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Diabetes: Management and Pharmacotherapy01:15

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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.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
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Diabetes Mellitus: Type 2 and Gestational01:22

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Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
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Drug Dosing: Obese Patients01:21

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In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
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Diabetes Mellitus: Overview and Type I Subtype01:22

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Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
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Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

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Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
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Medication Optimization Among People With Type 2 Diabetes Participating in a Continuous Glucose Monitoring-Driven

Amit R Majithia1,2, David M Erani3, Coco M Kusiak4

  • 1Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, United States.

JMIR Formative Research
|February 11, 2022
PubMed
Summary

The Onduo virtual care program facilitated medication adjustments for type 2 diabetes (T2D) patients, leading to improved treatment regimens. This virtual care approach enabled timely access to guideline-based medications and technologies for T2D management.

Keywords:
GLP-1 receptor agonistHbA1cappcoachingcontinuous glucose monitoringdiabetesdigital healthlifestylemedicationmonitoringoptimizationprospectiveself-managementtelemedicinetype 2 diabetesvirtual care

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Area of Science:

  • Endocrinology
  • Digital Health
  • Pharmacotherapy

Background:

  • The Onduo virtual care program integrates a mobile app, remote coaching, connected devices, and telemedicine for type 2 diabetes (T2D) management.
  • A prior 4-month study showed a 1.6% mean HbA1c decrease in T2D patients using the program, without increased hypoglycemia.

Purpose of the Study:

  • To evaluate medication optimization and management within the Onduo virtual care program.
  • To analyze medication changes in T2D patients during a 4-month prospective study.

Main Methods:

  • Participants received telemedicine consultations with endocrinologists for diabetes medication management.
  • Real-time continuous glucose monitoring (RT-CGM) was used intermittently to guide therapy adjustments.
  • Medication changes, including dose adjustments, additions, and discontinuations, were analyzed.

Main Results:

  • 87% of participants (48/55) experienced medication changes.
  • The use of glucagon-like peptide-1 receptor agonists increased significantly (25% to 56%).
  • Use of sulfonylureas and dipeptidyl peptidase 4 inhibitors decreased, indicating a shift towards newer diabetes medications.

Conclusions:

  • The Onduo virtual care program provides timely access to guideline-based medications for T2D.
  • Telemedicine consultations and RT-CGM support effective medication optimization in T2D management.
  • Virtual care models can enhance diabetes pharmacotherapy and patient outcomes.