A Conversation on an Effective, Straightforward, Quantitative Approach to the Outpatient Use of Insulin

2022 ◽  
Author(s):  
Mayer B. Davidson
Keyword(s):  
Primary Care ◽  
Human Insulin ◽  
Primary Care Providers ◽  
Quantitative Approach ◽  
Insulin Regimen ◽  
Maximal Effect ◽  
Care Providers ◽  
Injection Regimen ◽  
Straightforward Approach

For primary care providers, using insulin can present challenges that can be met by a straightforward approach using the following principles. Depending on when it is injected, each component of the insulin regimen has a maximal effect on a specific period of the 24-hour cycle (e.g., overnight, morning, afternoon, or evening). The glucose pattern in that period determines whether the dose of that component of the insulin regimen requires adjusting. Regarding which insulin types and insulin regimens to use, human insulin (NPH and regular) is as effective as analog insulins, and a two-injection intensified insulin regimen is as effective as a four-injection regimen.

scholarly journals Use of Computerized Insulin Dose Adjustment Algorithms to Facilitate Adjusting Insulin Doses by Primary Care Providers

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Mayer Davidson ◽  
S. Davidson
Keyword(s):  
Primary Care ◽  
Dose Adjustment ◽  
Insulin Dose ◽  
Glucose Monitoring ◽  
Primary Care Providers ◽  
Insulin Regimen ◽  
Care Providers ◽  
Baseline Hba1c ◽  
Hba1c Levels ◽  
Clinic Visits

Insulin use is challenging for both primary care providers (PCPs) and patients. For PCPs, a major challenge is time constraints, and for many, inexperience. For patients, it is providing enough fingerstick glucose readings for insulin dose adjustments to be made. The first author has developed algorithms for adjusting insulin doses based on the following principles. Depending on when injected, each component of the insulin regimen has a maximal effect on a specific period of the 24-hour cycle, e.g., overnight, morning, afternoon, evening. The glucose pattern in that period determines whether the dose of that component of the insulin regimen requires adjusting or not. There needs to be enough glucose readings in a period that reflects a patient’s current lifestyle for a decision to be made about that component of the insulin regimen that maximally affects that period. A registered nurse using these algorithms at clinic visits lowered HbA1c levels in 111 poorly controlled insulin-requiring patients from 11.0% to 7.2% within 9-12 months. When computerized, these FDA-cleared algorithms produce a report within 15 seconds after glucose meters are downloaded with recommendations for insulin dose adjustments that the PCP can modify or accept. In a pilot project utilizing these computerized algorithms in poorly controlled insulin-requiring patients who performed remote glucose monitoring, baseline HbA1c levels decreased from 10.0% to 8.1% in 3 months and to 7.6% in 6 months without any clinic visits for adjustment of insulin doses. In a proof-of-concept project utilizing these computerized algorithms in poorly controlled insulin-requiring patients using continuous glucose monitoring (CGM), baseline HbA1c levels decreased from 11.5% to 8.3% over a mean of 3 months. Computerized insulin dose adjustment algorithms and CGM meet both the PCP and patient challenges. These innovations should be strongly considered to effectively decrease HbA1c levels, especially in poorly controlled patients.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

The Bridge Program: A Model for Delivering Mental Health Services to Asian Americans through Primary Care

2005 ◽  
Vol 3 (1) ◽  
pp. 13-29 ◽  
Author(s):  
Hongtu Chen ◽  
Elizabeth Kramer ◽  
Teddy Chen ◽  
Jianping Chen ◽  
Henry Chung
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Asian Americans ◽  
Mental Health Professionals ◽  
Primary Care Providers ◽  
Care Providers ◽  
Bridge Program ◽  
Community Awareness

Compared to all other racial and ethnic groups, Asian Americans have the lowest utilization of mental health services. Contributing factors include extremely low community awareness about mental health, a lack of culturally competent Asian American mental health professionals, and severe stigma associated with mental illness. This manuscript describes an innovative program that bridges the gap between primary care and mental health services. The Bridge Program, cited in the supplement to the Surgeon’s General’s Report on Mental Health: Culture, Race, and Ethnicity as a model for delivery of mental health services through primary care; (2) to improve capacity by enhancing the skills of primary care providers to identify and treat mental disorders commonly seen in primary care; and (3) to raise community awareness by providing health education on mental health and illness. Results are presented and the potential for replication is addressed.

scholarly journals How Primary Care Providers Talk to Patients About Alcohol.

2006 ◽  
Vol 0 (0) ◽  
pp. 060721075157048-??? ◽  
Author(s):  
Kinsey A. McCormick ◽  
Nancy E. Cochran ◽  
Anthony L. Back ◽  
Joseph O. Merrill ◽  
Emily C. Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Care Providers
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