Daily Piece: Gestational Diabetes Blog

I recently had the opportunity to write a blog on gestational diabetes for Diabetes Sisters (a great peer support organization for women living with prediabetes and diabetes). In this blog, I tell the story of a gestational diabetes clinic that I had the opportunity to serve for 10 years.

https://diabetessisters.org/article/gestational-diabetes

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#gestational #diabetes #blog

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Changing the Name of Diabetes Education Specialty

It has been almost two weeks since I last posted a daily piece. I took a few days of vacation followed by attending the American Association of Diabetes Educators Annual Meeting. It is always such a fun event full of networking and learning (and meeting new friends!). I have some news to share…diabetes educators are now DIABETES CARE AND EDUCATION SPECIALISTS. Now, I am excited because this title for the specialty best captures the variety of services and support that these specialists can provide for persons living or at risk for diabetes. Wow!

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#diabetes #care #education #specialists #AADE

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Daily Piece: July 31st Updates to ADA Living Standards

Three important updates to the ADA “Living” Standard to know about are the incorporation of:

  1. International consensus report on continuous glucose monitoring and time in range (which tells a much more thorough story than A1c) (Standards 6 and 7)
  2. Results of Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial which reveals reduction in cardiovascular events with dulaglutide in adults with type 2 diabetes with or without existing cardiovascular disease (now that is exciting!!!) (Standards 9 and 10)
  3. FDA’a approval of liraglutide in pediatric patients with type 2 diabetes, and publication detailing drug’s effects in this population (a game changer as we now have more metformin as non-insulin options in pediatrics) (Standards 9 and 13)

Boy, such exciting updates! To review the updated standards for more details, please click below.

https://care.diabetesjournals.org/content/42/Supplement_1?utm_source=living-standards-update-073119&utm_medium=email&utm_content=diabetes-care-website-2&utm_campaign=PRO&s_src=email&s_subsrc=649516

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#ADA #updates #CGM #dulaglutide #pediatrics #liraglutide

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Daily Piece: Now Available – Latest Blog, Preparing for In Person Meeting, in the Advocacy Summer Series

Advocacy Summer Series

Part II: Preparing for In Person Meeting

Hi, it’s Mandy from Gainesville again to share my stories and tips preparing for the in-person meeting with a legislator.  Like most things in life, advocacy requires PATIENCE and most of all – PRACTICE.  You may not get a reply on your first request for an in person meeting with a legislator. I learned this lesson in late 2018 when I contacted a local office of a U.S. Senator to only receive no reply to numerous emails.  You bet I was frustrated, and I had to remind myself this is an exception to the rule to not receive any reply after several attempts. 

It is also worth mentioning; you do not have to travel to Washington, D.C. to meet with federal legislators or even travel to your state capital to meet with your state legislators.  Rather, you can meet with them locally – yes, locally in their districts where it is so much more convenient and they are more accessible. 

Do not be disappointed if you meet with staff member rather than the legislator.  Over time, I have developed a working relationship with Joel, deputy chief of staff, for my Congressman.  I always walk away from the meetings feeling like he listened and he will share the materials and my message with the legislator.  I have yet to be disappointed.  Do keep in mind that staff members do change and the next time you call don’t be surprised if you are reintroducing yourself and your purpose.

Back in May, I participated in the American Association of Diabetes Educators (AADE) Public Policy Forum during which my fellow Georgia diabetes educators and I met with Charlotte, staff member with one of our U.S. Senator’s.  Charlotte listened, took notes, asked clarifying questions and provided the information shared (verbally and materials left) with the Senator during a briefing.  Yet, again I walked away confident that my advocacy goals had been accomplished. 

Always come prepared for the meeting. Yes, have your key points about the proposed legislation and any available statistics – these are called your “Talking Points”. Also, have a story to share of how a constituent will be impacted positively by the legislation.  Stories are powerful as they connect the legislation  to their constituents – suddenly, it becomes more personal to the legislator. Even better is if the legislation directly impacts the legislator, a staff member’s family or even their close friends.  Stories are the bridge that transforms proposed legislation from an abstract to worthy of consideration.  An additional advocacy, Congressional Budget Office (CBO) number for proposed federal legislation is important to legislators and their staff, so do your best to provide the number during your visit. I would be remiss if I did not remind you to dress professionally – no, this does not mean a suit but business attire is appropriate.

How many times have you walked away from a meeting not really remembering the details?  Okay, you are normal.  Legislator’s and staff members are no different than rest of us.  While they most likely will take notes during the meeting, it is vital to provide written materials that summarize your request backed with statistics and evidence.   Additionally, ask if you can provide the more detailed information after the meeting which brings up the all-important follow up email and hand written thank you note (yes, a hand written note). 

Bottom line, you are selling your passion.  Whether you meet with a legislator or their staff member, the passion you exhibit will be seen over your lobbying – passion sticks.  Federal legislators have access to a wealth of research, while state legislators typically have limited access to research. You become part of their research team by providing them with balanced and accurate data – they will appreciate the data and YOU!  Lastly, legislators whether state or federal see a much bigger picture – they must look beyond what is directly in front of them.  Please do not be discouraged, but rather remember to sell your passion, and be patient and persistence as it may take several meetings and potentially a few years for your advocacy efforts to pay big dividends. 

