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Diabetes Mellitus: Type 2 and Gestational01:22

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Improving IV Insulin Administration in a Community Hospital
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Glycemic relapse in a collaborative primary care-based type 2 diabetes management program.

Sarah E Wheeler, Tamara Struebing, Rachel L C Drury

    Journal of the American Pharmacists Association : Japha
    |March 15, 2021
    PubMed
    Summary
    This summary is machine-generated.

    This study found a low incidence of glycemic relapse in type 2 diabetes (T2D) patients achieving A1C goals via a collaborative care program. Risk factors like higher BMI indicate a need for continued intensive management.

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    Area of Science:

    • Endocrinology
    • Primary Care Medicine
    • Pharmacist-led Interventions

    Background:

    • Type 2 Diabetes (T2D) management programs aim to achieve glycemic control.
    • Glycemic relapse can occur even after patients attain their target glycosylated hemoglobin (A1C) levels.
    • Identifying factors contributing to relapse is crucial for sustained T2D management.

    Purpose of the Study:

    • To determine the incidence of glycemic relapse in T2D patients post-program completion.
    • To identify risk factors associated with glycemic relapse after achieving A1C goals.
    • To evaluate the effectiveness of a collaborative, primary care-based T2D management program.

    Main Methods:

    • Retrospective cohort study of T2D patients with baseline A1C ≥ 9% in a management program.
    • Primary outcome: incidence of glycemic relapse; time to relapse analyzed using Kaplan-Meier curves.
    • Cox proportional hazards models used to identify risk factors for relapse.

    Main Results:

    • 10.5% of 362 patients experienced glycemic relapse; 12-month relapse rate was 8.3%.
    • Univariate analysis identified medication adherence barriers, more chronic medications, BMI 30-39.9, and insulin use as relapse risk factors.
    • Multivariate analysis showed baseline BMI 30-39.9 remained significant; older age decreased relapse risk.

    Conclusions:

    • Collaborative pharmacist- and CDCES-led T2D programs demonstrate low glycemic relapse rates.
    • Specific risk factors (e.g., higher BMI) suggest a need for ongoing, intensive patient care.
    • Program success in achieving A1C goals can be sustained with targeted interventions for high-risk individuals.