Non-"diabetes", diabetes medications
Updated: Mar 19, 2020
Diabetes is a BEAST of a disease mostly because it is primarily managed by the patient. That means YOU. As you may be able to tell, I encourage all PWD to be active members of their health care team. WE are in charge of our own health. WE are the team captains and we must be able to ask the “why” questions! Medication compliance is the key to a healthy life with diabetes and compliance tends to improve if the reason for the medication is understood. All it takes is a little patient-provider communication. Why do we take insulin? We’ll that’s obvious, but what about the other many meds that are prescribed for us? Why do we need those? For instance, many PWD are taking an ACE-inhibitor (lisinopril, captopril, enalapril). This medication is commonly used for blood pressure control, but in normotensive PWD, a small dose of an ACE-I can act as a kidney protector! Pretty cool right?
This benefit can be demonstrated early in kidney disease when microalbuminuria (tiny amounts of protein in the urine) is the only manifestation. Studies have shown that not only can an ACE-I decrease microalbuminuria, but after 2-years, it can prevent progression to overt kidney disease. An additional 4-year study demonstrated that the initiation of an ACE-I in patients with current CKD can prevent progression to end-stage renal disease. The benefits of this therapy have been shown in both normotensive and hypertensive PWD making an ACE-I the perfect therapy for hypertension in a PWD. Additionally, a baby Aspirin (81mg) is recommended for secondary prevention in PWD and a history of MI, stroke, or peripheral vascular disease. It is also recommended for primary prevention in PWD with at least one cardiovascular risk factor (hypertension, tobacco use, hyperlipidemia, albuminuria, obesity, family history of CVD). Why do we take statins? High cholesterol is diagnosed in >50% of PWD at their time of diagnosis. In the general population, the reduction of LDL cholesterol has been shown to significantly decrease the risk of cardiovascular disease, especially heart attacks. Because PWD are at a much higher risk for cardiovascular disease, statin therapy is recommended not only based on LDL, but also based on cardiovascular risk factors (in addition to lifestyle changes, of course). The need for statin therapy is obvious in PWD who have already been diagnosed with CVD, but interestingly, it is also recommended in diabetics >40 years old regardless of lipid profile levels. I hope this helps give a little clarity as to why clinicians are asking for compliance with these meds. If you have any questions, feel free to ask.
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