1. February 2013 Webinar: “Practical Ways to Help Get Our Diabetes Patients to Goal” Controlling the ABC’s Cases

2. The ‘ABCs’ A 1C B P < 140/90 C holesterol (LDL<100, if CAD <70)

3. Improving Glucose Control

5. 5

6. Who Are Your High A1C Patients? Orals and need second oral? Need insulin? On insulin? There can be inertia at each level DEPRESSION? Adherence? Open-ended ended question: “Some people find it hard taking their insulin every day, how’s it going for you?”

7. BP CONTROL

8. BP Management <140/90 Multiple meds Don’t miss an opportunity to titrate Standing orders?

9. Medication Treatment Algorithm? Start with ACE or ARB and/or HCTZ Either one Best might be early combo since all will likely need it Third agent based on co-morbidity Beta blocker and/or Ca channel Add the 4 th and hopefully you’ve reached goal - if not call an expert +/- alpha blocker?

10. Tashko and Gabbay, Integrated Blood Pressure Control (2010) 150/90140/80150/90 140/80

11. Cholesterol LDL control <100 If CVD <70

12. Getting to Goal on LDL Most myalgia not from statins! Stop and observe Switch to another statin Mention stroke risk TITRATE

13. Evidence Based Interventions That Reduce Morbidity and Mortality HbA1C < 7 BP < 130/80 LDL cholesterol < 100 (or <70 if CAD) Aspirin age > 50 men, 60 women with 1 risk factor ACE -age >55 Statin use- age >40 Yearly screen for nephropathy, feet, and eye exams

14. QUESTIONS? Any Cases?