Medical Management Of Diabetes Research Articles

Assessment of prevalence and need for screening of diabetic retinopathy using non-mydriatic fundus camera in rural and tribal diabetic populations in Maharashtra.

To assess the prevalence of DR and the need for screening and management of DR with medical management of diabetes in rural and tribal population in Maharashtra. The known diabetics of rural area and tribal area were screened at corresponding primary health centers, subcenters, and village level with the help of local healthcare workers using a portable non-mydriatic fundus camera. The prevalence of blindness among known diabetics in rural area was 1.29%, and 0.84% in tribal area. In the rural area, the prevalence of diabetic retinopathy (DR) was 5.67% (n = 776), out of those 18.18% had sight threatening diabetic retinopathy (STDR). The prevalence of DR was 7.73% (n = 711) in tribal areas, out of those, 30.90% had STDR. The significant risk factors were identified to be the duration of diabetes and poor glycemic control. Implementation of targeted interventions for screening and management are required to reduce the risk of blindness among known diabetics in rural and tribal areas.

Effectiveness of a pharmacist-led, community group-based education programme in enhancing diabetes management: A multicentre randomised control trial

AimsThis study presents a protocol for the Pharmacy Integrated Community Care (PICC) program, meticulously designed to enhance Hemoglobin A1c (HbA1c) levels and augment knowledge about diabetes mellitus (DM) among individuals diagnosed with Type 2 Diabetes Mellitus (T2DM) in the Sarawak State of Malaysia. MethodsFrom 1 May to December 31, 2023, a prospective, multicenter, parallel-design randomised controlled trial will be conducted with two groups, each consisting of 47 participants. The intervention group will receive a structured, four-session group-based program guided by experienced pharmacists, focusing on medication adherence and diabetes management. The control group will follow the standard Diabetes Mellitus Adherence Clinic program. The primary outcomes of this study encompass enhancements in knowledge regarding diabetes medication management and adherence, followed by subsequent changes in HbA1c levels. ConclusionsThe successful implementation of the PICC program holds promise for enhancing health outcomes in the T2DM population, potentially leading to more effective diabetes management initiatives and better health practices in the community. Trial registration clinicaltrials.gov identifierNCT05106231.

Short-term multifactorial intervention (STEMI): An approach using structured blood glucose monitoring (BGM) and conventional therapies in persons with diabetes

ABSTRACT Background: Achieving glucose and glycosylated hemoglobin (HbA1c) targets have been shown to reduce long-term microvascular complications of diabetes; however, suboptimal glucose control is common. We tested whether glucose control could be improved within 8 weeks by employing structured blood glucose monitoring (BGM) qid in addition to seven times per day prior to visits for diabetes education and medication management that occurred every 2–4 weeks. Methods: This single-center, prospective study was conducted on 78 adults with either type 1 diabetes (T1D) or type 2 diabetes (T2D), HbA1c >8%, and serum creatinine (sCr) <2.0 mg/dl. HbA1c was checked at baseline, Week 2, Week 4, and at Week 8. Patients were evaluated by a physician and a certified diabetes educator (CDE) at baseline, Week 2, and Week 4 for treatment adjustments and lifestyle advice based on a review of BGM done qid plus 7-point profiles conducted before Weeks 2, 4, and 8. Study outcomes were change in HbA1c from baseline to Week 8 and change in mean glucose on the 7-point profile from Week 2 to Week 8. These were compared using one-way repeated measures ANOVA. Results: Of the 78 patients, 64.1% had T2D, 50% were women, and 72% were Caucasian. Mean age (±SD) was 51.3.5 ± 11.1 years, and median diabetes duration was 9 (5–17) years. The percentage of patients using insulin increased from 58.9% at baseline to 67.9% at Week 8. The mean (±SD) HbA1c was 9.53% (±1.71) at baseline, declined -1.38% from baseline to week 8 (CI -1.62 to -0.14, P < 0.001). The mean (±SD) glucose on the 7-point profile was 187 (±52) mg/dl at Week 2, and 157 (±5) mg/dl at Week 8. (P < 0.01). Conclusions: An intensive glucose optimization program using structured BGM qid plus 7-point profiles, diabetes education, and conventional anti-diabetic therapies was successful in reducing HbA1c by 1.38% over 8 weeks in patients with poor glucose control.

