Category: Uncategorized

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

Please share your thoughts and subscribe to receive my blogs.

#Christmas  #story  #hope  

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

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.

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.

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

Please share your thoughts and subscribe to receive my blogs.

#avoid  #diabetes  #blame #game 

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

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.  

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. 

Please share your thoughts and subscribe to receive my blogs.

#health  #literacy  #action #steps 

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

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. 

 

Please share your thoughts and subscribe to receive my blogs.

#ADA  #diabetes  #standards #care 

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

Walmart and Express Scripts have partnered together to offer more value to consumers though a unique pricing on several brand name medications. The most interesting innovation is InsideRx which provides significant discounts on several brand name prescriptions.  Potentially,  up to 40% on a select group of brand name prescriptions.  While it is worth learning more to see if this program will assist you,  cost is still issue for many brand name medications. Interestingly, there is also an InsideRx program for pet meds. To learn more, please click below. 

https://insiderx.com

Please share your thoughts and subscribe to receive my blogs.

#savings  #brand  #prescriptions #medications 

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

Did you know that Kroger and GoodRx have joined forces to create Kroger Rx Savings Club?  Yes!  This program focuses on cost savings for generic medications.  There are 3 tiers of low cost medications: 1) free 30 day and 90-day medications; 2) $3-30 day and $60-90 day medications; 3) $6-30 day and $12-90 day medications.  To learn more, please click below. 

https://www.drugstorenews.com/pharmacy/kroger-goodrx-launch-kroger-rx-savings-club/

Please share your thoughts and subscribe to receive my blogs.

#savings  #generics  #prescriptions #medications 

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

An exciting new potential for interchangeable insulin products that can be substituted for branded insulin as a result of new FDA biosimilars policies.  Under the Biologics Price Competition and Innovation Act of 2009 (BPCI Act), biologics (such as insulin) that have been approved under NDAs (drugs) will be deemed on March 23, 2020, to be approved under BLAs (biologics). This change could potentially drive down the cost of insulin which means increased access to insulin. To learn about this exciting news, please click below. 

https://www.biocentury.com/bc-extra/politics-policy/2018-12-11/fda-biosimilars-policies-will-bring-interchangeable-insulin-

Please share your thoughts and subscribe to receive my blogs.

#interchangeable  #insulin #biologics

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

In the British Medical Journal (BMJ), an interesting population based cohort study found that use of incretin based drugs (dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists) might be associated with an increased risk of cholangiocarcinoma (cancer of bile ducts) in adults with type 2 diabetes. While this certainly does not prove cause and effect, it is certainly an interesting finding.  Please click below read more about this study and cholangiocarcinoma (cancer of bile duct).

https://www.bmj.com/content/363/bmj.k4880

https://www.hopkinsmedicine.org/liver_tumor_center/conditions/bile_duct_cancer.html

Please share your thoughts and subscribe to receive my blogs.

#incretin #drugs #cancer

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

Barbara came in for her monthly diabetes education appointment this morning. She shared that she had not been consistent in taking her evening dose of glimepiride because she was on the go in the evening.  She did not want to take her full bottle of glimepiride with her as she might lose the bottle.   I suggested that she get an extra labelled bottle (but empty) for her glimepiride from her pharmacy. She could  put her evening dose of glimepiride in this extra labelled bottle so she could take her medicine before her dinner on the go.  Flexibility and creativity for life in the fast lane.  

Please share your thoughts and subscribe to receive my blogs.

#extra  #labelled #medicine #bottle #diabetes

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.

Medications are no longer one size fits all.  Pharmacogenomics is an area of study that reveal how genes affect an individual’s response to medications.  This area of study allows for precision/personalized medicine.  To learn more about this cutting edge science, click on the links below.

https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics

https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/personalized-medicine/art-20044300

Please share your thoughts and subscribe to receive my blogs.

Follow me on Twitter and Facebook @ReecesPiecesDi and Instagram ReecesPiecesDI.