Latest Conference Articles

Highlights from American Diabetes Associations (ADA) which took place on June 21-25, 2013, in Chicago, IL, are available in a newsletter published by The American Journal of Managed Care.

Rodney Hayward, MD, and Sheldon Greenfield, MD, discussed the benefits of quality care measures and explored some of the remaining areas for improvement. Some groups advocate for the use of composite quality care measures that reflect treatment guidelines and suggest that the same targets not be applied to all patients.

Glucagon-like peptide-1 (GLP-1) agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors are associated with additional effects beyond prolonging the effect of incretins. Laurie Baggio, PhD, reviewed many of the studies showing the independent anti-inflammatory effects of these drugs, which may be explored for future indications. These effects may help scientists understand some of the mechanisms behind inflammation in the body, as explained by Julio Ayala, PhD. Finally, concerns about pancreatitis with DPP-4 inhibitors and GLP-1 agonists may be largely unfounded, as explained by Vanita Aroda, MD.

In this session, Robert Eckel, MD, discussed new and emerging therapies for obesity. New agents fill a therapeutic gap by allowing patients to achieve weight loss between 5% and 15% of body weight, leading to improved outcomes in patients with type 2 diabetes and metabolic disease.

Ronald J. Sigal, MD, MPH, a professor of medicine, cardiac sciences, kinesiology, and community health sciences at the University of Calgary in Canada, and a Health Senior Scholar at the Alberta Heritage Foundation for Medical Research, pulls from his experience to discuss the reality of the current expectations and goals for exercise and physical activity in the overweight or obese patient with diabetes, and offers his solutions.

Philip R. Schauer, MD, the director of the Bariatric and Metabolic Institute (BMI) at the Cleveland Clinic in Ohio contends that accountable care organizations (ACOs) need to recognize obesity as a legitimate disease that is the basis for many other serious conditions. He emphasizes that obesity certainly requires treatment, and surgery is an appropriate intervention for certain patients.

Carl Dean Benton, RPh, explains how pharmacists can contribute to improvements in patient care through counseling programs. With the provisions of the Affordable Care Act, many insurers may begin to recognize the benefits of pharmacist-driven counseling initiatives, and integrate these programs to help improve outcomes for patients with type 2 diabetes.

Todd Brusko, PhD, of the Todd M. Brusko Laboratory at the University of Florida College of Medicine, discussed how knowledge of regulatory T-cells has grown and improved, and noted that research has now entered a phase of harnessing the potential of our immune system through specific cell populations to combat root causes of type 1 diabetes (T1DM).

Allan Geliebter, PhD, the senior research scientist in the Department of Psychiatry at Columbia University and a professor of psychology at Touro College explains the roles of various hormones in appetite stimulation and suppression, and discusses how functional MRI of the brain may demonstrate a relationship between bariatric surgery in obese patients, neurological response, and hormone regulation.

Jaakko Tuomilehto, MD, PhD, a professor of public health at the University of Helsinki in Finland provides global epidemiological data for T1DM and discusses the World Health Organization's Diabetes Mondiale (DiaMond) study. He compares the rates of incidences of T1DM among well-developed, high-income countries to low- and middle-income nations and takes note of the epidemiological trends.

In light of ongoing healthcare reform in the US, Sheldon Greenfield, MD, the executive co-director of the Health Policy Research Institute and Donald Bren Professor of Medicine at the University of California Irvine School of Medicine, shared his insights on the role of quality care measures in the management of diabetes, and weighed in on the advantages and disadvantages associated with implementing these tools.

Accounting for what is known about the association between diabetes and low testosterone in men, Rita Basu, MD, a professor of medicine at the Mayo Clinic in Rochester, MN provides her insights on the role of testosterone supplementation in men with diabetes, and notes how clinical and managed care perspectives are integrated in practice.

Cost-effectiveness analyses (CEAs) have real effects on therapeutic approaches for patients with type 2 diabetes mellitus (T2DM). Dr. Gilmer discusses how studies like the United Kingdom Prospective Diabetes Study (UKPDS) and the Diabetes Prevention Program (DPP) have affected how researchers and scientists evaluate the benefits of new treatments.

