Today at MEDS
Clinician Reviews and the Primary Care Metabolic Group welcomed more than 300 NPs, PAs, RNs, CDEs, and other clinicians involved in the diagnosis and management of metabolic and endocrine disorders from across the United States and abroad to the 2018 Metabolic and Endocrine Disease Summit (MEDS). This annual conference, headed by Meeting Chair Scott Urquhart, PA-C, DFAAPA, and Co-Chair Christine Kessler, MN, ANP-BC, CNS, BC-ADM, FAANP, was held August 1-4, 2018, at the Wyndham San Diego Bayside in San Diego, California, providing the opportunity for attendees to earn up to 24.25 CE/CME credits.
View summaries from the event on the following pages.
Afternoon session
Nephrology Secrets: Diabetic Kidney Disease (DKD) and Hypertension
Kim Zuber, PA-C, MS, Executive Director of the American Academy of Nephrology PAs
Zuber focused on the diabetic kidney, noting that 30 million Americans (15% of the population) have chronic kidney disease (CKD), and that many of these don’t know they have it. She talked about the effect of DM on the kidneys, the stages of CKD, and the significance of albumin and of decreasing proteinuria. Switching gears, Zuber then discussed management of patients with diabetes and hypertension, noting that patients with DM are twice as likely to die of cardiovascular disease as those without diabetes, and that CKD occurs 4 times more frequently in patients with hypertension than in those without. While disagreement about target blood pressure goals complicates treatment, she provided tips for step-wise pharmacologic management and for whether an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker should be first-line treatment.
Numb Toes and Other Woes: Diabetic Peripheral and Autonomic Neuropathies
Lucia M. Novak, MSN, ANP-BC, BC-ADM, CDTC, The Uniformed Services University of the Health Sciences
Novak emphasized that early and aggressive glucose stabilization and control is key to minimizing the neuropathic complications affecting patients with diabetes. She discussed recognizing the clinical manifestations of these underdiagnosed ailments and applying current screening recommendations so that patients receive timely care. In addition to diabetic peripheral neuropathy, she reviewed gastrointestinal and genitourinary autonomic neuropathies, including the use of flibanserin for female sexual dysfunction.
Type 2 Diabetes, Pre-Diabetes, and Reproductive Concerns
Donna Jornsay, MS, BSN, CPNP, BC-ADM, CDE, CDTC, Mills Peninsula Medical Center
Rates of childhood obesity and diabetes are rising, according to Jornsay. In the first of her afternoon sessions, she discussed screening obese children for diabetes, tests that help differentiate type 1 from type 2 DM in children, and some of the nuances of managing this population. For example, T2DM in children is not the same as type 1 or 2 in adults; youngsters are less insulin sensitive at all body mass indices. Jornsay also discussed the reproductive concerns of adults with DM, outlining the prenatal, natal, and postnatal needs of those with type 1 and type 2 diabetes, as well as the neonatal and childhood risks for offspring of those with DM.
Adult Onset Diabetes: Which Type is it?
Ji Hyun (CJ) Chun, PA-C, MPAS, BS-ADM, President, American Society of Endocrine PAs
When signs and symptoms of diabetes beset an adult, how do you know if it’s type 1, type 2, or something else? Chun answered this question through the use of case studies. He reminded that latent autoimmune diabetes in adults (aka type 1.5 or noninsulin-requiring autoimmune diabetes) tends to occur in people who have a personal or family history of autoimmune disease and tends to have a later onset and faster progression to insulin dependence. Secondary diabetes, like type 1, is responsible for about 5% of diabetes diagnoses. Monogenic diabetes, which is often incorrectly diagnosed as type 1 or 2, represents 1% to 2% of DM diagnoses. Chun mentioned that it often takes up to 10 years for a correct diagnosis of monogenic diabetes to be made.
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