Optimal Management of Insulin in Patients Undergoing 18F-Fluorodeoxyglucose Positron Emission Tomography Scans

ObjectiveThe management of insulin injections and insulin pumps before 18F-fluorodeoxyglucose-positron emission tomography integrated computerized tomography (FDG-PET/CT) scans is an important area to investigate given the rising rate of diabetes, the significant association between diabetes and cancer, and the complex relationship among glucose, insulin, and FDG tumor uptake. The purpose of this study was to determine the recommendations around subcutaneous insulin administration, insulin pumps, and hybrid closed-loop systems before FDG-PET scans. MethodsWe examined the websites of 100 hospitals selected from the 2022 US News and World Report top cancer hospitals for specific strategies around diabetes medication management before FDG-PET/CT scans. ResultsOf the 100 hospital websites, 61 had instructions addressing patients with diabetes. Of the 61 hospitals, 47.5% (n = 29) referred patients to their provider for further instructions, 18% (n = 11) referred patients to their own internal radiology department for further instructions, 16.4% (n = 10) had instructions on oral diabetic medications, 23% (n = 14) had instructions on insulin, and 3.3% (n = 2) had instructions on insulin pump management. Most commonly, instructions were to stop insulin 3 to 4 hours before the study and direct patients to their referring provider for more detailed instructions (n = 7). ConclusionThere is a lack of guidance and consensus among US cancer hospitals on managing insulin and continuous subcutaneous insulin infusions before FDG-PET/CT studies and a majority rely on referring providers to advise patients. However, society guidelines offer inconsistent recommendations and little research has been carried out to help guide referring providers. A multidisciplinary panel of specialists could help to guide practitioners on optimal management.

A descriptive analysis of primary care providers' interest in clinical pharmacy services

BackgroundVarious clinical pharmacy services exist to improve the health outcomes of patients. However, there are numerous barriers to their implementation and execution, especially in outpatient settings. As pharmacists design and implement clinical pharmacy services in outpatient settings, they often do not consider the needs of providers until after service development. ObjectivesThe purpose of this study was to assess primary care providers' (PCPs') perceptions of clinical pharmacy services and their clinical pharmacy support needs. MethodsA web-based survey was distributed via email to PCPs across North Carolina (NC). Survey dissemination was completed in two phases. Data analysis consisted of mixed methods – quantitative and qualitative. Descriptive statistics were used to analyze demographic differences within each phase as well as the ranking of medication classes/disease states by providers. Qualitative data analysis through inductive coding was done to assess provider perceptions of clinical pharmacy services. ResultsThe response rate of the survey was 19.7%. Providers with previous experience with a clinical pharmacist rated overall services as positive. 62.9% of PCPs (N = 80) provided their perception of the positive attributes (pros) of clinical pharmacy services. 53.5% of PCPs (N = 68) provided their perception of the negative attributes (cons) of clinical pharmacy services. The top three medication classes/disease states that providers indicated they would value clinical pharmacy services for were: comprehensive medication management (CMM), diabetes medication management, and anticoagulation medication management. Of the remaining areas assessed, statin and steroid management ranked the lowest. ConclusionsThe results from this study demonstrated that clinical pharmacy services are valued by PCPs. They also highlighted how pharmacists can best contribute to collaborative care in outpatient settings. As pharmacists, we should aim to implement the clinical pharmacy services that PCPs would value most.

