Daily Piece: Protecting Yourself against the Flu and Cold

Tis the season of cold and flu. Being proactive to protect yourself from cold and flu is of the essence. The most basic step to take is to wash your hands with soap and water throughout the day especially after touching door knobs and handles. Cleaning your hands with alcohol is an alternative to hand washing although hand washing is the best. Getting a sufficient amount of sleep (ideally 6 – 8 hours), eating balanced healthy meals and being physically active are also great prevention steps.

For some protection against getting a cold, taking vitamin C 500 mg daily is fine although not proven protection. If you take more than 500 mg of vitamin C at a time, your body will simply eliminate it so more is not better.

Lastly, the flu vaccine is of particular importance. Now a flu shot is not a guaranteed protection against getting the flu. Rather it lessens the severity and duration of the flu – bottom line it is worth it. FluMist, the nasal version of the flu vaccine, has been approved for this flu season but it is not as effective injected (intramuscular) formulation of the vaccine. A commentary published recently in Pediatrics highlights this finding.

http://pediatrics.aappublications.org/content/early/2019/01/03/peds.2018-3290

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#protection #against #cold #flu

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Daily Piece: Integration of CoverMyMeds Into Cerner Electronic Health Record (EHR)

This is great news! Why you may ask? It is usually quite difficult to know the cost of medication for the patient when the provider enters it into the electronic health record (EHR). This leads to sticker price shock at the pharmacy. And no, it is certainly not the fault of the pharmacy or pharmacist. Please do not shoot the messenger.

One of the major health information technology companies, Cerner, has collaborated with CoverMyMeds to integrate prescription princes into the electronic health record so both providers and patients can know the cost of medication before is prescribed. Also, know the price allows for a more informed decision on all fronts. Genius!! Time saved and frustrations minimized. Please click on the link below to learn more about his exciting collaboration. Wishing you a great week!

https://www.healthcarefinancenews.com/news/cerner-and-covermymeds-integrate-prescription-prices-and-patients-ability-pay-within-ehr

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#integration #medication #cost #collaboration 

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Daily Piece: Mediterranean Best Diet of 2019

So you may we wondering…why am I writing a daily piece about diet and not medications? Well, when it comes to our health, our nutrition and eating habits is natural medicine for our bodies. Our eating habits matter. I was excited to see that the Meditterranean diet is chosen as the best diet for 2019 according to U.S. News and World Report. This eating plan does not cut out certain food groups or produce magical short term weight loss. Creating sustainable long term changes in our eating habits rather than following the most popular fad diet is vital. To learn more click below.

https://www.medscape.com/viewarticle/907133

https://www.healthline.com/nutrition/mediterranean-diet-meal-plan

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#mediterranean #eating #habits #2019 

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Daily Piece: Canagliflozin and Fracture Risk

We have heard lots of news about sodium-glucose transporter type 2 (SGLT2) inhibitors over the last year or so. Canagliflozin being the first drug in this class has been highlighted in many of the studies. In one the two trials of the Canagliflozin Cardiovascular Assessment Study (CANVAS) program, a 56% increased fracture risk with canagliflozin was seen. The question that this study left was whether the increased fracture risk was limited to patients in study with high baseline risk.

However, an interesting recent systematic review of clinical trial data found no association between canagliflozin and increased fracture risk. It is worth noting that these patients with Type 2 diabetes were relatively young in this review. To read more about this systematic review, please click on link below.

https://www.medscape.com/viewarticle/907088

Image result for fracture risk

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#canagliflozin  #fracture  #risk  

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Daily Piece: Insulin and Sulfonylureas Associated with Increased Heart Risks

Metformin is usually the first prescribed medication for a person with Type 2 diabetes upon diagnosis. Usually an additional medication is added to the diabetes medication regimen. Several classes of diabetes medications are available for second line treatment (medications added on the initial medication regimen) of Type 2 diabetes. A number of factors such as cost, effect on weight, liver and kidney function, and etc impact the selection of the second line treatment. A major factor in determining preference of second line is the medication’s cardiovascular effect (or effect on the heart). A recent retrospective analysis found that use of insulin or sulfonylureas as second line treatment is associated with cardiovascular harm. To read more about this interesting anaylsis, click below.

https://www.medscape.com/viewarticle/906898?src=soc_tw_share

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#cardiovascular  #harm  #insulin #sulfonylureas  

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Happy New Year!

So I have made a BIG decision this year. No more new year’s resolutions. That is right. No more new year’s resolution. Instead I am a making a few goals that are very specific (who, what, when, where, how) that stretch me a bit out of my comfort zone. Please share your goal(s) for 2019. Wishing each of you a great 2019!

