Diabetes 2015 and Beyond!Sarah Levin Martin, PhD

Husson University School of PharmacyMarch 20, 2015

Wheel of Fortune

 

Would you like to buy a vowel?

• A• E• I • O• U• And sometime, Y

= A1c and current Guidelines= Economic Burden of Diabetes= Insulin and other Treatments= Obesity and Diabetes Trends= Useful resources= You guess it, YOU!

A a a - A1C ≥6.5%

A a a – ADA 2015 Guidelines

2015 updates (not all inclusive):• BMI cut point for Asian Americans: 23 kg/m2

• Physical activity: limit sitting time (<90 min)• E-cigarettes not supported• Immunizations in line with CDC for PCV13 and

PPSV23 vaccinations in older adults• Diastolic BP 90; lipids in line with AHA & ACC

A a a – ADA 2015 Guidelines

A a a – ADA 2015 Guidelines

A a a – ADA 2015 Guidelines

A a a – ADA 2015 Guidelines

E e e

• The average annual cost of caring for individuals with diabetes are approximately 2.3 times higher than other patients.

• Since 2007, the cost of diabetes in the U.S. has risen by 41% and is estimated to cost $245 billion in 2012.

Ref: American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care 2013;36:1033-46

E e e

2015 Update: “For example, in 2011 nearly 150,000 Americans were diagnosed with diabetes between the ages of 65 and 69 years (CDC DDT). Based on our estimates, this cohort of patients with newly diagnosed diabetes alone would be expected to add $4.6 billion to future medical spending, the majority of which would be paid by Medicare.”

Ref: Xiaohui Zhuo, Ping Zhang, Lawrence Barker, Ann Albright, Theodore J. Thompson, and Edward Gregg. The Lifetime Cost of Diabetes and Its Implications for Diabetes Prevention. Diabetes Care 2014;37:2557–2564 | DOI: 10.2337/dc13-2484

The discounted excess lifetime medical spending for people with diabetes was$124,600 ($211,400 if not discounted), $91,200 ($135,600), $53,800 ($70,200), and$35,900 ($43,900) when diagnosed with diabetes at ages 40, 50, 60, and 65 years,respectively.

E e e

• Diabetes leads to several costly complications; e.g., – diabetes induced end-stage renal disease are estimated to cost

$71,714 per event;– a hypoglycemic event requiring hospitalization cost $16,478

per event;– Diabetic retinopathy leading to blindness: $2,862;– An Acute MI: $56,445;– An Ischemic Stroke: $42,119; and– Neuropathy leading to lower extremity amputation: $9,041

Ref: Ward A, Alvarez P, Vo L, Martin S. Direct medical costs of complications of diabetes in the United States: estimates for event-year and annual state costs (USD 2012). J Med Econ. 2014 Mar;17(3):176-83.

I I iThe Year in Medicine 2014

(Medscape Pharmacists)

The FDA approved the inhaled human insulin product Afrezza (MannKind) to improve glycemic control in adults with type 1 and type 2 diabetes, making needles no longer necessary.

I I I - alternatives

Complementary and Alternative Medicine for Diabetes

Medscape Pharmacists: December 2014

“Dietary Supplement for diabetes: What is new?” by Veronique Duqueroy

http://www.medscape.com/features/slideshow/dietary-supplements-for-diabetes?src=wnl_edit_specol&uac=228279PX#1

O o o

Obesity http://stateofobesity.org/adult-obesity/

- 1990 to 2013 slide show

O o oDiabetes- Trends http://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html

- 1994 to 2012 slide show

- County level http://www.cdc.gov/diabetes/atlas/countyrank/atlas.html- Slide show by county level 2004 to 2011

U u u

http://www.cdc.gov/diabetes/pubs/statsreport14/diabetes-infographic.pdf

U u u

U u u

NIH: NIDDKDiabetes Prevention Programhttps://www.youtube.com/watch?v=14hOhKW8xlM

In Maine:https://nccd.cdc.gov/DDT_DPRP/State.aspx?STATE=ME

U u u

• Indian Health Service (IHS) Diabetes Self Management Education (DSME)

http://www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=SOCLifestyleTherapy

U u u

American Diabetes Association

Improving Diet Quality Reduces Risk for Type 2 Diabetes

https://www.youtube.com/watch?v=gDmzIEl7Quk&list=PL7w2f4Xy5xYqdOn-i3FFEzQ5BaQ__fuQU&index=3

Y y y

You!“Education and counselling by community pharmacists can result in favourable improvements to the cardiovascular risk profile of patients with Type 2 diabetes.”1 (UK)

“This study provides new evidence, from a randomized controlled trial, of the beneficial effect of community pharmacist intervention in the clinical management of type 2 diabetic patients.”2 (Belgium)

“The provision of pharmaceutical care has positive effects on medication adherence as well as the glycemic control of people with type 2 diabetes.”3 (Malaysia)

1. Ali M, Schifano F, Robinson P, Phillips G, Doherty L, Melnick P, Laming L, Sinclair A, Dhillon S. Impact of community pharmacy diabetes monitoring and education programme on diabetes management: a randomized controlled study. Diabet Med. 2012 Sep;29(9):e326-33.

2. Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Annemans L, Remon JP, Giri M. Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial. J Clin Pharm Ther. 2011 Oct;36(5):602-13.

3. Chung WW, Chua SS, Lai PS, Chan SP. Effects of a pharmaceutical care model on medication adherence and glycemic control of people with type 2 diabetes. Patient Prefer Adherence. 2014 Sep 4;8:1185-94.

Y y y

You!A Pharmacy Student-Facilitated Inter-professional Diabetes Clinic at the Penobscot Nation

“Over 90% of participants were well satisfied with the clinic. Among the uncontrolled group (n = 18), average HgbA1c values dropped from 9.3 to 7.6% (p = 0.004). Among the controlled patients (n = 30), 83% remained in the “controlled” category (average HgbA1c increased slightly from 6.2 to 6.4%).”

Y y y

SummaryDiabetes depends on You

A, E, I, O, U, Y

Diabetes Q & A section

The most costly complication from diabetes is…

a. An acute myocardial infarctionb. An ischemic strokec. A hypoglycemic event leading to

hospitalizationd. An end-staged renal disease evente. A lower leg amputation

The most costly complication from diabetes is…

a. An acute myocardial infarctionb. An ischemic strokec. A hypoglycemic event leading to hospitalizationd. An end-staged renal disease evente. A lower leg amputation

$71,714 ($56,445 MI; $24,119 stroke, $16,478 hypo-event, $9,041 amputation) Source: Ward A, et al. Direct medical costs of complications of diabetes in the US: estimates for event-year and annual state costs (USD 2012). J Med Econ. 2014 Mar;17(3):176-83.

Which are resources for patients?

a. Diabetes info-graphicb. Maine based diabetes prevention programsc. CDC’s diabetes prevention sited. CDC’s diabetes management sitee. All of the above

Which are resources for patients?

a. Diabetes info-graphicb. Maine based diabetes prevention programsc. CDC’s diabetes prevention sited. CDC’s diabetes management sitee. All of the above and more!

What percent of persons with diabetes are using some form of CAMs?

a. About 18%b. About 25%c. About 34%d. About 47%

What percent of persons with diabetes are using some form of CAMs?

a. About 18%b. About 25%c. About 34%d. About 47%

Source: Birdee GS, Yeh G. Complementary and alternative medicine therapies for diabetes: a clinical review. Clinical Diabetes. 2010;28:147-155.

Thank you for your time and attention