545174582-210462200.1544567894. Available at: http://www.onlinejacc.org/content/early/2018/11/02/j.jacc.2018.11.003?_ ga=2.254610568.1420954589.1545174582-210462200.1544567894 [Accessed 18 Dec. 2018]. 3 American Diabetes Association. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes – 2018. Diabetes Care. 2018 Jan.; 41 (Supplement 1): S86-S104. Accessed 12/11/2018; http://care.diabetesjournals.org/content/41/Supplement_1/S86 Doc#: PCA-1-013284-12112018_12312018 PATH1286_IR 1 1/14/19 9:29 AM Client Alts Internal & External Team Project Details Color Dimensions Date: 1-14-2019 9:29 AM Depot #: None Cyan, Magenta, Flat: 8.5" x 11" Creative Prod. Mgr: Shelby Mobley Name: PATH1286: Statin Use in Persons With Yellow, Black Folded: N/A Job Number: UHC201900021 Diabetes Software: CC 2018 1 Stage: IR Reading Level: None Notes: File Name: PATH1286_IR None T:8.5” Statin Use in Persons With Diabetes Tips and best practices for closing the care opportunity We’re grateful for the steps you take to help your patients who are UnitedHealthcare Medicare Advantage plan members avoid complications from diabetes. The following ideas can help make it easier for you to identify which members with diabetes haven’t received a statin fill this year – and next steps you can take with their treatment plan. • Check your Patient Care Opportunity Report (PCOR) every month. Look in the Pharmacy Detail tab for members with open care opportunities. Those marked as yellow in the D14-Statin Use in Persons With Diabetes measure have had two fills of a diabetes medication, but haven’t filled a statin yet this year. • Log in to UHCTransitionsTM (Health BI) to review members with open care opportunities. – Under the Quality drop-down menu, select Member Rx Adherence to view your patient list. – Members without a statin fill this year will be marked with a “Gap” under the SUPD measure. • Consider prescribing a statin, as appropriate. If you determine a statin medication is appropriate, please send a prescription to the member’s preferred pharmacy.4 Statins shown in this table are available on a member’s UnitedHealthcare Medicare Advantage formulary.5 To close the SUPD care opportunity, a member must use their insurance card to fill one of these prescriptions in any strength/ dose by the end of the measurement year. Formulary Statins7 Tier Tier 16 Atorvastatin Rosuvastatin Simvastatin Pravastatin Lovastatin Tier 2 Amlodipine/ Fluvastatin Atorvastatin Tier 3 Ezetimibe- Livalo® simvastatin T:11” Contact us to learn more. For more information about how our programs can help support your patients who are UnitedHealthcare Medicare Advantage plan members, please contact your UnitedHealthcare representative. Thank you. PATH 4 Member may use any pharmacy in the network but may not receive preferred retail pharmacy pricing. Pharmacies in the Preferred Retail Pharmacy Network may not be available in all areas. Copays apply after deductible. 5 The formulary and pharmacy network may change at any time. 6 Lowest copay of all tier levels. 7 Medication adherence tip taken from package inserts, which were written by the medication manufacturer: Atorvastatin, rosuvastatin, pravastatin and Livalo can be taken at any time during the day. Simvastatin, lovastatin (immediate release) and fluvastatin must be taken in the evening. Please see each medication’s package inserts for specific details. All product names are registered ® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them. Doc#: PCA-1-013284-12112018_12312018 © 2019 United HealthCare Services, Inc. PATH1286_IR 2 1/14/19 9:29 AM Client Alts Internal & External Team Project Details Color Dimensions Date: 1-14-2019 9:29 AM Depot #: None Cyan, Magenta, Flat: 8.5" x 11" Creative Prod. Mgr: Shelby Mobley Name: PATH1286: Statin Use in Persons With Yellow, Black Folded: N/A Job Number: UHC201900021 Diabetes Software: CC 2018 1 Stage: IR Reading Level: None Notes: File Name: PATH1286_IR None.
