"Diabetes Is Primary": Primary Care Providers Are the Foundation of Diabetes Care

Saturday started early: a number of people were up at the crack of dawn preparing for the “Diabetes Is Primary” session that is a parallel program to the ADA Scientific Sessions. The fact that such a session is held is a significant recognition by the ADA that primary care providers are the foundation of diabetes care in the United States.

Dr Eric Johnson from North Dakota gave an excellent review of basal insulin use and dosing. He, and others, continued to develop the notion that most individuals need at most 0.5 units of basal insulin daily (NPH and glargine, that is). Dr Jack Leahy, in the afternoon, stressed that the 0.5 unit/kg dosing parameter relates only to glargine and NPH, since several studies confirm that often much larger doses of detemir are required.

Dr Carol Wysham, an endocrinologist from Spokane, WA, gave an excellent overview of our new therapies. She reviewed recent data about the risk of pancreatitis and pancreatic cancer with GLP-1 RA’s and reminded the audience that recent releases by the FDA and EMA (European Medicines Association) stress that there is no evidence currently establishing a causal relationship between incretin therapies (GLP-1 RAs and DDP-4 inhibitors) and pancreatitis or cancer (of the pancreas or thyroid). It seems that many of these adverse conditions are an inherent part of the diabetes disease state.

Dr Silvio Inzucchi, lead author of the current ADA guidelines, led a discussion of the guidelines and their implications for primary care providers. When asked why SGLT2 inhibitors weren’t on the guidelines, he said he feels a new therapy should be on the market about 3 years before being included.

In the “Taking Care of Diabetes on a Budget” workshop, participants explored the benefit of older, generic drugs on diabetes management and cost of care. While not as easy to use, nor as free of side effects such as nocturnal hypoglycemia, the old tried and true therapies such as metformin and slow-dose, rapid-acting sulfonylureas and NPH insulin do provide cost-effective alternatives in a financial pinch. The participants also explored management of type 2 diabetes in a homeless population and the special aspects of their care.

At the end of the day Drs Leahy and Johnson were peppered with questions by a large audience who stayed until the bitter end to avail themselves of the expert thoughts of these experienced clinicians.

It was a most excellent day for all in attendance. For those of you who missed this session, please go to the ADA website to access the content in full and obtain CME hours. Last year, over 2000 people attended online, so don’t miss out on this excellent educational opportunity.

Tomorrow holds the president’s lecture . . . always a highlight of the ADA.  Also, Dr Dan Drucker will deliver the Banting lecture. He is a leading expert on incretin therapies, so his comment should be very interesting.