Sandeep Dhindsa, MD, an associate professor of medicine at the University of Buffalo School of Medicine and Biomedical Sciences discusses the relationship between diabetes and low testosterone in men, and also notes the significance of accounting for BMI and obesity.

Dr Andrew J. Palmer describes the costs of type 2 diabetes (T2DM) in the United States and worldwide. He also explains the importance of choosing treatments that are cost-effective and cost-saving for patients.

Jaakko Tuomilehto, MD, PhD, a professor of public het the University of Helsinki in Finland explains the association between a country's socioeconomic status and its epidemiology of type 1 diabetes (T1DM), shedding light on the various circumstances and factors that may contribute to the differences we see among other nations.

In this session, Daniel Picchietti, MD, discussed changes to the diagnostic guidelines for restless legs syndrome/Willis-Ekbom disease published jointly by the International Restless Legs Syndrome Study Group and the National Institutes of Health.

In this session, Stephany Fulda, PhD, discussed the common causes of restless leg syndrome (RLS), considerations for the clinical application of treatment strategies for RLS, and changes to treatment guidelines for RLS that may be on the horizon.

Type 2 diabetes is a multifactorial condition that requires optimization of glycemic control as well as cardiovascular care. This presentation highlighted key aspects of the 2013 American Diabetes Association Standards of Medical Care to provide guidance on managing insulin therapy and to help clinicians optimize cardiovascular care in adult patients with diabetes.

The US healthcare system is in need of transformation. The United States spends more than any other industrial country on healthcare, yet regardless of demographics, life expectancy is shorter and the US population is less healthy compared with populations in other countries. Collaborative efforts and a focus on the Triple Aim will be key in improving the quality and cost-effectiveness of healthcare.

The PILL Service is a care transition program designed to support older adults with cognitive impairment and help them maintain independent function. This program, which has resulted in improved clinical and economic outcomes, is characterized by a team effort focusing on proactive medication review and patient-centered medication reconciliation.

Safe use of prescription drugs continues to be a key topic for discussion and education. As part of the 2013 Medication Safety Collaborative, this presentation provided a federal-, state-, and local-level overview of ways healthcare providers (physicians, prescribers, nurses, pharmacists) and individuals can take part in contributing to solutions.

Judy Murphy, RN, the deputy national coordinator for programs and policy in the Office of the National Coordinator for Health IT in Washington, DC, updated participants regarding the efforts under way under the Health Information Technology for Economic and Clinical Health (HITECH) Act to promote improvement in the quality of healthcare through health information technology.

Increasing numbers of patients are using the emergency department (ED) for acute healthcare needs. Infectious diseases such as urinary tract infections and skin and soft tissue infections (cellulitis) rank among the top diagnoses made in the ED. While empiric treatment of these infections is common, it is critical that results and susceptibilities are reviewed to ensure appropriate therapy. Pharmacists are in a unique position to lend expertise in this area to improve outcomes and reduce readmissions.

Dr Thomas Roth, PhD, presented on the evolution of our understanding of insomnia, and the importance of insomnia in the context of other disease states. Roth noted that insomnia is primarily a disorder of increased wakefulness from a pathophysiologic standpoint, and presented data to support this. Presenting the effect of improved sleep on diseases such as depression, worker productivity, and cardiovascular disease, Roth revealed rich prospects for the future of sleep medicine in treating a variety of disorders.

In this video, Phyllis Zee, MD, Associate Director, Center for Sleep & Circadian Biology, discusses the relationship between circadian disruption and metabolic disease.

In this video, Denise Sharon, MD, PhD, Clinical Director and Founding Partner, Comprehensive Sleep Medicine Center of the Gulf Coast, discusses how insurers have responded to the availability of therapies and changes in clinical practice guidelines for RLS.

In a session on the neurobiology of sleep loss in humans, Andrea Spaeth, Daniel Aeschbach, PhD, and Clare Anderson, PhD, presented findings about the effects of sleep deprivation on various biological measures in humans.