PSUN172 Prescribing SGLT-2 Inhibitors and GLP-1 Agonists in Primary Care: Improving Rates of Guideline-Concordant Practice

Abstract Background In practice, prescribing of a GLP-1 agonist (GLP-1a) or SGLT-2 inhibitor (SGLT-2i) for patients with type 2 diabetes mellitus (T2DM) and multiple risk factors for atherosclerotic cardiovascular disease (ASCVD) may be lagging behind the guidelines that recommend it. We aim to increase the prescribing rates of GLP-1as and SGLT-2is in a primary care resident clinic. Methods Eligible patients included adults with T2DM in an internal medicine primary care resident practice at the University of Vermont who were not already taking a SGLT-2i or GLP-1a. These patients were offered a diabetes medication management (DMM) visit with their PCP. The residents participated in a 30-minute educational intervention on: prescribing guidelines, medication risks and side effects, counseling patients, dose titration, and current Medicaid and Medicare insurance coverage estimates. This information was summarized in two tables that were included in a templated progress note to be used for DMM visits. DMM visits took place over a six month period. Chart review was conducted to determine patient co-morbidities and outcomes of the initial and follow-up DMM visits. Additional data was gathered from a post-visit survey completed by resident PCPs. Data was analyzed using descriptive methods. Results One hundred sixteen patients with T2DM were eligible. Sixty-five patients either declined, could not be reached, or did not present for their scheduled appointment. Fifty-one patients (44% of those eligible) completed a DMM visit. Of these 51, 18 (35%) were started on a SGLT-2i, either at the initial visit or at a follow-up visit. A GLP-1a was started for 14 (27%) patients. Nearly all who completed a DMM visit had at least one risk factor for ASCVD, and most had multiple risk factors. Problem lists for these patients showed that 40 (78%) had hypertension, 33 (65%) had hyperlipidemia, 12 (24%) had coronary artery disease, and 5 (10%) were current smokers. Two (4%) had a diagnosis of CHF, and 12 (24%) had CKD. Forty (out of 46) (87%) survey respondents reported that they were "more likely" to prescribe SGLT-2is and GLP-1as after participating in the intervention. The two most common reasons that these medications were not prescribed were the presence of competing visit priorities and co-management of diabetes medications by an endocrinologist. Conclusions Most patients with T2DM also have risk factors for ASCVD and would benefit from a GLP-1a or SGLT-2i. Prescriber education is an effective way to expand prescribing of these medications. Primary care providers are well-positioned to consider patients’ cardiovascular co-morbidities when prescribing diabetes medications, but may also be burdened by other visit priorities taking precedence. This study highlights the importance of a team-based approach to diabetes management and demonstrates a role for enhanced communication between primary care and specialties such as endocrinology and cardiology. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

1115-P: Does Spouse’s Diabetes Status Impact the Diabetes Care Cascade? A National Study of Couples in India

Background: Diabetes detection and treatment in married couples presents opportunities for designing dyadic interventions to improve screening and management. Methods: Using data from 59237 heterosexual married couples (women: 18-49y, men: 21-54y) assessed in India’s National Family Health Survey (2015-16) , we estimated the diabetes care cascade as the percent diagnosed, treated, and controlled with measured high blood glucose (BG) by spouse’s diabetes status. Results: The prevalence of high BG was 8.8% (men) and 14.2% (women) . In adults with high BG, the percent diagnosed, treated, and controlled was 22.6%, 18.7%, and 9.2% (men) and 22.5%, 18.0%, and 8.5% (women) , respectively. Of adults with high BG, the prevalence of diabetes diagnosis was higher in men (prevalence ratio [PR]: 1.85 [1.37, 2.49]) and women (PR: 2.03 [1.47, 2.8]) whose spouse was diagnosed (ref=spouse undiagnosed) . Among the diagnosed, the prevalence of being treated for diabetes did not differ by their spouse’s diagnosis status in men or women. Among the treated, the prevalence of blood glucose control was higher in women (PR: 1.45, [0.93, 2.25]) , but not men (PR: 0.96 [0.66, 1.40]) , whose spouse was diagnosed (ref=spouse undiagnosed) . Conclusions: Spouse’s diabetes was associated with higher probability of detection of diabetes but not with treatment. Outreach among couples may improve medical management of diabetes in India. Disclosure J.Varghese: None. S.A.Patel: Research Support; Johnson & Johnson.

