NSG-533 Diabetes/Endocrine Topic Discussion

NSG-533 Diabetes Endocrine Topic Discussion

Recent data indicates that 85.6% of adults with diagnosed diabetes are treated with Diabetes medication. Results from the National Health and Nutrition Examination Survey (NHANES) indicate that only about 50% of American adults with Diabetes are achieving HbA1c <7.0% (<53 mmol/mol) (Edelman & Polonsky, 2017). Modern day medicine and guidelines from the American Diabetes Association (ADA) have spent an enormous amount of time and resources to prove that certain classes of medications are best served to treat diabetes. It is argued that therapeutic interventions that target hyperglycemia but do not correct the underlying pathogenic disturbances are unlikely to result in a sustained benefit on the disease process, (Abdul-Ghani & DeFronzo, 2017).

Metformin is effective and safe, is inexpensive, and may reduce risk of cardiovascular events and death, (“Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2019,” 2018). While Metformin is an effective first line drug that offers several benefits such as cardiovascular protection, it lacks any effect on β-cell function, which is the primary pathophysiological disturbance responsible for progressive hyperglycemia in T2D patients, (Abdul-Ghani & DeFronzo, 2017). Medication and lifestyle changes should be introduced prior to adding a concomitant therapy. If this prescribed regimen is not successful, then other therapies may be introduced. Studies on additional treatments have now been done to get to the root cause of the issue which is hyperglycemia.

Metformin has been found to have additional benefits in its use. The addition of Metformin for patients with type 2 diabetes and a high risk of cardiovascular disease had reduced risk of a cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke relative to those randomized to receive placebo (Edelman & Polonsky, 2017). The use of SGLT2Is is now widely acceptable as a successful therapy to treat. For the first time, SGLT2 inhibitors offer a therapeutic approach acting directly on the kidneys without requiring insulin secretion or action, (Seufert, 2015).

The rate of compliance for a medication is directly correlated on the understanding of its use as well as the access to the medication at hand. Each practitioner and patient must be open to educating themselves on the risks versus the benefits of the medication as well as reading multiple, evidenced based studies that have been completed. These studies should not have been sponsored by organizations that have a stake in monetary gain. Patients need to understand that the medication they are taking is used for their benefit and must not cause additional harm to their physical being nor their finances.

Diabetes, especially Type II Diabetes is a hot topic in my household as well as in my daily practice. I myself was diagnosed with type II Diabetes some years ago while pregnant. Over the course of several years, I was trialed on several therapies until I landed on the treatment that truly worked for me and this treatment, did not include medication therapy at all.

References

Abdul-Ghani, M., & DeFronzo, R. A. (2017). Is it time to change the type 2 diabetes treatment paradigm? yes! glp-1 ras should replace metformin in the type 2 diabetes algorithm. Diabetes Care, 40(8), 1121–1127. https://doi.org/10.2337/dc16-2368

Edelman, S. V., & Polonsky, W. H. (2017). Type 2 diabetes in the real world: The elusive nature of glycemic control. Diabetes Care, 40(11), 1425–1432. https://doi.org/10.2337/dc16-1974

Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes-2019. (2018). Diabetes Care, 42(Supplement 1), S90-S102. https://doi.org/10.2337/dc19-s009

Seufert, J. (2015). Sglt2 inhibitors — an insulin-independent therapeutic approach for treatment of type 2 diabetes: Focus on canagliflozin. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 543. https://doi.org/10.2147/dmso.s90662

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. NSG-533 Diabetes Endocrine Topic Discussion

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. NSG-533 Diabetes Endocrine Topic Discussion

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For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score. NSG-533 Diabetes Endocrine Topic Discussion

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

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Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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