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Diabetes Update 2014

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Diabetes is one of the most common chronic diseases in the U.S.; it is estimated that nearly 26 million people are affected – or about 8.3% of the population. The diabetes epidemic does not seem to be stopping, but instead is accelerating as people continue to live longer and more people, including children, adolescents, and young adults, are diagnosed with this disease. Projections suggest that the prevalence of diabetes (diagnosed and undiagnosed) will increase from the current level of 1 in 9 adults to as many as 1 in 3 adults by the year 2050.

The impact of diabetes on health is significant. Complications arising from uncontrolled diabetes include macrovascular disease (eg, atherosclerosis leading to heart attacks and strokes) as well as microvascular disease (eg, retinopathy, kidney damage, and neuropathy). These complications now account for nearly 14% of all U.S. healthcare expenditures.

The estimated total cost of diagnosed cases of diabetes was $245 billion in 2012, up from $174 billion in 2007. The largest component of this cost (43%) was inpatient medical care. Other direct costs included medications, physician office visits, and nursing/residential facility care. The average person with diabetes spends $13,700 per year on medical expenses; $7,900 is directly attributable to diabetes. In addition, immense indirect costs result from lost productivity, which can also have a psychosocial impact (Table 1).

Management of diabetes can be challenging. Delays in diagnosis and suboptimal treatment after diagnosis may contribute to poor health and increased healthcare costs. Educating patients and caregivers about glucose control, blood pressure control and lipid management, along with preventive care for diabetes-related neuropathy affecting the eyes, ears, feet, kidneys, bladder, nerves and heart, can help reduce complications and related hospitalizations. Healthcare providers must stay current with evidence-based recommendations for drug therapy and other medical treatments in an effort to provide optimal, individualized, continuous care for patients with diabetes.

This issue focuses on recent changes to the American Diabetes Association (ADA) Standards of Medical Care and new trends in diabetes management. Newly approved medications (canagliflozin [Invokana™], dapagliflozin [Farxiga™] will be covered in the July/August issue.


Publication Date: 05/18/2014
Expiration Date: 05/18/2017
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.


Susan Cornell, BS, PharmD, CDE, FAPHA, FAADE

Disclosure Statement

Dr. Cornell reports serving as non-CME faculty for Johnson and Johnson Diabetes Institute and Abbott Diabetes Care, and is a member of the Advanced Practitioner Advisory Board for Astra Zeneca, Sanofi, and Novo-Nordisk.

Target Audience

This accredited program is targeted to pharmacists .

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Describe the methods used for screening and diagnosing diabetes, including type 1 and gestational diabetes. State the current ADA recommendations for frequency of follow-up after diagnosis.
    2. List 3 non-insulin diabetes drugs that may be used (with insulin) in type 1 diabetes. Explain the rationale(s) for their use. Discuss the use of metformin in patients with chronic kidney disease.
    3. Explain the problem of clinical inertia in diabetes management; list 1 recommended solution. Review the evidence linking statins and certain antihypertensive drugs to an increased risk of diabetes.
    4. Outline key ADA recommendations for inpatient care of people with diabetes, including discharge planning and transitions of care

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The Rx Consultant is a publication of Continuing Education Network, Inc.

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Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

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Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-14-008-H01-P

Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator

Terry M. Baker, PharmD

Managing Editor

Tracy Farnen, PharmD

Associate Editors

James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor

Gerard Hatheway, PharmD, PhD

Editorial Advisors

Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners

Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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