Medication Optimization Among People With Type 2 Diabetes Participating in a Continuous Glucose Monitoring-Driven Virtual Care Program: Prospective Study.

BackgroundThe Onduo virtual care program for people with type 2 diabetes (T2D) includes a mobile app, remote lifestyle coaching, connected devices, and telemedicine consultations with endocrinologists for medication management and prescription of real-time continuous glucose monitoring (RT-CGM) devices. In a previously described 4-month prospective study of this program, adults with T2D and baseline glycated hemoglobin (HbA1c) ≥8.0% to ≤12.0% experienced a mean HbA1c decrease of 1.6% with no significant increase in hypoglycemia.ObjectiveThe objective of this analysis was to evaluate medication optimization and management in the 4-month prospective T2D study.MethodsStudy participants received at least 1 telemedicine consultation with an Onduo endocrinologist for diabetes medication management and used RT-CGM intermittently to guide therapy and dosing. Medication changes were analyzed.ResultsOf 55 participants, 48 (87%) had a medication change consisting of a dose change, addition, or discontinuation. Of these, 15 (31%) participants had a net increase in number of diabetes medication classes from baseline. Mean time to first medication change for these participants was 36 days. The percentage of participants taking a glucagon-like peptide-1 receptor agonist increased from 25% (12/48) to 56% (n=27), while the percentages of participants taking a sulfonylurea or dipeptidyl peptidase 4 inhibitor decreased from 56% (n=27) to 33% (n=16) and 17% (n=8) to 6% (n=3), respectively. Prescriptions of other antidiabetic medication classes including insulin did not change significantly.ConclusionsThe Onduo virtual care program can play an important role in providing timely access to guideline-based diabetes management medications and technologies for people with T2D.Trial RegistrationClinicalTrials.gov NCT03865381; https://clinicaltrials.gov/ct2/show/NCT03865381

Implementation of App-Based Diabetes Medication Management: Outpatient and Perioperative Clinical Decision Support.

Outpatient and perioperative therapeutic decision making for patients with diabetes involves increasingly complex medical-decision making due to rapid advances in knowledge and treatment modalities. We sought to review mobile decision support tools available to clinicians for this essential and increasingly difficult task, and to highlight the development and implementation of novel mobile applications for these purposes. We found 211 mobile applications related to diabetes from the search, but only five were found to provide clinical decision support for outpatient diabetes management and none for perioperative decision support. We found a dearth of tools for clinicians to navigate these tasks. We highlight key aspects for effective development of future diabetes decision support. These include just-in-time availability, respect for the five rights of clinical decision support, and integration with clinical workflows including the electronic medical record.

Applying the Social-Ecological Approach to Evaluate Diabetes Medication Management in Older People.

Glucagonlike peptide-1 receptor agonist is a common antidiabetic medication class to lower HbA1c, weight, and cardiovascular risk. This case study describes the challenges a patient with uncontrolled diabetes faced after receiving a prescription for liraglutide because of multiple levels of influence, including individual, family, institutional, and policy level barriers. The case highlights the importance of utilizing a person-centered care approach by evaluating patient's preferences, visual and motor coordination, cognitive function, psychological stress, and medication cost before prescribing injectable products for elderly patients.

Person-Centered Medication Therapy for Diabetes in Older Adults: A Practical Review.

