COMMENTARY

What I Learned at ADA: 5 Family Physicians' Advice for Diabetes Management

Eric L. Johnson, MD; Stephen A. Brunton, MD; Eugene E. Wright Jr, MD; Jay H. Shubrook, DO; Seth A. Berkowitz, MD, MPH

Disclosures

July 12, 2016

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New Drug Options

Eric L. Johnson, MD: I am Dr Eric L. Johnson, from the University of North Dakota School of Medicine and Health Sciences. I am an assistant medical director at the Diabetes Center at Altru Health System, in Grand Forks, North Dakota.

I am here at the American Diabetes Association (ADA) Scientific Sessions. I am a primary care physician. Some of the interesting things I am taking away from this meeting are some of the changes in metformin guidelines.

Patients who have poorer renal function are still candidates for metformin. This is going to increase the population who can be prescribed this important drug, particularly elderly people who might have AIDS-related renal decline.

I am also coming away with some good information on combination drugs, particularly basal insulin and glucagon-like peptide 1 (GLP1) agents. I think these might be strong primary care drugs that can be used to attack a couple of different mechanisms, and at the same time, trying to improve diabetes control in type 2 [diabetes] patients.

CV Risk and SGLT2 Inhibitors

Stephen A. Brunton, MD: Hello. I am Dr Stephen Brunton, a family physician from Los Angeles, California. It is always fun to be at the ADA [meeting] because you hear not only some new information, but also a reaffirmation of some of the things we have been doing before.

What I find most interesting is the results of the cardiovascular outcome studies that reaffirm the importance of the sodium/glucose cotransporter 2 (SGLT2) inhibitors—not just looking at glucose reduction, but also looking at other parameters. Tomorrow, we hear the lead results. Everyone has been waiting for that. That is the impact of liraglutide, a GLP1 agonist, on cardiovascular outcomes as well. It is fun to be here, and it is fun taking in new knowledge.

And the Best Drug Is...

Eugene E. Wright Jr, MD: Hello. My name is Dr Eugene Wright. I am from the Duke Southern Regional AHEC [Area Health Education Center] in Fayetteville, North Carolina. I am here at the 76th Annual ADA Scientific Sessions.

I attended the "Diabetes Is Primary" symposium on Saturday morning. One of the things I learned that I thought was useful and practical in my practice is that the best medicine for the patient is the one they will take.

This sounds pretty obvious, but so often, we want to choose the single best medicine that we think the patient should be on. Many times, that is not always what the patient wants to try. I think I am going to allow my patients to participate a little more in the decision of what medicines they will take, to increase their adherence to the therapy that we agree on.

Think About Cost

Jay H. Shubrook, DO: Hi. [I'm] Jay Shubrook, DO, family physician and diabetologist, Touro University California, College of Osteopathic Medicine, here today at the ADA Scientific Sessions.

One thing that I took away from this meeting that is so important is that diabetes is a costly disease. It is a disease that costs society. It costs our healthcare system. It certainly costs individuals.

I think that we have a fair amount of work that we can do to make sure that we can be culturally and patient-competent and patient-centered in terms of making the treatment match their financial situations, and maximizing those things to give them the best success for the incremental costs that is a result to them. Think about being patient-centered and looking at the cost of their care.

Family Knows Best

Seth A. Berkowitz, MD, MPH: Hi. I am Seth Berkowitz. I am a primary care doctor practicing in Revere, Massachusetts. I am here at the ADA meeting in New Orleans, Louisiana, and wanted to talk about an important thing that I learned.

I went to an interesting session on engaging family members in the care of diabetes. I thought this was important in my primary care practice because so much of our work involves helping patients overcome their own specific barriers, their own specific socioeconomic conditions, and the social determinants of health that they all face. I think there is no one better than family members in a lot of situations.

[I] went to a great talk by Dr Michele Heisler from the University of Michigan, who emphasized the potential of enlisting family members who may also have the same conditions. Even if they do not, they certainly have the same background and experiences of your own patients [and can be helpful] in trying to come up with care plans that work for patients and that can be carried out in their own life.

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