Load more

Recommended publications
  • Management of Hyperglycaemia and Steroid (Glucocorticoid) Therapy
    Management of Hyperglycaemia and Steroid (Glucocorticoid) Therapy October 2014 This document is coded JBDS 08 in the series of JBDS documents Other JBDS documents: Admissions avoidance and diabetes: guidance for clinical commissioning groups and clinical team; December 2013, JBDS 07 The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes; August 2012, JBDS 06 Glycaemic management during the inpatient enteral feeding of stroke patients with diabetes; June 2012, JBDS 05 Self-management of diabetes in hospital; March 2012, JBDS 04 Management of adults with diabetes undergoing surgery and elective procedures: improving standards; April 2011, JBDS 03 The Management of Diabetic Ketoacidosis in Adults; revised September 2013, JBDS 02 The hospital management of hypoglycaemia in adults with diabetes mellitus; revised September 2013, JBDS 01 These documents are available to download from: ABCD website: www.diabetologists-abcd.org.uk/JBDS/JBDS.htm Diabetes UK website: www.diabetes.org.uk Contents Page Foreword 4 Authorship and acknowledgments 5-6 Introduction 7 Steroids - mechanism of action 8 Steroid therapy – impact on blood glucose 9 Glucose targets 10 Glucose monitoring 11 Diabetes treatment options 12-13 Treatment of steroid induced hyperglycaemia 14-15 Hospital discharge 16-17 Steroid treatment in pregnancy 18 Steroid treatment in end of life 19 Audit standards 20 Controversial areas 21 References 22 Appendix 1 – Algorithm to show treatment of steroid 23 induced diabetes Appendix 2 – Algorithm to show management of patients 24 with diabetes on once daily steroids Appendix 3 – End of life steroid management 25 Appendix 4 – Patient letter – Glucose monitoring and 26 steroid use 3 Foreword This is the latest in the series of Joint British Diabetes Societies for Inpatient Care (JBDS-IP) guidelines, and focuses on steroid induced hyperglycaemia and steroid induced diabetes.
    [Show full text]
  • Diabetes Medication Reference for Clinicians This Table Provides Clinicians a Brief Overview of Examples of Medications Used to Treat Diabetes
    Diabetes Medication Reference for Clinicians This table provides clinicians a brief overview of examples of medications used to treat diabetes. This is not a complete list and is not intended to be used as a sole reference. Nursing responsibilities with ALL diabetes medications: Emphasize importance of self-monitoring of blood glucose (SMBG); teach to be aware of signs/symptoms of allergic reactions; teach to be aware of possible side effects and contraindications; and monitor A1C levels. Oral Medication Action Possible Side-effects Contraindications Nursing Responsibilities Biguanide • Lowers glucose levels • Anorexia, nausea, • Renal disease Patient education: • metformin by decreasing the vomiting, diarrhea - • Liver failure or • Take with food (Glucophage, amount of glucose usually occurs during alcohol abuse (can • Keep appointments Glucophage XR, produced by the liver initiation of the drug result in lactic for regular kidney Glumetza, Fortamet, • Increases glucose • Vitamin B-12 acidosis) function lab tests Riomet) uptake in muscle deficiency • Temporarily held on • Avoid alcohol • Multiple combinations cells • Lactic acidosis day of procedures • Report abnormal with other classes • Improves (severe but rare) with dye and glucose levels • First line therapy for hyperglycemia & • Should not cause withheld 48 hours • Report s/s lactic type 2 diabetes; hypertriglyceridemia hypoglycemia as after the procedure; acidosis (weakness, current in obese patients monotherapy restart after drowsiness, malaise) recommendation is to with diabetes; may confirmation of renal start upon diagnosis promote weight loss function This material was prepared by Quality Insights, the Medicare Quality Innovation Network-Quality Improvement Organization supporting the Home Health Quality Improvement National 1 Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S.
