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Diabetes Update from CALTCM 2019 Summit

For many reasons, our education committee chose to focus this year on reducing the risk of hypoglycemia in persons with diabetes.  CMS has data from April 2016-March 2017 showing this is a major reason for a higher first 30 day all-cause SNF Readmissions rate. As of Jan 1, 2019, the CMS “SNF Readmission Measure” (SNF-RM) adjusts payments to facilities based on this measure. From multiple randomized controlled studies, we know that serious hypoglycemia increases mortality. For this reason, in high risk patients, AGS and ADA have recommended higher A1C targets in those with higher hypoglycemic risk.  

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A Little-Acknowledged Danger of Sliding Scale Insulin…

Let’s face it: sliding scale insulin (or “rescue dose”) is still very common. This is in spite of the practice being actively discouraged for years, and being listed in the “Beers Criteria” (for years) as a treatment modality to “avoid.” The reasons for this are many, but the main reasons are:
 

1.    Prescribers want an “intervention” for high blood glucose readings (>150) that doesn’t involve a phone call.

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Are you Prescribing Too much Insulin for Persons with Type 2 Diabetes?

In the October 4, 2018 issue of Diabetes Care, the ADA and EASD (European Association for the Study of Diabetes) published their consensus report for Management of Type 2 Diabetes, 2018.  Both organizations now favor the use of Incretin Receptor Agonists or SLG2 Inhibitors for persons with established macrovascular disease (or high risk for Cardiovascular Disease), for improving glycemic control, if metformin alone isn’t adequate or not appropriate.  

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