Insurance Companies Switching Medicine

One very prevalent issue that has more than doubled since the 1980’s and is growing rapidly is diabetes. In fact, “diabetes prevalence is particularly high among people age sixty-five and older, and it doubled among Medicare beneficiaries between 1987 and 2008, rising from 11.3 percent to 22.6 percent” (Thorpe, 2012, p. 61). The ACA granted the Centers for Disease Control and Prevention

The study showed that the benefits of glucose reduction did not accrue for several years, and despite achieving statistical significance, the absolute risk reduction from intensive glycaemic control was small, with a reduction of 5 events over 10 years, and a small differential HbA1c between the conventional and intensive groups. Furthermore, due to the progressive nature of the disease, increasing combinations of oral and insulin drug therapy were introduced over to time to maintain the tight glycaemic control, therefore providing greater variability and a limited scope of comparison for statistical data on the efficacy of individual agents used amongst the patient cohorts.(King, Peacock, and Donnelly, 1999). This has raised further questions for clinicians in assessing how worthwhile are the benefits achieved with tighter glycaemic control, and how can targets be achieved in routine practice? It is not always clinically acceptable to maintain intensive glycaemic control, for example with the frail and elderly, or those with existing severe co-morbidities or complications. The Diabetes Control and Complications Trial follow up study reported that patients who achieved an average HbA1c value of 53mmol/mol had better outcomes after 20 years of follow-up than the control group (who had an average HbA1c of 75 mmol/mol), irrespective of

Diabetes can be treated in three basic ways: by diet, by diet in conjunction with tablets, or diet in conjunction with insulin. Diet serves as an initial control for non-urgent patients. If a person’s diet will have a major effect on glycaemic control, it does so reasonably quickly, within a few weeks of changing

Diabetes is a disease where the body is unable to produce or use insulin effectively. Insulin is needed for proper storage and use of carbohydrates. Without it, blood sugar levels can become too high or too low, resulting in a diabetic emergency. It affects about 7.8% of the population. The incidence of diabetes is known to increase with age. It’s the leading cause of end-stage renal disease in the US, and is the primary cause of blindness and foot and leg amputation. It is known to cause neuropathy in up to 70% of diabetic patients. Individuals with diabetes are twice as likely to develop cardiovascular disease. There are two types of diabetes: Type 1 and Type 2.

The American Diabetes Association (2004) defines diabetes as a subset of metabolic diseases associated with hyperglycemia secondary to insulin failing to release, act, or both. Complications related to chronic diabetes can be detrimental to one’s health including but not limited to: heart disease, stroke, kidney disease, amputations, blindness, and other optical diseases. Furthermore, the prevalence of diabetes is rising at an astronomical rate within the United States as well as internationally. According to the Center for Disease Control and Prevention (CDC) (2016) an estimated 29 million people suffer with diabetes and 86 million are prediabetic within the United States (US). Without major interventions from the healthcare community,

Diabetes is a growing concern and health challenge for the American people (b). Diabetes is a condition in which the body cannot react to insulin appropriately or either cannot produce insulin efficiently (w). “Without a properly functioning insulin signaling system, blood glucose levels become elevated and other metabolic abnormalities occur, leading to the development of serious, disabling complications” (w). There are numerous forms of diabetes amongst the nation, however, there are three main forms of diabetes. Most people have heard of type one diabetes, type two diabetes, and gestational diabetes because they are common. Type two diabetes deals with a resistance to insulin, while

A restriction on coverage may be added to a drug or removed if it is already restricted.

Glyburide is another generic medication used in the management of diabetes mellitus type 2. Two trade names of this drug are DiaBeta and Glynase. The chemical name is 1-[ [p-[2-(5-chloro-o-anisamido) ethyl]phenyl]-sulfonyl]-3-cyclohexylurea. Doses up to 0.75-12 mg/day can be given as a single dose or divided doses. The circulation of the glyburide is that protein binding is extensive and half-life is 10 hours. It is excreted through the renal and biliary system. Glyburide acts as an oral blood glucose lowering drug. The drugs uses include binding and activating the sulfonylurea receptor 1, which causes depolarization. This results in an increase in intracellular calcium in the cells and stimulation of insulin release. Major drug interactions are noted between glyburide and

now become one of the leading causes of death among Americans. According to the American

with diagnosed diabetes accounts for more than 1 in 5 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes.

The evidence-based practice should be the force behind changes in medical and nursing practice especially when it is advantageous to patient's health. Moreover, this principle should always be the first requirement despite the financial hurdles we face these days. With that in mind, one of the obstacles which we are trying to overcome in my department is for the leaders to realize that treating diabetic patients with GLP-1 drugs has been proven to be cost-effective while providing greatest HbA1c and weight reductions comparing to other hypoglycemic agents ( ). Besides, those patients would ultimately have higher life expectancy and less microvascular and macrovascular complications leading to considerably improved lifestyle. Although our case

There is growing concern that intense glucose lowering or the use of certain agents may be associated with adverse cardiovascular outcomes.

Non-diabetic volunteers (age 38±2 yrs, BMI 26±1kg/m2) were studied in a single-blind fashion during separate 2 day randomized protocols consisting of 2 hr hyperinsulinemic (9pmol/kg/min) euglycemic (4.9±0.1mmol) and hypoglycemic (2.9±0.1mmol/L) clamps. Individuals received biologically equivalent doses of glimepiride (4mg) or glyburide (10mg) 1 hr prior to each glucose clamp (n=11) as well as a control group of placebo studies. Glucose kinetics were calculated using D-Glucose-6-6d2. this study has investigated the acute physiologic in-vivo differences of glimepiride and glyburide in healthy individuals. During hypoglycemia glyburide increased insulin levels, but resulted in decreased glucagon, decreased combined epinephrine and

Again, to be consistent with earlier works, the subjects recruited will be patients who were diagnosed a minimum of six months prior and whose condition is well-controlled.1,3 The definition of well-controlled in the existing literature is not consistent. For the purposes here, it will include subjects who are currently using dietary and lifestyle measures to manage their disease, either alone or in combination with low-dose oral medications. Medication type or dosage will not have changed in the three months prior to recruitment. Subjects will be excluded if they are currently pregnant or trying to conceive, if they are taking medication known to affect glucose metabolism, that was prescribed for purposes other than the treatment of their diabets2,3

Diabetes is a systemic disease caused by a decrease in the secretion of insulin or reduced sensitivity or responsiveness to insulin by target tissue. (Beale, et al., 2011) The incidence of diabetes is growing rapidly in the United States and worldwide. An estimated 347 million people around the world are afflicted with diabetes. (Whalen, et al., 2012) According to World Health Organization (WHO), Diabetes prevalence among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014. It is the major cause of blindness, kidney failure, heart attack, stroke and limbic amputation. World Health Organization (WHO) projects that diabetes will be the 7th leading cause of death in 2030. It is a complex and costly disease that can affect nearly every organ in the body and result in devastating consequences. The leading cause of non-traumatic lower extremity amputations, renal failure, and blindness in working-age adults, diabetes is also a major cause of premature mortality, stroke, cardiovascular disease, peripheral vascular disease, congenital malformations, perinatal mortality, and disability. (Cefalu, 2000) Insulin therapy and oral hypoglycemic agents have demonstrated improvement in glycaemic control. However, Insulin therapy has some disadvantages such as ineffectiveness following oral administration, short shelf life, of the need for constant refrigeration, and fatal hypoglycaemia, in the event of excess dosage.