    [Show full text]
  • Antidepressant Prescription Practices Among Primary Health Care Providers for Patients with Diabetes Mellitus
    Research Article Curre Res Diabetes & Obes J Volume 2 Issue 4 - June 2017 Copyright © All rights are reserved by Gillian Bartlet DOI: 10.19080/CRDOJ.2017.2.555593 Antidepressant Prescription Practices among Primary Health Care Providers for Patients with Diabetes Mellitus Gagnon J, Lussier MT, Daskalopoulou SS, MacGibbon B, Bartlett G 1Department of Family Medicine, McGill University, Canada 2Department of Family Medicine and Emergency Medicine, Université de Montréal, Canada 3Department of Medicine, McGill University, Canada 4Department of Mathematics, Université du Québec à Montréal, Canada 5Department of Family Medicine, McGill University, Canada Submission: June 13, 2017; Published: June 27, 2017 *Corresponding author: Gillian Bartlett, Department of Family Medicine, McGill University, Canada, Tel: ; Fax: ; Email: Abstract Purpose: Depression is a common comorbidity in people with diabetes that increases the risk of poor diabetes control and diabetes- related complications. While treatment of depression is expected to help, some antidepressants have been associated with impaired glucose metabolism. Evidence is lacking in the scope of this problem for people with diabetes. The objective of this study is to describe the prescription of antidepressants for diabetic patients with a focus on medications suspected to impair glucose control. Methods: A cross-sectional study of electronic medical record data from 115 primary care practices in the Canadian Primary Care Sentinel Surveillance Network was conducted. Descriptive statistics were used to describe the prescription of antidepressants for people with diabetes between 2009 and 2014. Results: From the sample, 17,258 diabetic patients were prescribed at least one antidepressant (AD) between 2009 and 2014. In terms of pharmacological class, the greatest proportion of people were prescribed selective serotonin reuptake inhibitors (46.2%), followed by serotonin-norepinephrine reuptake inhibitors (24.3%) and tricyclic antidepressants (23.8%).
    [Show full text]
  • Diabetes Management: Directory of Provider Resources (PDF)
    DIABETES MANAGEMENT: DIRECTORY OF PROVIDER RESOURCES 2 Diabetes Management: Directory of Provider Resources ACKNOWLEDGMENTS Diabetes Management: Directory of Provider Resources was prepared with input from National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases; Centers for Medicare & Medicaid Services Advisory Panel on Outreach and Education; NORC at the University of Chicago; Jamie Murkey, MPH, PhD, Program Alignment and Partner Engagement Group 2019 summer intern; Asian Services in Action – International Community Health Center; Chinatown Public Health Center; Colorado Coalition for the Homeless; Garden City Community Health Center, Genesis Family Health; Jackson Medical Mall and Jackson Hinds Comprehensive Health Center; Montefiore Medical Center; Nash Health Care Systems; Sun Life Family Health Center; and Bryan W. Whitfield Memorial Hospital, Tombigbee Healthcare Authority. 3 Diabetes Management: Directory of Provider Resources PURPOSE The purpose of this directory is to support providers and care teams by identifying resources on the management of type 2 diabetes. It is particularly suited for providers who work with Medicare beneficiaries and vulnerable populations for whom the prevalence of type 2 diabetes and diabetes complications is higher. This directory will help the care team identify resources to improve diabetes management by promoting medication adherence. This directory also aims to equip primary care teams with tools to manage diabetes and that patients with more complex needs are appropriately referred to specialists. While some patients require care from endocrinologists, primary care teams can effectively manage many patients with prediabetes and type 2 diabetes.i Other health professionals and patients can play an important role in facilitating medication management and other diabetes self-care behaviors.
    [Show full text]
  • Diabetes Medication: Metformin
    FACT SHEET FOR PATIENTS AND FAMILIES Diabetes Medication: Metformin What is metformin? Metformin [met-FORE-min] is a medication that is used to treat type 2 diabetes and insulin resistance. Metformin is taken orally (by mouth) as a pill. Like other diabetes medications, it works best when you follow the rest of your treatment plan. This means checking your blood glucose regularly, following your meal plan, and exercising every day. What does it do? Metformin helps lower your blood glucose (blood sugar). It does this by: • Decreasing the amount of glucose released by your Does metformin cause hypoglycemia liver. Less glucose enters your bloodstream. (low blood glucose)? • Increasing the ability of your muscles to use glucose No. Metformin doesn’t cause hypoglycemia by itself. for energy. As more glucose is used, more glucose But combined with other medications, vigorous leaves your bloodstream. exercise, or too little food, it can make your blood glucose drop too low. Why is metformin important for my health? Since low blood glucose can be dangerous, make sure that you and your family know the symptoms. These Metformin can’t cure your diabetes. But, by helping include feeling shaky, sweaty, hungry, and irritable. control your blood glucose, it lowers the chance that If you have these symptoms, take some quick-acting your diabetes will cause serious problems. sugar. Good sources are 3 or 4 glucose tablets, a half- When you have diabetes, you tend to have high blood cup of fruit juice or regular soda, or a tablespoon of glucose. Over time, this can damage your blood honey or sugar.
