Recent Updates in the World of Evidence-Based Medicine
Apr 9, 2019, 21:27 PM
I have been writing blogs for the American Association of Diabetes Educators since March 2013. Over the course of 6 years, I have written 62 blogs; it has been a privilege to write about updates, changes and other news report related to my area of expertise – pharmacy. Based on the organization’s new strategic plan, there will be rotating contributions from partner organizations, collaborators, leadership, COI/LNG groups and staff to cover updates in the field of diabetes, the association, Project Vision, Advocacy updates and more to diversify the breadth of topics covered in the AADE Blog.
As my last blog, I wanted to write about updates from the past month that could impact our practice or have an influence on the clinical management of people with diabetes.
Recommend lifestyle modifications for people with prediabetes; the guidelines do not recommend metformin for this population
Recently, the Endocrine Society released guidelines on screening for and treating diabetes in people aged 65 and older. This information was published in the Journal of Clinical Endocrinology & Metabolism
. The major highlights include:
- Focus on regimens that minimize the risk of hypoglycemia; therefore, avoid sulfonylurea and glnides and use insulin sparingly.
- Use metformin as first-line therapy but be cautious of renal function as it declines with age.
- Recommend lifestyle modifications for people with prediabetes; the guidelines do not recommend metformin for this population.
- Screen patients periodically for cognitive impairment. If a patient has cognitive impairment, consider adjustments with their regimens to promote medication taking and prevent complications (e.g., hypoglycemia). In addition, the desired glycemic goals should be less stringent for the patient.
Use metformin as first-line therapy for glycemic control for people with type 2 diabetes
The American College of Cardiology and American Heart Association recently published guidelines
on the use of aspirin, indicating that aspirin 81 mg should be reserved for individuals at high cardiovascular (CV) risk and low bleeding risk. Other major highlights include:
- Do not recommend low-dose aspirin among patients over the age of 70 and in patients with a high risk for bleeding.
- Use metformin as first-line therapy for glycemic control for people with type 2 diabetes (and potentially other CV risk factors), with add-on therapy being glucagon-like peptide-1 receptor agonists or sodium glucose co-transporter-2 inhibitors due to the reduction of CV disease risk.
- Recommend physical activity to lower CV risk and the use of statins among patient with elevated LDL levels; a minimum of 150 minutes of moderate activity or 75 minutes of vigorous physical activity per week.
One week ago, the American Diabetes Association published an update to the 2019 Standards of Medical Care in Diabetes considering new evidence regarding atherosclerotic cardiovascular disease (ASCVD). While you could pull the individual trials and review on your own, the new update is the recommendation to use icosapent ethyl for people with diabetes and ASCVD who are currently prescribed a statin but have elevated triglycerides. This recommendation is based on findings from a trial called REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial). The updated standards also note the reduction in hospitalization for heart failure and progression of chronic kidney disease with the use of dapagliflozin, which comes from the DECLARE-TIMI 58 trial (The Dapagliflozin Effect on Cardiovascular Events-Thrombosis in Myocardial Infarction 58). In addition, there was an update to the glomerular filtration rate (GFR) for dapagliflozin as it can be used if the rate is equal to or above 45 mL/min/1.73 m2.
I’ve enjoyed the opportunity to serve as a core AADE blogger! I look forward to the new content posted here on the AADE Blog and hope you all continue to this platform that is for and by diabetes educators.
About the Author
Jennifer Clements received her Doctorate of Pharmacy from Campbell University in 2006 and completed a primary care residency at a Veterans Affairs Medical Center in 2007. She is also a certified diabetes educator and board certified in pharmacotherapy. Currently, she is an Associate Professor of Pharmacy Practice at Presbyterian College School of Pharmacy.