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Posted By: Lawrence Herman, PA-C, MPA
November 15, 2019
Along with the colder weather and the promise of holiday season, November brings us the opportunity to raise awareness about diabetes. Both type 1 and type 2 diabetes are increasingly prevalent in today's society, giving us all the more reason to spend a full month focusing on strategies to improve diabetic patient care and management.
According to the Centers for Disease Control and Prevention (CDC), 6 in 10 Americans have a single chronic disease, and 4 in 10 have two or more. Regardless of your practice setting, your next patient is likely to have one or all of the following diseases: obesity, diabetes, cardiovascular disease (CVD) (including hypertension, dyslipidemia, atherosclerotic cardiovascular disease, and heart failure). While CVD is trending downward, the rates of both obesity and diabetes are dramatically increasing.
If you are reading this post, you likely have attended one of PCE's live symposia, or taken one of our online, on-demand CE/CME courses. You then know that one of PCE's primary focuses is treatment of diabetes. This isn't by chance. According to the PCE Annual Survey taken just last month (October 2019), PCE's NPs see an average of 43 patients with diabetes per month, and PCE's PAs see an average of 34. Combined, the NPs and PAs surveyed manage a staggering 4,413,387 patients with diabetes in any given month. And though diabetes may not be the primary purpose of each visit, its prevalence makes it more important than ever for clinicians to stay up-to-date on how the disease can play into patients' general healthcare concerns.
Why so many patients with diabetes in this cohort of NPs and PAs? According to the CDC, in 2017 there were 30.3 million people in the US with diabetes, and nearly a quarter (23.8%) of these 30.3 million people were undiagnosed. These numbers are growing, in part because of the concomitant obesity epidemic.
But there is some good news: insulin was developed in the 1920s and has been continuously developed to meet the needs of patients ever since. It's hard to believe that the first recombinant insulin was released in 1983 and since then we've had astonishing advancements in rapid-acting, basal, and other insulins—as well as in pumps. Sulfonylureas were released in the 1950s. Metformin was introduced in 1959. Then we had an explosion of diabetes medications including thiazolidinediones in 1996, alpha-glucosidase inhibitors in 1995, glinides in 1997, glucagon-like peptide 1 receptor agonists in 2005, dipeptidyl peptidase-4 inhibitors in 2006, and sodium-glucose cotransporter-2 inhibitors in 2013. There were a handful of other minor players along the way, and now there are 11 different classes of medications for the treatment of hyperglycemia.
While we may still struggle with the efficacy and potential side effects of the drugs within each class, we should recognize that diabetes care has advanced tremendously since the 1990s, and has dramatically improved life expectancy for patients.
The rapidity of development of new classes of medications and the plethora of drugs within each class presents a significant challenge for clinicians: how do we keep up? Statistically, we need to know this information during the 53 million or so patient visits each year. That is just one of the reasons that PCE places an ongoing focus on diabetes care activities. PCE currently has several online activities focused on T2DM, as well as live presentations to keep clinicians up-to-date on diabetes patient care practices (the most recent being "GLP-1 RA Therapy in T2DM: Implementing a New Standard of Care" presented at PCE's Series 3 Symposia).
So please take a moment and review PCE's CE/CME activities. If your schedule allows it, sign up for a live meeting in 2020 to hear from leading experts in the field.
After all, there are more than 30 million Americans who count on your knowledge and expertise.
- Centers for Disease Control and Prevention. Chronic diseases in America. www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm . Accessed November 15, 2019.
- The Marshall Protocol Knowledge Base. Incidence and prevalence of chronic disease. mpkb.org/home/pathogenesis/epidemiology. Accessed November 15, 2019.
- White JR. A brief history of the development of diabetes medications. Diabetes Spectrum. 2014;27:82-86.