    [Show full text]
  • Kaiser Permanente Bernard J. Tyson School of Medicine, Inc. Exclusive Provider Organization (EPO) Student Blanket Health Plan Drug Formulary
    Kaiser Permanente Bernard J. Tyson School of Medicine, Inc. Exclusive Provider Organization (EPO) Student Blanket Health Plan Drug Formulary Effective September 1, 2021 Health Plan Products: Kaiser Permanente Bernard J. Tyson School of Medicine, EPO Student Blanket Health Plan offered by Kaiser Permanente Insurance Company For the most current list of covered medications or for help understanding your KPIC insurance plan benefits, including cost sharing for drugs under the prescription drug benefit and under the medical benefit: Call 1-800-533-1833, TTY 711, Monday through Friday, 7 a.m. to 9 p.m. ET Visit kaiserpermanente.org to: • Find a participating retail pharmacy by ZIP code. • Look up possible lower-cost medication alternatives. • Compare medication pricing and options. • Find an electronic copy of the formulary here. • Get plan coverage information. For cost sharing information for the outpatient prescription drug benefits in your specific plan, please visit kp.org/kpic-websiteTBD The formulary is subject to change and all previous versions of the formulary are no longer in effect. Kaiser Permanente Last updated: September 1, 2021 Table of Contents Informational Section...........................................................................................................................................3 ANTIHISTAMINE DRUGS - Drugs for Allergy.....................................................................................................9 ANTI-INFECTIVE AGENTS - Drugs for Infections...........................................................................................
    [Show full text]
  • Dynamic Approaches to Improve Glycemic Control and Primary Diabetes Care 1‑Or 2‑Or 3‑Or
    DYNAMIC APPROACHES TO IMPROVE GLYCEMIC CONTROL AND PRIMARY DIABETES CARE DYNAMIC APPROACHES TO IMPROVE GLYCEMIC Figure. CONTROL AND PRIMARY DIABETES CARE 1‑OR Characterizing Clinical Inertia in a Large, National Database CORI R. RATTELMAN, ANUPAMA ARORA, JOHN K. CUDDEBACK, ELIZABETH L. CIEMINS, Alexandria, VA Objective: To characterize clinical inertia in the treatment of diabetes using a large, geographically diverse clinical database. Study Design: A retrospective descriptive analysis was conducted in a clinical database containing 22 million patient records across 22 health care organizations (HCOs). Population Studied: A total of 281,000 patients aged 18-75 were included during the 5.5-year study period (1/2012-6/2017). Patients had an outpatient visit in the last 12 months of the study period, an HbA1c in the last 24-30 months (index A1c), and a diagnosis of type 2 DM on a claim or EHR prob- lem list at least 6 months prior to index A1c. A subset of 47,693 patients with an index A1c ≥8 and a prior A1c ≥8 or lack thereof, was observed for Supported By: National Institute of Diabetes and Digestive and Kidney Diseases four 6-month follow-up periods for actions including a new class of diabetes (T35DK104689); Yale University medication prescribed or an A1c <8. The absence of observable action fol- lowing index A1c suggests potential “clinical inertia.” Principal Findings: Six months following an index A1c≥8, 55% of patients 3‑OR received no observable clinical action ranging from 45-65% across HCOs Influence of Diabetes Complications on the Cost‑Effectiveness of and 18-96% across individual providers.
    [Show full text]
  • Association Between Medication Non-Adherence and Increases in Hypertension and Type 2 Diabetes Medications
    healthcare Article Association between Medication Non-Adherence and Increases in Hypertension and Type 2 Diabetes Medications Angshuman Gooptu 1,*, Michael Taitel 2, Neda Laiteerapong 3 and Valerie G. Press 3 1 IMPAQ International LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD 21044, USA 2 Walgreen Co., 102 Wilmot, 5th Floor MS#125D, Deerfield, IL 60015, USA; [email protected] 3 University of Chicago Medicine, University of Chicago, 5841 Maryland Avenue, Chicago, IL 60637, USA; [email protected] (N.L.); [email protected] (V.G.P.) * Correspondence: [email protected]; Tel.: +1-312-515-3898 Abstract: Importance: Medication non-adherence is highly costly and leads to worse disease control and outcomes. However, knowledge about medication adherence is often disconnected from pre- scribing decisions, and this disconnect may lead to inappropriate increases in medications and higher risks of adverse events. Objectives: To evaluate the association between medication non-adherence and the likelihood of increases in the intensity of medication regimens for two chronic conditions, hypertension and type 2 diabetes. Design: Cohort Study. Setting and Participants: This study used US national pharmacy claims data for Medicare Part D (ages ≥ 65) and commercial (ages 50–64) plans to evaluate medication adherence and its association with the likelihood of receiving an increase in medication intensity for patients with hypertension and/or oral diabetes medication fills. Patients had an index fill for hypertension (N = 2,536,638) and/or oral diabetes (N = 701,376) medications in January 2015. Medication fills in the follow-up period from August 2015 to December Citation: Gooptu, A.; Taitel, M.; 2016 were assessed for increases in medication regimen intensity.