Diabetes is one of the most common disease states in older adults and there are significant risks to the use of antidiabetic medications. The older adult population varies greatly in functional ability, independence, and cognition. These factors, along with increased risk of hypoglycemia, falls, and other comorbidities, add to the complexity of creating medication regimens to treat diabetes in older adults. In the current review, a person-centered approach to diabetes care in older adults is described to aid clinician decision making. By keeping the patient and their individual factors in the center of the decision, risks of over- or under-treating diabetes can be minimized. The review will discuss person-centered goal setting, practical approaches to diabetes medication management, and specific considerations for choosing medication classes based on patient characteristics. [Journal of Gerontological Nursing, 47(10), 7-13.].

664-P: The Case for Targeted Diabetes Medication and Device CME for PCPs

Objective: This study aimed to evaluate primary care physicians’ (PCPs) perceptions of and desired improvements to diabetes continuing medical education (CME). Methods: In March-April 2019, 306 U.S.-based PCPs who treat people with diabetes and earn diabetes CME credits completed an online survey. Results: On average, respondents regularly see 391 people with diabetes (38% on insulin) for checkups and allot 16% of annual CME credit hours to diabetes. More than 75% of PCPs believe that improved PCP education could enhance care for people with diabetes and 82% believe that new diabetes technologies and therapies will change their practice significantly over the next five years. Respondents commonly reported that CME does not adequately cover diabetes drugs/devices, cost/insurance, or behavioral health. More than 80% of surveyed PCPs currently initiate and manage diabetes medications, though >55% would prefer to outsource to a diabetes specialist. The trend is reversed for diabetes devices: 34% of PCPs in this study currently initiate and manage CGM, whereas 54% would like to, and 24% currently initiate and manage insulin pumps, whereas 53% would like to. Respondents most commonly used journal articles and online courses—used by 79% and 65%, respectively—to obtain diabetes CME credits, though academic/medical conferences were regarded as the most useful. Nearly all PCPs also believe improved patient education would improve diabetes care. Discussion: PCPs in this study believe both online and live CME, alongside improved patient education, can help them adapt to the rapidly evolving diabetes management landscape. More PCPs would prefer to outsource diabetes medication management than do currently, suggesting discomfort with managing these medications. Conversely, PCPs would like to take a more active role in diabetes device management. CME could help close both gaps in order to enhance PCPs’ comfort and efficacy in managing diabetes. CGM should be emphasized given its dual applications in diagnostics and therapy. Disclosure B.J. Levine: Employee; Self; Onduo. J.M. McDermott: Other Relationship; Self; Various. J.B. Lackner: None. E. Shoger: None. K.C. Stoner: Other Relationship; Self; Various companies and organizations. R.S. Beaser: None. K.L. Close: Other Relationship; Self; Abbott, Air Liquide, American Diabetes Association, AstraZeneca, Dexcom, Inc., Janssen Pharmaceuticals, Inc., JDRF, Leona M. and Harry B. Helmsley Charitable Trust, Lilly Diabetes, Merck & Co., Inc. Funding The Leona M. and Harry B. Helmsley Charitable Trust

The Challenges of Diabetes Medication Management at Hospital Discharge in Older Adults

The Challenges of Diabetes Medication Management at Hospital Discharge in Older Adults

Pharmacist-Provided Diabetes Education and Management in a Diverse, Medically Underserved Population.

