PART 3 OF 3—Click "Full Text" to view commentary from presenters on other endocrine-related topics
In July 2011, the inaugural MEDS (Metabolic and Endocrine Disease Summit) was held in Orlando, Florida. The meeting focused exclusively on diabetes, thyroid disorders, and other common endocrine-related conditions and was designed for PAs and NPs in primary care, with presentations by their counterparts in endocrinology.
In 2012, two MEDS events are planned: July 26-28 in Orlando and August 9-11 in San Diego. Save the dates and keep checking www.MEDSummit.qhc.com for more information. In the meantime, read on for a recap of some of the presentations from the first MEDS, in the faculty’s own words.
Scott Urquhart, PA-C, DFAAPA
It’s been an absolute honor to put this meeting together and to work with an amazing group of colleagues who are not only experts in their field but really wonderful clinicians with great clinical experience. And then to have the opportunity to work with Quadrant HealthCom—they really made it possible. You know, I’m a PA with an idea and a passion for education, but I can’t make it happen without the resources of that team. And then to work with the great editorial board and staff of Clinician Reviews, helping us to really start the spark of recognition for endocrinology and for this meeting. The meeting is clearly more than I ever expected it to be. All the hard work that went into it was absolutely worth it.
The feedback that I’m receiving … it really humbles you to see how happy and respectful people are of the time we’ve put into this meeting. So the reward is really giving back to the professions, to the patients, to the recipients of the best quality care. This meeting without a doubt has definitely met that goal and surpassed my own personal goals and expectations. I was expecting a good meeting, don’t get me wrong, but to really see it come together and have the attendance be nearly double what we expected for our inaugural meeting is amazing.
Joyce Ross, MSN, RNC, CRNP, CS, FNLA, FPCNA
Dyslipidemia and Current Guidelines for Lipid Management
The major issue in really dealing with dyslipidemia is utilizing that as a way of preventing cardiovascular disease. We understand and know that if we treat people early, we can prevent cardiovascular disease. There are numerous medications that work differently in the body, but the main drug is going to be LDL-lowering. Then many times, we’ll need to combine therapies because of other dyslipidemic problems, such as high triglycerides or low HDL cholesterol. You need to categorize your medication to know what problem you have.
Looking at the guidelines and finding out what the appropriate LDL and non-HDL level is for the patient is key. Once that’s established, then you can prevent disease in those who have it and in those who don’t have it yet, you can help prevent further problems by following the guidelines that are set by the NCEP.
People fail to understand the power of lifestyle management in dealing with dyslipidemia. And of course we have to add glucose in there. Patients are not being appropriately encouraged to be a part of the treatment plans. We see the changes in the health care system, and we say that there’s going to be less time to spend with the patients and more penalties for not getting people to target. We’re going to have to learn, as health care providers, to encourage our patients, to contract with them, and to have them as part of the treatment plan.
Christine Kessler, MN, CNS, ANP, BC-ADM
Obesity: The Epidemic and Outcomes
Obesity is a national epidemic with more than 60% of the population being at least overweight and 30% being obese; that’s a big part of our practice because of the comorbidities. We hear a lot about diet—there are a lot of pros and cons with different interventions—as well as the importance of exercise. I wanted to look at the science of signaling what the language of fat is and understand also the biochemistry. We’re learning, first of all, some of the unusual things we think are actually causing the epidemic, which may not be what most providers think, but also the unique signaling of the gut in relationship to food and how different food that people take in can send different signals to the brain to help people feel full and improve satiety. This can also improve how we absorb calories in our diet. It’s also important to learn how we can adapt diet and how we eat, sequencing the food types, timing how and when we eat, and then incorporating some of the newer pharmacologic and nonpharmacologic and surgical treatments aimed at this new understanding of adiposity and obesity.
Right now, based on what we’re just starting to learn, it seems if you eat unopposed carbohydrates first, at any time, that you might then send certain chemicals from the gut to the brain that actually turn down satiety and makes, you absorb more calories. That’s why people would feel hungry about an hour after eating a high-carb meal. If you take more fiber, certainly more protein or appropriate fats, it signals totally differently and the gut sends chemicals to the brain that actually turn on satiety, turn on receptors in the brain that make you feel better. This also tells your gut to absorb less calories, and what calories do absorb are put into metabolism, not to storage—storage means fat. And one other signaling too, in timing, is to drink before or after but not during a meal. We also say you get better bang when you eat most of your calories in the morning and midday and less at night, because it signals the gut, the brain, and fat quite differently.
Rick Pope, MPAS, PA-C, DFAAPA
Osteoporosis: Overview, Workup, and Diagnosis
Over the past 10 years, there has been a significant increase in the recognition of osteoporosis and medication for it. Although we’re nowhere near where we want to be—osteoporosis remains underrecognized and undertreated—I think for this number of PAs and NPs to come together and have a two-hour discussion on osteoporosis is an important step forward.
I think the two points that I’d like to make are, particularly in regard to bisphosphonate therapy, what the problems are, specifically what is supposed to be a side effect of bisphosphonate osteonecrosis of the jaw, and the second, funny atypical fractures of the femur. We’re going to flesh both of them out so that hopefully the audience will have some degree of comfort about recommending these drugs to their patients and in particular, those patients who have significant questions about those two particular issues in regard to osteoporosis treatment.’
One of the significant risk factors for osteoporosis is diabetes type 1, and we’re in a perfect setting to flesh that out at the MEDS conference. It’s important for us, I think, to learn about new drugs that are coming down the pike. We do have a new one out in the past year called denosumab, which has a different method of action from the bisphosphonate. And in a few years, we will have other drugs that are completely unrelated to the ones we have presently, which will foster a new education about osteocyte function rather than simply osteoclast and osteoblast. Those drugs are on the horizon, and we hope to flesh those out in years to come.
Lucia Novak, MSN, ANP-BC, BC-ADM
Vitamin D Deficiency
My goal for the Vitamin D presentation was to review where we were, where we’ve come from as far as having two different sets of guidelines, and then just clinically how to address that. That’s really just trying to keep the patients safe and making sure that they’re not doing it on their own. Patients are consumers and they’re reading and they’re out there and they’re taking high doses of Vitamin D—and especially our women who we also have on calcium supplements, we’ve got to really be careful with the higher dose of calcium because it can cause stones and a lot of other problems. So it’s more about just making providers aware of what the guidelines are and making them proceed cautiously and talk with their patients to make sure that they’re not doing anything on their own without the clinician being involved.