    [Show full text]
  • Obesity and Weight Management
    Learning and Earning with Gateway Professional Education CME/CEU Webinar Series Obesity and Weight Management Nicole Kohler, CDE, Clinical Design Specialist, Gateway HealthSM Jennifer Pennock, MD, Center for Diabetes & Endocrine Health, West Penn Hospital Megan Proper, PharmD, Sr. Pharmacist, Gateway HealthSM Wednesday, October 2, 2019 1 | DATE| PRESENTED BY: DISCLOSURES Speakers for today’s webinar have no real or potential conflict of interest in relation to this presentation 2 | DATE | PRESENTED BY: To receive CME/CEU credit for today’s webinar • If you haven’t already, create an account at cme.ahn.org • Text code xxxxxx to xxx-xxx-xxxx • You will receive an email with a link to complete evaluation and claim CE credit • You MUST text by the end of the day today to receive credit! • For pharmacists only: instructions given in Chat box towards end • Questions? Email us at [email protected] Save the dates! Wednesdays 12-1pm: • November 6, 2019 – Cultural Competency • December 4, 2019 – Management of Hepatitis C in the Primary Care Practice Setting 3 | DATE | PRESENTED BY: Enroll today to receive monthly webinar invitations: https://www.surveymonkey.com/r/NZJYDF7 Questions? Email [email protected] This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Allegheny General Hospital and Gateway Health Plan. Allegheny General Hospital is accredited by the ACCME to provide continuing medical education for physicians. Allegheny General Hospital designates this live webinar activity for a maximum of 1.0 AMA PRA Category 1 CreditTM.
    [Show full text]
  • Metformin As an Antidepressant in Type 2 Diabetes Mellitus Patients
    Sys Rev Pharm 2020;11(7):232-239 A multifaceted review journal in the field of pharmacy Metformin as an Antidepressant in Type 2 Diabetes Mellitus Patients Andri Rezano1,2,3, Afifa Khairinnisa4, Savira Ekawardhani2,3,5* 1Department of Biomedical Sciences, Division of Cell Biology, Faculty of Medicine Universitas Padjadjaran 2Biomedical Sciences Master Program, Faculty of Medicine Universitas Padjadjaran 3Oncology and Stem Cell Working Group, Faculty of Medicine, Universitas Padjadjaran 4Graduate Program of Anti-aging dan Aesthetic Medicine, Faculty of Medicine, Universitas Padjadjaran 5Department of Biomedical Sciences, Division of Parasitology, Faculty of Medicine, Universitas Padjadjaran *Correspondence author E-mail: [email protected] ABSTRACT Depression and diabetes are diseases that share similar mechanisms with the Keywords: Aging-related mechanisms, AMPK, Depression, Diabetes, IGF-1 aging process, specifically inflammation and oxidative stress. Metformin is an signaling approved drug to treat diabetes but appears to several aging-related mechanisms. It currently targets multiple pathways of aging that involves the Correspondence: AMPK pathway, mTOR pathway, and IGF-1 signaling pathway. Thus, for its Savira Ekawardhani aging-related mechanism, glucose metabolism may not be the most important 5Department of Biomedical Sciences, Division of Parasitology, Faculty of one. This study reviews 12 types of research related to the use of metformin to Medicine, Universitas Padjadjaran treat depression. This study used online research engines such as PubMed and *Correspondence author E-mail: [email protected] Google Scholar to review the current finding of metformin and depression- related issues. We found that metformin targets age-related diseases, such as neurocognitive functions other than to regulate blood glucose levels through multiple biological pathways.