Diabetes prevalence continues to rise in the United States, affecting more than 30 million people (9.4% of the population) in 2015 (1). Diabetes is expensive in terms of both direct medical costs and indirect costs of disability, lost work productivity, and premature death. The estimated cost of diabetes in the United States was $245 billion in 2012 (2). Optimizing care by facilitating glycemic control, patient education, preventive health screenings, and adherence to the treatment regimen have been suggested as methods to decrease the cost of this disease (3). There are inequalities in the disease burden of diabetes in the United States. The prevalence, incidence, and complications rates of diabetes are higher in non-Hispanic black, Hispanic, and American Indian/Alaska Native populations (4,5). Minority, low-income, and uninsured people have a higher risk for omissions of recommended diabetes prevention services (6). Furthermore, people who are non-English–speaking may experience barriers to effective diabetes medication management, including prohibitive costs of medications, hindered communication, knowledge deficits, and difficulties in understanding (7). The American Diabetes Association consistently identifies the promotion of health equity for populations disparately affected by diabetes as an advocacy priority (8). Federally Qualified Health Centers (FQHCs) provide primary care, behavioral health services, dental care, and other health care services to medically underserved populations. These safety-net clinics work to reduce barriers to health and health care in low-income populations disproportionately affected by chronic disease by increasing access to health care providers and medications (9,10). In 2016, FQHCs provided care to more than 26 million patients, more than half of whom had an income below the federal poverty level. The Health Resources and Services Administration (HRSA) reported in its 2016 health center data report that 32.1% of the more than 2 million patients with diabetes receiving care at FQHCs had …

Validierung der deutschen Version der Pediatric Self-Efficacy for Diabetes-Type-1 Scale

Since there is no suitable tool for measuring the specific, diabetes-related self-efficacy in children with type-1-diabetes in German language, this paper presents the construction and validation of Pediatric Self-Efficacy for Diabetes-Type-1 Scale (PSEDT-1). The intention was to develop a guideline-compliant, pediatric, revised self-efficacy scale on the basis of Grossman, Brink and Hauser̓s SED. Children with type 1 diabetes (N=221) were included in a clinical, multi-centre validation study. To assess sensitivity to change, 85 of these children were asked to complete the PSEDT-1 before, immediately after, and 6 months after inpatient diabetes training. PSEDT-1 has been associated with scales that measure constructs that are similar and different in terms of content. The interpretation of the correlation results should provide information on validity. The PSEDT-1 was thus reviewed using the German Multidimensional Self-Assessment Scale (MSWS), the German questionnaire on health and illness-related control beliefs (KKG). The reliability results showed a good internal consistency with Cronbach's α=0,87; the discriminatory power of the items was acceptable. Exploratory factor analysis identified 4 factors that account for 54% of the variance: 1) diabetes self-management skill, 2) (medical) insulin management competence, 3) (general) self-assertiveness, 4) autonomous self-regulation. The construct validity of PSEDT-1 has been evaluated by estimating its association with other variables. It was possible to verify the theoretically expected correlation patterns. In addition, the study results showed indications of sufficiently high sensitivity to change. The results suggest that PSEDT-1 is a valid and reliable tool that, in addition to the scale values of the competence areas of diabetes self-management, medical management, and general self-assertion, also determines the scale value of autonomous self-regulation to assess diabetes-related self-efficacy.

Medical and surgical management of obesity and diabetes: what's new?

We conducted a narrative review of the medical and surgical management of people with obesity and diabetes. Results of this review showed that a 5-10% loss in body weight can be achieved with a change in lifestyle, diet and behaviour and with approved pharmacological therapies in people with obesity and diabetes. New targeted therapies are now available for patients with previously untreatable genetic causes of obesity. Compared to medical treatment, metabolic and bariatric surgery is associated with significantly higher rates of remission from type 2 diabetes and lower rates of incident macrovascular and microvascular complications and mortality. The National Institute for Health and Care Excellence and the American Diabetes Association endorse metabolic and bariatric surgery in obese adults with type 2 diabetes and there may also be a role for this in obese individuals with type 1 diabetes. The paediatric committee of the American Society for Metabolic and Bariatric Surgeryhave recommended metabolic and bariatric surgery in obese adolescents with type 2 diabetes. Earlier and more aggressive treatment with metabolic and bariatric surgery in obese or overweight people with diabetes can improve morbidity and mortality.

Management of periodontal disease in patients with diabetes- good clinical practice guidelines: A joint statement by Indian Society of Periodontology and Research Society for the Study of Diabetes in India.