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#goal  #new #year #2019 

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Daily Piece: Merry Christmas

This is Mandy with Reece’s Pieces in a Diabetes World wishing you and yours a very Merry Christmas and Happy New Year. If you are interested in learning more about the story of Christmas, please click below to read Luke 2:1-21.

https://www.bible.com

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#Christmas  #story  #hope  

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Latest Blog: Avoid the Blame Game

III Part Series: Language of Diabetes

Part II: Avoid the Blame Game

Unfortunately, blame and guilt seem to be a frequent reality for people with diabetes.  Meet Beth who comes to see me for her monthly diabetes education visit. Honestly, Beth shares that she comes for accountability and support in an environment that neutralizes guilt and blame at least for the visit time.  It isDecember when Beth comes for her visit and she seems a bit deflated.  She states, “…you know I almost cancelled my appointment because I feel so guilty because I have not been taken my diabetes medications this week.”  On the surface, it is so easy to brush Beth off as a “non-compliant patient”.  Yes, this term induces blame and does not address the why Beth is struggling with taking her diabetes medications.

Image result for blame game

In our fast paced healthcare environment, where volume is often more price than value, it is so easy and convenient to simply label a person with diabetes as“non-compliant” or “non-adherent” then move onto the next person on our schedule.  It is like the analogy of the iceberg where you see the tip and not the massive base underneath the water.   Back to Beth, I challenge the notion that she is simply “non-compliant” rather she struggles with anxiety and her diabetes takes a back seat when life gets overwhelming.    

With regards to medications, the statement, “Beth takes her diabetes medication about 75% of the time,” quantifies the frequency of her taking her medication.  Then it is possible to build upon the fact that she is doing well taking her medications a majority of the time, and now simply focus on building upon the frequency Beth is taking her medications. 

What are alternative terms to “compliant” and“adherent”?  When focusing on terms that emphasize the vital and active role people with diabetes play in self managing this condition, Utilizing terms such as engagement, participation, and involvement of the person with diabetes are much more ideal.  Why is this? Diabetes is not a disease where a person is simply told what to do to better manage their treatment method, but rather it is a disease that requires ongoing engagement of the person with diabetes being active in the treatment decision making process.  The person knows their body best and is the team captain. The bottom line is all about empowering the person with diabetes by focusing on their strengths and building upon what they are doing well. My call to action for readers is to drop the words compliant, adherent, non-compliance and non-adherence.

Good news!  Beth was open to discussing tools and resources that could assist in her taking her medications more consistently as she sees clearly the benefit that her medication provides. She leaves her appointment strengthened and more confident in managing her diabetes.

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Special thanks to Jane Dickinson, Susan Guzman, Melinda Marynik, Catherine O’Brian, Jane Kadohiro, Richard Jackson, Nancy D’Hondt, Brenda Montgomery, Kelly Close and Martha Funnell who wrote Use of Language in Diabetes Care and Education

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#avoid  #diabetes  #blame #game 

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Daily Piece: Health Literacy and Action Steps

Health literacy (ability to read, understand and act on health information) is not he same as literacy (ability to read or write).   A person can be proficient in literacy yet lack health literacy.  So what is the big deal if a person lacks health literacy? Consequences include difficulty navigating the healthcare system (which we all know is very complicated even for most experienced person), sharing personal information with providers (vital subjective information is missing) and engaging in self care or disease management and inability to understand health related mathematical concepts (i.e. calculating insulin dose). So who is at high risk?  Persons with limited English proficiency, poor vision and older age.  

Image result for health literacy
Image result for health literacy

So what can we do as healthcare professionals?

  1. Use plain language – avoid medical jargon (i.e. high blood pressure rather than hypertension)
  2. When reviewing medications, ask person to bring in their medications, and ask them to identify meds, their purpose and how they are supposed to be taken. 
  3. Use Teach Back Method – ask person to repeat back to you the key information that you shared with them (don’t forget to engage them in the planning and goals – remember they are the team captain)

Now imagine how many medication errors that lead to emergency room visits or death, how health outcomes and quality of life could be improved. 

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#health  #literacy  #action #steps 

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Daily Piece: 2019 ADA Standards of Medical Care in Diabetes Updates Highlighted

Over the last 10 years or so, a much greater emphasis has been placed on risk of adverse cardiovascular outcomes (now also cardiovascular benefit) with diabetes medications. Below is a short list of updates as well as link to download standards. Great news!! You can download full or abridged version, or app of Standards of Care. Happy reading (these standards are sure to not disappoint)! 

https://professional.diabetes.org/content-page/practice-guidelines-resources

  • More treatment algorithms to provide decision support for individualized care with patient-centered care as top priority
  • Updated cardiovascular disease management recommendations – ADA and ACC (American College of Cardiology) now align in their recommendations
  • New section focused on diabetes technology ( lots of great details on recommendations on insulin delivery, blood glucose meters, continuous glucose monitors, automated insulin delivery devices, and insulin injection technique) 
  • Significant revisions to the pharmacologic treatment guidance for type 2 diabetes allowing for individualized therapy with a strong emphasis on incorporation of comorbidities (ASCVD, chronic kidney disease, heart failure), hypoglycemia risk (really important especially for senior adults), effect on body weight, cost, side effects, and patient preferences. 

 

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#ADA  #diabetes  #standards #care 

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