Diabetes Series

Click on a question to view poll results

Of the following clinical scenarios, which do you find most challenging to manage?
Results from 103 respondents:

Transitioning patient on multiple oral medications and basal insulin to a basal/bolus regimen
22.3%

Making insulin dosing adjustments based on BG readings
5.8%

Managing the patient with labile BG readings
30.1%

Analyzing low BG readings
1.9%

Evaluating cause of high morning blood glucoses
3.9%

Prescribing and adjusting meal doses of insulin
4.9%

Explaining carb counting
27.2%

Prescribing and adjusting correction doses of insulin
3.9%

When starting a basal/bolus insulin regimen, which of the following is the primary concern voiced by patients in your practice?
Results from 103 respondents:

Concern that their disease has worsened
14.6%

Hassle and pain of injections
37.9%

Hassle and need for frequent glucose monitoring
14.6%

Greater loss of freedom to "eat and do what they want"
2.9%

Fear of complications, particularly loss of limb
5.8%

Potential loss of employment (i.e., truck drivers cannot drive and take insulin)
4.9%

Weight gain
6.8%

Fear of hypoglycemia
6.8%

Disappointment/feelings of failure
5.8%

What is the glucose target for a patient with type 2 diabetes admitted to the ICU with pneumonia?
Results from 219 respondents:

<90 mg/dL
11.9%

<110 mg/dL
32.4%

110-140 mg/dL
47.5%

140-180 mg/dL
8.2%

A 48-year-old male patient with a 5-year history of type 2 DM currently on metformin (1000 mg bid) and pioglitazone (45 mg/day) presents complaining of some burning sensation in both feet. His A1C is 11.5.

What would be your next step with regard to his diabetes management?
Results from 113 respondents:

Add a sulfonylurea
4.4%

Add an incretin agent mimetic
2.7%

Add a secretagogue
2.7%

Add basal insulin
78.8%

Add basal insulin plus a secretagogue
11.5%

If you were to start a medication for the neuropathy, which one of the following would you select?
Results from 114 respondents:

Tricyclic antidepressant
13.2%

Gabapentin
67.5%

Pregabalin
11.4%

Duloxetine
7.9%

An 18-year-old male presents with polyuria, polydipsia, weight loss and blood glucose readings of 280-400 mg/dL.

What initial treatment regimen do you prescribe?
Results from 102 respondents:

Lifestyle modification
15.7%

Metformin
43.1%

Metformin plus glipizide
17.6%

Metformin plus glipizide plus glargine
23.5%

Do you routinely advise your patients with type 2 diabetes to monitor their blood glucose?
Results from 116 respondents:

Yes, I advise my patients to test once daily.
43.1%

Yes, I advise my patients to test twice daily at set times.
17.2%

Yes, I advise my patients to test twice daily at varying times.
19.0%

Yes, I advise my patients to test multiple times daily.
6.0%

No, I do not routinely provide advice regarding blood glucose monitoring.
14.7%

Case Profile: 55 y.o. man is diagnosed with diabetes; initial labs are glucose = 225 mg/dL and A1C = 8.6%.

How would you approach treatment in this patient?
Results from 80 respondents:

Lifestyle modification alone for 3–6 months
10.0%

Lifestyle modification and metformin
82.5%

Lifestyle modification and a sulfonylurea
2.5%

Lifestyle modification and insulin
5.0%

The patient is on glyburide and metformin and his A1c is 9.2%.

What treatment would you recommend next?
Results from 80 respondents:

Pioglitazone
28.8%

Sitagliptin
10.0%

Long-acting insulin 10 units q hs; follow-up visit for insulin adjustment in 1 month
12.5%

Long-acting insulin 10 units q hs to be increased by 2 units every 3 days as long as fasting glucose tests are above 130
48.8%

Case Profile: 37 y.o. man with sedentary lifestyle presents for a routine annual physical exam:
  • Past medical and family history: Negative
  • Physical exam: No abnormality detected
  • Height: 5 ft 8 in; Weight: 180 lbs
  • BP: 128/76
  • Lungs: Clear
  • CV: Regular rate and rhythm
Based on American Diabetes Society recommendations, how would you proceed with this patient?
Results from 104 respondents:

Screen now with a fasting blood glucose
66.3%

Screen when he is 40 with a fasting blood glucose
10.6%

Screen when he is 45 with a fasting blood glucose
11.5%

Screen at any of the above ages using A1c
11.5%

 

 

 

 

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