The incidence of diabetes is rapidly increasing in the United States, and the Federal Drug Administration (FDA) has recently released numerous new medications. Nurses need knowledge of diabetes medications in order to assist patients in understanding how their ordered medications control diabetes.
According to the United States Department of Health and Human Services (2011), about 25.8 million people in the United States have diabetes mellitus and 7 million Americans are undiagnosed. Type 2 diabetes accounts for about 90% of cases of diabetes in adults.
Diabetes is a disease that requires complex balancing of self-management behaviors prescribed by health care providers and carried out by the patient with diabetes. Literature describes factors that influence medication adherence such as cost, medication beliefs, participatory decision-making, and health literacy (Aikens & Piette, 2009; Kocurek, 2009; Parchman, Zeber, & Palmer, 2010).The incidence of Type 2 diabetes in specific cultural groups, such as the high rates currently seen in Latino groups, remind caregivers to consider ethnic factors when developing a treatment plan.
Lifestyle modification, defined as intervening in meal planning and activity to achieve glucose targets, is the foundation of Type 2 diabetes management (American Diabetes Association [ADA], 2012). Increasingly, diabetes medications are used at the time of diagnosis, or very early in the disease process, in combination with medical nutrition therapy and lifestyle modification.
When diabetes management includes treatment with medication, the plan becomes more complex. In the past, clinicians have never had as many pharmacologic options to choose from to treat diabetes as those that are currently available. Medication choices are based upon a number of factors: the course of the disease, the effectiveness of lifestyle modification, the predicted insulin sensitivity, and the expected effect on glycosylated hemoglobin (HgbA1c) (Rodbard et al., 2009). Nurses are in an important position to assist patients with diabetes in understanding the nature of the medications prescribed.
The approach to medication management recommended by The American Association of Clinical Endocrinologists (AACE) is based in part upon the HgbA1c level at the time of presentation. Persons who present with a HgbA1c level between 7.6% and 9% are usually started on I-2 medications and lifestyle modification at the same time (Rodbard et al., 2009). The recommendation of both the ADA and the AACE is a target HgbA1c level of less than 7% in the general diabetes population and less than 6.5% in the very young or those treated early in the disease process (ADA, 2012; Rodbard et al., 2009).Treatment goals should be individualized based upon the associated risks. In the elderly or those with multiple comorbid conditions or a limited life expectancy, a goal of an HgbA1c of 7.5% may be appropriate. A key to rapid achievement of the targeted level is regular measurement of HgbA1c every 2-3 months during therapy adjustments. This schedule ensures timely evaluation of the effectiveness of the regimen and reduces the risk of prolonged use of ineffective therapies (ADA, 2012).At each interval of adjustment of medications, it is important to evaluate the HgbA1c for responsiveness to...
This is a preview. Get the full text through your school or public library.