Symposium covers diabetes from basics to latest research
|Wilma J. Wooten, M.D., MPH
The management and treatment of type 2 diabetes, from the basics through the
latest guidelines and therapies, were covered Saturday in a 5.5-hour "Diabetes
Management Symposium and Certification Workshop" featuring 15 speakers.
Presentations began with "Diabetes 101" and quickly moved on to the
natural history of the disease, prevention, treatment options, dealing with
complications, using a team approach for treatment, nutrition and exercise, and
how management and treatment can change throughout the lifespan of a patient.
In the past two decades, the prevalence of children who are obese has
doubled, while the number of adolescents who are obese has tripled.
"Because of the obesity epidemic, we are seeing more type 2 diabetes in
adolescents. It is important for the primary care provider to know how to manage
it," said Wilma J. Wooten, M.D., MPH, the symposium moderator and a presenter.
"Diabetes is also increasing in the adult population. As of 2007,
national statistics show an increase in diabetes from 21 million to 24 million
people, and one-fourth of those people do not know they have it," said Dr.
Wooten, public health officer for the county of San Diego and the principal
investigator for NMA Diabetes Education Program, funded by the Centers for
Update on treatment options
Changes in treatment options were reviewed by Oluwaranti Akiyode, Pharm.D,
BCPS, BC-ADM, in her presentation, "Update on Treatment Options." A key is the
measurement of hemoglobin A1c blood levels, which has become the prime marker
for treatment options in the past few years. Hemoglobin A1c represents the
percentage of glucose that binds to hemoglobin in red blood cells, which is an
indicator of a patient's overall glucose control.
"A1c drives our
decision of what to use and when; it is one of the markers we use for glycemic
control. The American Diabetes Association's (ADA) goal for A1c is to have it be
less than 7 percent," said Akiyode, associate professor at the Howard University
School of Pharmacy and a clinical pharmacist at the Howard University Hospital
Diabetes Treatment Center.
If the A1c level is between 7 percent and 8.5
percent, older oral therapies, such as sulfonylureas, biguanides and
thiazolidinediones can be effective, she said.
Still, these therapies
can only lower A1c levels by 1-2 percent, so if the level is 8.5 percent or
higher, a patient needs insulin, Akiyode said.
"A lot of times,
physicians tend to wait a while before they initiate insulin therapy. Usually, a
lot of damage is taking place in those cells, so early initiation of insulin is
necessary for effectiveness for glycemic control," she said, adding that data
from the Diabetes Control and Complications Trial-Epidemiology of Diabetes
Interventions and Complications (DCCT-EDIC) and follow-up study to the United
Kingdom Prospective Diabetes Study (post-UKPDS) trials demonstrate the benefit
of early glycemic control in the reduction of long-term complications.
"The key is that all the data show patient glycemic control needs to be
attained as early as possible, and that is not being done. The fact is that the
earlier a patient reaches glycemic control, the better long-term quality of
life, not only in clinical outcomes but also in economic outcomes," Akiyode
These treatment guidelines are supported by two treatment
guidelines developed by the ADA and the European Association for the Study of
Diabetes, which was updated in January, and the American College of
Endocrinology and the American Association of Clinical Endocrinologists.
Team approach to diabetes management
discussed the effectiveness of using a team of health-care professionals in
diabetes management, an approach based on the medical home principle for
patients with chronic disease.
"That model takes a team approach, so
just a physician is not needed in management," Dr. Wooten said. "The patient is
an integral part of this. This looks at several constructs and how they speak to
the success of the management of chronic diseases. We are trying to drive home
the fact that doing that will provide the best patient outcomes."
symposium reflected this team approach, with an endocrinologist, internal
medicine doctor and OB-GYN discussing gestational diabetes, neuropathy, mental
health and erectile dysfunction, she said.
"This chronic care model has
been around for a while. It also takes into account that in your office you will
have an electronic health record (EHR)," Dr. Wooten said. "This is important
given the fact that the federal government is encouraging all providers to have
some type of electronic medical records by 2014. Studies show that when you have
EHR, there are decreased errors and your practice is more efficient."
Type 2 diabetes is also on the increase
among adolescents because of the increase in obesity, said Tanya Pagan
Raggio-Ashley, M.D., MPH, director of the Office of Minority Health and Health
Disparities and chief medical officer for the Health Resources and Services
In her presentation, Dr. Raggio-Ashley addressed the
basics of introducing teens to living with diabetes, how physicians should talk
to adolescents about the disease and how to treat both type 1 and type 2
"The epidemic of obesity is related to diabetes, and even
though many of these patients can be treated with oral medications, we need to
try to prevent complications with lifestyle modifications, such as a better diet
and an increase in aerobic activity," she said.