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#advocacy #legislative #preparation #meeting

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Daily Piece: FDA Approval of Nasal Glucagon is Game Changer

FDA’s approval this week of Lilly’s nasal glucagon (Baqsimi) is a true game changer. No more reconstitution!! It comes in portable, compact package containing fixed 3 mg dose. The list price is $280.80 for one pack and $561.60 for two pack. It is approved for treatment of severe hypoglycemia in persons four years of age and older. Baqsimi should be available within pharmacies within a month.

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https://investor.lilly.com/news-releases/news-release-details/baqsimitm-glucagon-nasal-powder-3-mg-first-and-only-nasally?utm_source=Closer+Look+Subscribers+2018&utm_campaign=3fc7210552-2019-07-24_Lilly_Nasal_Glucagon07_24_2019&utm_medium=email&utm_term=0_c55d924bf1-3fc7210552-412262441

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#nasal #glucagon #severe #hypoglycemia #Lilly

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Daily Piece: SGLT-2 Inhibitors and Fracture Risk

SGLT-2 inhibitor drug class has been a game changer in the treatment in of type 2 in its novel approach and more recently in terms of cardiovascular and renal benefits. At the same time, warnings such as fracture risk (specific to canagliflozin) have arisen previously in an overall safe drug class (when prescribed appropriately). While data from Canagliflozin Cardiovascular Assessment Study (CANVAS) showed a small but significant fracture risk increase with canagliflozin, a recent large population based database (aka real world data) did NOT find an associated increased fracture risk with SGLT-2 inhibitors. It is important to note that person with Paget’s disease, osteomalacia or hyperparathyroidism (risk factors for fractures) were excluded from this database review. The controversy over fracture risk will continue although using common sense in prescribing can go a long way in lowering fracture risk with this drug class. Please click below if you are interested in more details regarding this real world data.

https://care.diabetesjournals.org/content/early/2019/07/10/dc19-0849

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#SGLT-2 #inhibitors #fracture #risk #real world #data

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Daily Piece: FDA Rejects Expanding Farixiga Type 1 Indications

While SGLT-2 inhibitors are often used off label in type 1 diabetes (aka not FDA approved for use in type 1 diabetes), FDA rejected expanding indication of dapagliflozin (Farxiga) for type 1 diabetes. This is disappointing news yet hope is not lost .

For those with type 1 diabetes using SGLT-2 inhibitor, risk for DKA is real and serious so it is important to check for ketones daily. Please seek medical attention immediately if you suspect DKA. Below is the STICH protocol for treating DKA associated with SGLT-2 inhibitors.

STop SGLT inhibitor immediately (will need to do stop for a few days)

Insulin administration

Carbohydrate (30 grams or less) consumption

Hydration with beverage (water or non-caloric athletic drink with balanced carbohydrates. Adults 8 oz of fluid every 30 – 60 minutes)

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#FDA #dapagliflozin #type1 #STICH

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Daily Piece: Adding GLP-1 Agonist to Insulin

As an educator and clinician, I hear the frustration over weight gain resulting from insulin therapy. For those requiring insulin therapy, this reality can be disheartening to say the least. So I when I read summary of study that showed liraglutide (Victozia) can improve glycemic control and reduce body weight in persons with type 2 diabetes on insulin therapy, I thought it was worth sharing. The link is below. I do encourage persons with type 2 diabetes on insulin to have discussion with their primary care provider, endocrinologist or diabetes educator about adding GLP-1 agonist to their current diabetes medication regimen as it will lower glucose and weight (now that sounds good!).

http://univadis.com/player/ysgckxcim?m=unv_eml_essentials_enl_v5-q12019_20190715&partner=unl&rgid=5xzzntsmvumvuucxuzefqyb&ts=2019071500&o=tile_1_id&utm_source=Retention&utm_medium=newsletter&utm_campaign=unv_eml_essentials_enl_v5-q12019_20190715_01

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#liraglutide #insulin #therapy #diabetes

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Daily Piece: Antidepressant Decreases Death

For people living with diabetes and major depression, antidepressant (medication used to treat symptoms depression) medication classes except reversible inhibitor of monoamine oxidase A (RIMA) were shown to reduce death by approximately 35% in a small study.

https://www.medscape.com/viewarticle/915376

Bottom line: treating major depression is very important. If you are a person with diabetes who suspects you are suffering from depression, talk with your primary care provider, diabetes educator or other health care professional so can you get treatment. If you are health care professional and diabetes educators, screen persons with diabetes for depression that you see in your practice.

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#antidepressants #diabetes #major depression

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Daily Piece: Prediabetes Turning It Around

Being a person having had prediabetes (and having had a life long struggle with emotional eating), I was greatly encouraged by a recent study that show lifestyle interventions work for a group of older adults with prediabetes to prevent develop of Type 2 diabetes. In the study of 2,575 women and men 60 years of age and older, 36% (918 people) had prediabetes. Only 13% (119 people) who began study with elevated glucose went on to develop diabetes. 22% (204 people) had glucose levels return to normal range. I just love the quote by Ying Shang, lead study author, “progressing to diabetes is not the only destination.” Below is link to study.

https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12920

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#prediabetes #older #adults

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