Davida F Kruger, MSN: Combination Therapy, Prediabetes

Davida Kruger, MSN, Certified Nurse Practitioner from the Henry Ford Medical Center: Whenever we can provide can provide combination therapy it's always a benefit to the patient. Diabetes is a burden we're asking them to be physically active, we're asking to follow nutritional therapy, we're asking them to check their blood glucose and then we're going to give them a host of medications and they're already being treated for hypertension, hyperlipidemia and they may have other comorbids that they're being treated and now we're saying okay we'd like you to take a few oral agents prediabetes then let me add a few injectables, and anytime I can combine them and decrease their burden and their co-pays. You know that's a real win for the patients, it really is.

I think the problem we have is that nobody is treating prediabetes. They may be recognizing and they may not be recognizing but part of the problem is we don't have medications that can take care of it except for perhaps weight reduction medications, and most insurance companies don't pay for weight loss medications and so we're really talking about weight loss and physical activity, and perhaps for some patients we might lose some metformin. So the question is how do we deal with the vast number of patients who have diabetes that we know that ultimately will go on to having diabetes and the cost and the morbidity and mortality associated with diabetes? So if we could focus on prediabetes and help those patients understand the devastations of what it would be to move on to diabetes and I'm not into to scare tactics quite honestly, but I really do think an awareness and an education to help those patients understand what we're talking about and a reality check for not only the patients but the health care providers who see overweight and obese patients and don't comfort them or have a conversation about it.

I think we need to start really talking about cardiovascular disease. I don't think we talk enough about it. I'm in a specialty problem practice, I'm in an endocrinology practice so we're looking at blood pressure, we're looking at lipids, we're looking at diabetes. That's really where our focus is and even then we miss some patients in terms of discussion of their cardiovascular risk, weight reduction, physical activity, but most importantly the use of statins. I think we really need to introduce earlier. There's a benefit to just about putting it in the water quite honestly but we really need to start talking earlier on to most patients especially if they have diabetes about cardiovascular disease, and the need for the use of statins. So I really don't think that there is magic, nomenclature that we can have with patients but an honest conversation. My conversation with my patients are your greatest risk in life is going to be cardiovascular disease and that's whether you have type 1 or type 2 diabetes. We've got the statins, we should be using them. So that's where the time should be spent with patients who have diabetes and cardiovascular-risk diseases.