Episode 7 - Barriers When Managing Diabetes

During this segment, Peter Salgo, MD, notes that the success rates in the management of type 2 diabetes mellitus (T2DM) are mixed: the percentage of patients achieving the target glycated hemoglobin (A1C) of less than 7% has declined, but fewer patients have an A1C greater than 9%. To help get more patients to goal, Dr Salgo leads a discussion about the variables that physicians should consider when selecting therapy for patients with T2DM.

Kari Uusinarkaus, MD, FAAFP, FNLA, explains that as new agents emerge, physicians need to consider the risks and benefits of therapy on an individualized basis. Dr Uusinarkaus states that the costs of treatment affect treatment decisions, and in practice, less expensive sulfonylureas are often used as a first-line option.

Yehuda Handelsman, MD, FACP, FACE, FNLA, notes that the use of less expensive options such as sulfonylureas is an issue, due to their lack of effectiveness over the long term.

Jeffrey D. Dunn, PharmD, MBA, discusses the challenges that affect the costs and coverage of emerging agents. Dr Dunn explains that formularies are population-centric and are based on a comparison of efficacy, safety, and cost across drugs.

Maria Lopes, MD, MS, adds that clinical inertia is a challenge. Patients are still not at A1C goal despite being treated with multiple agents. Dr Lopes suggests that a more algorithmic approach may help get patients to goal more quickly, while taking into account risks versus benefits and treatment individualization.

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