    [Show full text]
  • DIABETES MEDICATIONS 2015 UPDATE: PRESCRIBING a SUCCESSFUL REGIMEN to ACHIEVE GLYCEMIC TARGETS Celia Levesque RN, MSN, CNS-BC, NP-C, CDE, BC-ADM EMAIL ADDRESS
    DIABETES MEDICATIONS 2015 UPDATE: PRESCRIBING A SUCCESSFUL REGIMEN TO ACHIEVE GLYCEMIC TARGETS Celia Levesque RN, MSN, CNS-BC, NP-C, CDE, BC-ADM EMAIL ADDRESS • [email protected] OBJECTIVES • Discuss diabetes medications on the US Market • Prescribe a medication regimen to meet target blood glucose Neurotransmitter dysfunction Increased glucose Increase reabsorption hepatic glucose production Increased glucagon Rapid secretion stomach Hyperglycemia emptying Decreased insulin secretion Visceral Fat Decreased glucose Increased uptake lipolysis Decreased incretin effect CONSIDERATIONS FOR CHOOSING MEDS Feature More strict 7% Aic Less strict Hypoglycemia High Low Disease duration Long Short Life expectancy Short Long Important comorbididites Many Few Established vascular complications Many Few Patient motivation Low High Resources and support Few Many Medication Class Route Year HbA1c % reduced Alpha-glucosidase inhibitor PO 1995 0.5-0.8 Amylin analog SC 2005 MEDICATIONS0.6 FOR DIABETES Biguanide PO 1995 1.5 Bile acid sequestrin PO 2008 0.5 with metformin Dopamine agonist PO 2009 0.5-0.9 DPP-4 inhibitors PO 2006 0.5-0.8 GLP-1 Receptor Antagonist SC 2005 0.6 Insulin SC 1921 > 2.5 Meglitinides PO 1997 1-1.5 SGLT2 inhibitor PO 2013 0.91-1.16 Sulfonylurea PO 1946 1.5 Thiazolidinedione PO 1999 0.8-1.0 BIGUANIDE: METFORMIN • Metformin, Metformin ER, Glucophage, Glucophage ER, Glumetza, Fortamet, Riomet • Activates AMP-kinase • Improves insulin resistance indirectly • Reduces hepatic glucose production METFORMIN Advantages Disadvantages •
    [Show full text]
  • Diabetes & Cardiovascular Disease Risk Reduction
    1/12/2019 Diabetes & Cardiovascular Disease Risk Reduction CAPT Judy Thompson PharmD, BCPS, CDE, BC-ADM CDR Brittany L. Keener PharmD, MPH, BCPS Disclosure • CAPT Thompson and CDR Keener have nothing to disclose. 1 1/12/2019 Objectives • Recognize cardiovascular disease and risk management strategies in patients with diabetes. • Identify goals for hypertension and lipid management. • Review which diabetes medications are proven to reduce major adverse cardiovascular events. Cardiovascular Disease • Also known as heart disease – Atherosclerotic Cardiovascular Disease (ASCVD) – Coronary Artery Disease (CAD) – Atherosclerosis: when plaque builds up in the walls of the arteries • Heart failure • Arrhythmia • Valve problems • Others 2 1/12/2019 Atherosclerotic Cardiovascular Disease (ASCVD) • Coronary heart disease, cerebrovascular disease, or peripheral artery disease presumed to be of atherosclerotic origin. • Leading cause of morbidity and mortality in patients with diabetes. • Results in an estimated $37.3 billion in cardiovascular-related spending per year associated with diabetes. Cardiovascular Disease Risk Factors • Hypertension • Hyperlipidemia • Diabetes • Unhealthy diet • Physical inactivity • Obesity • Excessive alcohol consumption • Tobacco use 3 1/12/2019 Cardiovascular Disease • About 610,000 people die of heart disease in the United States every year– that’s 1 in every 4 deaths. • Heart disease is the leading cause of death for both men and women. More than half of the deaths due to heart disease in 2009 were in men. • Coronary heart disease (CHD) is the most common type of heart disease, killing over 370,000 people annually. • Every year about 735,000 Americans have a heart attack. Of these, 525,000 are a first heart attack and 210,000 happen in people who have already had a heart attack.
    [Show full text]