Managing patients with type 2 diabetes and obesity uncovered,what percent of type 2 diabetes require insulin,medication errors health care costs qld,m 24 - You Shoud Know

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New research published in The Lancet Diabetes & Endocrinology suggests that, when considering overall costs of healthcare, obese patients with type 2 diabetes, especially those with recent disease onset, should be prioritised for obesity surgery over those without type 2 diabetes, since many patients see a reversal of diabetes after surgery and thus need fewer expensive diabetes medications or treatment for complications in future. Currently most healthcare systems prioritise access to obesity surgery based on a person’s body-mass index (BMI), and in general, those with the highest BMI are prioritised.
Several groups have recommended that a person’s diabetes status (rather than BMI alone), be used to prioritise obese patients to receive bariatric surgery.
The SOS study was conducted in the Swedish healthcare system and including 2010 adults who underwent obesity surgery and 2037 matched controls recruited between 1987 and 2001.
Compared with patients treated conventionally, total healthcare costs (accounting for costs of surgery, inpatient and outpatient hospital care and prescription drugs) were higher in surgery patients who did not have diabetes at the beginning of the study (by $22,390 per patient) or who had prediabetes ($26,292), but not in patients with diabetes, most likely because the remission of diabetes that often occurs after bariatric surgery means that patients need fewer diabetes medications and hospital appointments in the subsequent years.
Remission of diabetes also means that diabetes complications are lessened, further reducing future healthcare costs. Because previous studies have assessed the entire eligible obese population, they have likely underestimated the cost benefits of obesity surgery for those with type 2 diabetes, while overestimating them for patients without type 2 diabetes. Your doctor may ask you to take more than one type of tablet to control your blood glucose levels.
It is usual to add a tablet from a group which acts differently from what you have been taking. You will see that adding drugs from a different group which has a different action makes sense. Metformin can be added to a glitazone, as although belonging to the same category, their main actions are on different types of cells which supplement the actions of each other and lower the blood glucose levels. The sulfonylureas and meglitinides can only act is the pancreas still has the ability to secrete insulin.
Which is why they cannot be used by themselves to treat Type 1 diabetes in which a patient has practically no insulin in the body. Even the picture in Type 2 diabetes is quite different from what one sees in the Western countries. Even if the tablets have helped control your diabetes for many a year, many of you will reach a stage where the tablets, no matter in what combination, will not be able to adequately control you.
Firstly, starting insulin does not mean that you have reached end stage or a very critical stage and that death is only a few months away! Metformin and alpha-glucosidase inhibitors can be combined with insulin as their actions are complementary.
Although used often, the combination of a glitazone with insulin is still a little controversial as both insulin and the glitazones can lead to fluid retention. But this is something which your doctor would be in a better position to judge and the decision to use insulin along with which tablets, if any, must be made jointly by you and your doctor.
The main point is that you have to look at the addition of insulin as just another way to control your blood glucose and not as if you have reached a critical terminal phase of your life! It is important that you know about the tablets which you may have to take for many a year.

Hier gaat het ook om diabetes met een tekort aan insuline, aangemaakt door het lichaam, maar ditmaal gedeeltelijk.
Diabetes is a growing concern, and it has been estimated that the number of Americans living with diabetes will increase 64% to more than 53.1 million by 2025.
The total cost of diagnosed diabetes, as estimated by the American Diabetes Association (ADA), is $245 billion.
Primary care physicians can support patients in managing their diabetes by implementing the following tips and resources into their practices.
If a patient comes to the office for a routine diabetes recheck and has a complaint, address it but reschedule the diabetes recheck. While you may not provide this in your office, diabetes education will assist patients greatly in their self-management. For example, patients only on metformin can be asked to check their levels one to three times per week, while patients on sulfonylureas check more often.
Studies have shown that it takes more than 15 minutes to review data by scrolling the meter or looking at a written log, while reviewing a glucose pattern from a download can be done in less than two minutes.
This gives you the ability to see what the glucose readings are and allows you to discuss what contributes to high and low readings.
If patients bring in their meters, it is important that you take the time to review the readings and comment on them. This equipment gives you access to point-of-care information that may also be a source of revenue for your practice. Fasting can be a significant barrier to getting labs done for many patients, especially if they are on medications that can lower their glucose levels. One strategy is to focus each quarterly visit on a theme, such as immunizations and preventive care in the fall, nutrition and exercise in the winter, microvascular complication risk reduction in the spring, and cardiovascular risk reduction in the summer. Remember that patients have to work hard to maintain control of this progressive disease, so remember to congratulate patients for the work they do. All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. One of the cookies used is essential for parts of the site to operate properly and has already been set.
Patients with lower BMIs and comorbidities such as type 2 diabetes can also be considered eligible for surgery, but different countries have different guidelines. But so far, the long-term effect of bariatric surgery (relative to conventional therapy) on healthcare costs in obese patients according to their diabetes status has not been assessed using real-world data.
The data showed that accumulated drug costs over 15 years did not differ between the surgery and control group in patients without diabetes at the time of surgery, but were lower in surgery patients who had prediabetes (on average, -US$3329 per patient) or diabetes (-$5487 per patient). This finding of cost neutrality is seldom noted for health-care interventions, nor is it a requirement of funding in most settings. Thus, whilst, one could add a metformin to a sulfonylurea, it would not make sense to add another sulfonylurea or a meglitinide if you are already taking a sulfonylurea.
In India, as is true for many other countries, nearly 40% of people with Type 2 diabetes, have a decreased capacity to secrete insulin.
Yes, they can make your body more sensitive to insulin, but there must be enough insulin available to take advantage of this increase in the sensitivity.

If you are taking insulin injections, then "stressing" your pancreas more does not make sense and therefore, I believe that sulfonylureas and meglitinides would have no role to play once you are taking insulin.
In some patients with heart problems, there is a fear that it could precipitate heart failure.
Diabetes is considered a gateway disease; it can lead to a wide range of serious health conditions and complications, making effective management a crucial goal in the primary care setting. Diabetes is a chronic disease that needs ongoing management, and it is very difficult to try to add chronic management of a complex disease when the patient is coming for a specific complaint.
Studies have shown that the more visits committed exclusively to diabetes care the better the control.
This may save endless hours in problem -solving if the patient has a good base knowledge of the disease.
This will enable you to protect your patients and give them the ability to problem-solve if their levels are running high or low. Patients should be reminded always to check their glucose level before administering a shot of insulin. You can ask your patient to download in the lobby if the station is kept there or your staff can download the data before you go into the examination room. Many manufacturers will provide the machine for free if you purchase the cartridges, but a practice would need to run the machines enough so that the cartridges do not expire. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. Usually, buying of health benefits at an acceptable cost (eg, ?20,000 per quality-adjusted lifeyear in the UK) is the economic benchmark adopted by payers when new interventions are assessed. So whilst, they can push out some insulin from the pancreas, this is never going to be adequate to meet the requirements.
Going back to our analogy, you can make the gates of the winning post larger, but the horse still has to reach there and a lame horse will not be able to do it! It is just that your body does not have enough insulin and this deficit has to be made up with injected insulin. Most primary care practices likely will have a large enough patient base such that running a sufficient number of tests every three months won’t be a problem.
This means you can order labs prior to the appointment so that you can review the results at the time of the office visit. There is limit to how much one would be able to push the pancreas to increase the secretion of insulin by using sulfonylureas or meglitinides.
To give an analogy, no matter how much you "whip" a lame horse, he will not be able to run as fast as one would want!

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