There is a huge body of literature suggesting an association and a bidirectional relationship between periodontal disease and diabetes. Diabetes and periodontal diseases are both chronic diseases with a high prevalence. Dentists/periodontists, in their daily clinical practice, very often attend to diabetes patients with diverse oral health conditions and cater to their dental treatment needs. Safe and effective periodontal therapy in this population requires a broad understanding of diabetes, medical management of diabetes, and essential modifications to dental/periodontal therapy that may be required. This paper describes a joint statement put forth by the Indian Society of Periodontology and the Research Society for the Study of Diabetes in India aiming to provide expert consensus and evidence-based guidelines for optimal clinical management of periodontal conditions in diabetes patients or patients at risk for diabetes. Although this paper is not envisioned to be a comprehensive review of this topic, it intends to provide the guidelines for dental professionals and periodontists.

Academic Detailing in the New Era of Diabetes Medication Management

Educating clinicians on how to improve the medical management of type 2 diabetes in the modern pharmacologic era represents an enormous challenge given the number of medications available and the diversity across guideline recommendations. Academic detailing uses active social marketing techniques to deliver in-office, face-to-face educational encounters between a trained clinical educator (academic detailer) and a primary care clinician and can improve the quality of prescribing and management decisions, leading to better patient outcomes. This updated review provides context on how academic detailing programs can improve diabetes-related clinical knowledge and practice among primary care providers, incorporating the perspective of a field-based academic detailer. It also profiles 4 diabetes-specific academic detailing programs varying in geographic scope and detailing approach, based in Massachusetts, Pennsylvania, Vermont, and Saskatchewan Province (Canada). Academic detailing can effectively overcome challenges to increasing the evidence-based use of newer glucose-lowering medications in primary care settings.

Redesigning ambulatory care management for uncontrolled type 2 diabetes: a prospective cohort study of the impact of a Boot Camp model on outcomes

ObjectiveType 2 diabetes care management (DCM) is challenging. Few studies report meaningful improvements in clinical care settings, warranting DCM redesign. We developed a Boot Camp to provide timely, patient-centered, technology-enabled...

PDB75 DIABETES MEDICATION MANAGEMENT IN SLOVENIA FROM THE PERSPECTIVE OF PRESCRIBERS AND REPRESENTATIVES OF REGULATORY BODIES

The aim of the study was to get an insight into diabetes medication management from the perspective of prescribers and representatives of regulatory bodies in Slovenia. Focus panel was performed with 5 experts: two diabetologists, general practitioner and representatives of Health Insurance Institute of Slovenia and Agency for Medicinal Products and Medical Devices in January 2019. The discussion was audio-recorded and converted into a verbatim transcript. Two independent coders coded the transcript and derived main themes and subthemes of the discussion using NVivo 11. The main themes derived from the discussion were: general properties of antidiabetic medicines and new evidence on cardiovascular benefit of SGLT-2 inhibitors and GLP-1 agonists, medicine reimbursement and patient access to antidiabetic medicines in Slovenia, the role of healthcare professionals in diabetes care, diabetes pharmacotherapy and the quality of care in patients with diabetes. The experts agreed that patient access to antidiabetic medicines in Slovenia is comparable with other European countries. In their opinion the main issues in diabetes management in Slovenia are unequal access to diabetologists across Slovenian regions, prescribing restrictions that limit patient access to newer antidiabetic medications, untapped potential of primary level of healthcare and lack of reliable data on long-term outcomes of diabetes, especially on the incidence of lower extremity amputations. Suggestions for improvement of diabetes management in Slovenia were the need for change in prescribing restrictions in accordance with new evidence on cardiovascular benefit, development of national registry and quality indicators and optimization of activities at the primary level of healthcare. Overall, Slovenia provides satisfying patient access to antidiabetic medicines and healthcare for patients with diabetes; however, improvement in terms of prescribing restrictions, access to prescribers and monitoring of patient care by national registry is anticipated.