Pour Some Sugar...

Sharing sweet updates for diabetes management, more (potential) uses for the GLP-1 drugs, and some tea on fellowships

September 12, 2023

Credit: Giphy

In Today’s Edition:

  • Value-Based Healthcare? What does that mean?

  • Move over Metformin. addressing bbesity and type 2 diabetes

  • GLP- 1 RA’s: Everyone wants a piece of the sweetest drugs on the market - can it cure Alzheimer’s?

  • Not so sweet: U.S. life expectancy is on the decline

  • Getting ahead…consider a fellowship!

  • Sharing sweet resources, featuring The Curbsiders Internal Medicine Podcast

Value-Based Healthcare? What does that mean?

A bipartisan House bill known as the Value in Health Care Act of 2023 has gained the endorsement of seventeen influential figures in the healthcare industry. This legislation is designed to reinforce Medicare's transition to value-based care and make vital reforms to sustain the quality of care delivered through alternative payment models (APMs). It follows the reintroduction of the Value in Health Care Act of 2021 by a bipartisan group of representatives, aiming to refine methodologies in the Medicare Shared Savings Program.

Value in Health Care Act of 2023 Introduced to Congress to Reinforce Value-Based Care

The Value in Health Care Act of 2023, a bipartisan legislation that would make several important reforms to ensure alternative payment models (APMs) continue to produce high quality care for the Medicare program and its beneficiaries, was introduced in a letter signed by seventeen of the nation’s leading stakeholders in healthcare.

⚙️ The More You Know

Credit: Giphy

Move over Metformin

Addressing obesity and type 2 diabetes (DM2): Why metformin is no longer the “first line” treatment for DM2.

The ADA continues to update care and stress the individualized approach to glycemic control in diabetes. Make sure you are keeping up with the latest recommendations available via the ADA's Standards of Care updates. The short: after decades as the “gold standard” in diabetes care, metformin is out.

Why Metformin Is No Longer the First Drug Option for Type 2 Diabetes

The world's most popular type 2 diabetes drug has lost its exclusive perch as the condition's universal "first-line" treatment.

GLP-1 RA’s: Everyone wants a piece of the sweetest drugs on the market - can it cure Alzheimer’s?

Did you know the GLP-1 hormone is also produced in the central nervous system? Yep, and given the fact that Insulin resistance is a known contributor to the development of Alzheimer’s disease… this miracle drug just may have further benefits…at least we hope, and this quick read gives us just that! 🙏🏼

Coveted GLP-1 Drugs Show Early Promise in Alzheimer’s Disease | BioSpace

With a recent study yielding positive results, experts say GLP-1 drugs are making headway in treating Alzheimer’s and other neurodegenerative diseases.

Not sweet: U.S. life expectancy is on the decline

The research conducted by Steven H. Woolf, MD, MPH, of the Center on Society and Health and the department of family medicine and population health at Virginia Commonwealth University is raising some very good questions…we need to pay attention folks. 💡

US Life Expectancy Decreased Significantly Relative to Global Rates

An analysis of life expectancy growth since the 1930s suggest more than 50 countries have surpassed the US—with the gap compared to the leading countries widening in that time.

💡Inspiration for Aspirations

Without disclosing the decades we grew up in… All we can think about is cereal and pop-tarts, and the bread-based food pyramid...staples of the American diet…this quote hit hard this week…

❝

Food is being purposefully formulated to addict you.Then it is purposefully marketed, targeted to young children to addict them at an early age. This is unethical, right? This is immoral, particularly when you see the results of it which is this world-wide epidemic of diabetes and obesity.

Laurie David

📈Future APPs

Credit: Giphy

Getting Ahead…Consider a Fellowship…or Create One!

Are you a recent PA or NP grad or prospective student interested in speciality medicine? Are you just ready for a career or specialty change? Fellowships are an excellent way to gain the skills needed to hit the ground running, negotiate for a higher salary (especially for “new grads”), and position yourself for top-notch employment.

The APPAP has been the governing body for Advanced Practice Provider fellowship accreditation since 2014. They have information on all the fellowships, including a comprehensive list of programs... and growing!

PA and Joint PA/NP Postgraduate Programs Reference Chart By Specialty | APPAP

PA and Joint PA/NP Postgraduate Programs Reference Chart By Specialty. Chart is comprised of single or multitrack postgraduate programs affiliated with APPAP membership.

🧪Clinical Conundrums: Because We Love a Challenge!

Sharing Sweet Resources

Credit: The Curb Siders Internal Medicine

The Curbsiders Internal Medicine Podcast:

Watch them on YouTube or download the podcast, this resource is sure to bring you up to speed in evidence based care. They not only include important links but their page is packed with important takeaways, pearls and pitfalls, expert opinions, free CME, and memorable infographics. Check out #387 Diabetes updates with Dr. Marie McDonnell: New Tools for the New Rules…we included a sneak peek for pearls below….hint… they aren’t hating on metformin!

  1. Check what you are treating; easily distinguish between insulin deficiency and type 2 diabetes with labs before you start treatment.

  2. Updated guidelines focus not only on glucose control but also on helping patients with weight loss.

  3. Blood glucose control should be achieved with the least risk of hypoglycemia

  4. Semaglutide has been found to decrease stroke risk

  5. Extended release metformin may be better tolerated and the highest tolerated dose should be split twice a day

  6. Aim to attain the lowest A1c goal in younger healthier patients.

  7. Older, sicker patients or those with limited life expectancy should aim for an A1c goal of 7.5%

  8. To reduce the risk of yeast infections with SGLT2-i, try starting this drug when the A1c is less than 9%

  9. Pancreatitis incidence is low with GLP-1 but be aware of increased risk of thyroid cancer

  10. The GIP component in tirzepatide appears to enhance the effect of GLP-1 RA which could explain why this drug has less GI intolerance

🔎ICYMI

  • Re-boarding options for PAs

  • Nutrition in a nutshell, breaking down the importance of nutrient intake

  • Tips for healthy eating

  • The physiology of weight loss

  • Regular exercise balances the mind and body, it’s science

  • Summer temperatures aren't slowing down, the latest on sun protection

  • Worth a Repeat: Meet Karli Burridge, MMS, PA-C, FOMA, our Inspirational APP of the Week

  • Pro-Tips for Professional School Applicant Prep

  • Looking for free CME? Check out these free resources from Pri-Med

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