Davida Kruger is a Nurse Practitioner at Henry Ford Health System, Division of Endocrinology, Diabetes, Bone Disease, Adjunct Clinical Faculty, Graduate School of Nursing, Michigan State University, Detroit, Michigan.

Introduction

Welcome back to MEDS eNews. This month we spend some time with Metabolic and Endocrine Disease Summit Fall faculty Davida Kruger, who is a Nurse Practitioner at Henry Ford Health System, Division of Endocrinology, Diabetes, Bone Disease, and Adjunct Clinical Faculty, Graduate School of Nursing, Michigan State University in Detroit, Michigan.  Davida has spent her career as a certified nurse practitioner in diabetes for more than 35 years. Her role includes both clinical practice and research, and she is board-certified in both primary care and advanced diabetes management. She is also a co-investigator on numerous studies of diabetes interventions and care, including the National Institutes of Health-funded multicenter EDIC and ACCORD trials. She lectures extensively throughout the United States on maximizing outcomes in diabetes and diabetes management. We discuss several aspects of diabetes care, pharmacological advances for weight control and type 2 diabetes, and more. Following the interview is our Rapid Fire segment!

If you missed it, you can access the recent MEDS Summit and register here for virtual access that fits your schedule. The best resource for the most up-to-date, clinically relevant information on treatment of diabetes, obesity, Cushing’s Syndrome, PCOS, osteoporosis, hypercalcemia, and thyroid disease, it’s a one-stop shop to get you up to speed with CME!

Thank you to Davida for her time here and as Medscape conference faculty. Please contact me at colleen@cmhadvisors.com with comments or suggestions. Thanks for reading! —Colleen Hutchinson

5 Minutes with Davida Kruger, MSN, APN-C, BC-ADM

Davida is a Nurse Practitioner at Henry Ford Health System, Division of Endocrinology, Diabetes, Bone Disease, Adjunct Clinical Faculty, Graduate School of Nursing, Michigan State University, Detroit, Michigan.

What do you think about the recent pharmacological advances for weight control and type 2 diabetes?

Davida Kruger:  As providers, we all need to feel comfortable asking our patients if they would like to discuss their weight. These are needed conversations. We also must understand how to use the newer medications available for weight loss. All of the GLP1 and the SGLT2 assist with weight control and weight loss. These are our first line therapies. Semaglutide, dulaglutide at higher doses, and terzepatide offer significant weight loss and should be used for managing type 2 diabetes.  Additionally, semaglitide 2.4mg for weight loss is a great option. Watch for terzepatide to be approved for weight loss as well. But weight loss is an area we all need to focus on and assist our patients.

What are some pearls or takeaways you shared in your presentation in Session II: Diabetes Management Part 2 on Adult Onset Type 1 Diabetes: How do I Proceed— The Diabetes Sleuth at the Metabolic and Endocrine Disease Summit Fall?

Davida Kruger: Too often when we meet a patient based on age, we make an assumption that the patient has type 2 diabetes. The patient is then placed on the wrong therapy. It is important to remember that type 1 diabetes can occur at any age. Look at the patient, ask about family history (often type 1 no family history), did the patient have an episode of DKA, and do they have other autoimmune diseases. When in doubt, there are labs such as GAD antibodies that can be run.  

What were some of the pearls that came out of Session 2: Diabetes Management Parts 1 & 2?

Davida Kruger: Know the ADA standards of care for managing type 2 diabetes. Since we gave this presentation, those guidelines have changed. Therapy for patients with type 2 diabetes starts with GLP1 and SGLT2 inhibitors. Insulin may be needed but that is later in the care of the patient with type 2 diabetes. When insulin is needed, there are many options. Start with a long-acting basal insulin; the patient may also need a short acting insulin. Use continuous glucose monitoring for all patients who need insulin.  

How was the Expert On the Spot forum in which you were featured?

Davida Kruger: This was a wonderful opportunity to meet with our participants in a small group setting and talk about diabetes and diabetes care. The time went by much too quickly. Everyone was so engaged. This should be a regular feature of the conference. 

Rapid Fire!

Most critical new advance in my area of medicine: Weight loss medications that actually work and can sustain weight loss.

Where I go for continuing education: American Diabetes Association, MEDS

My mentor: Fred Whitehouse, many great women

Advice that has helped in my career: Don’t be afraid to ask for what you need; the worst that can happen is you will be told no.

Best tool in my clinical arsenal: The ability to develop relationships with my patients; once you have the relationship, the rest will follow.

What I wish the patient would remember: Ultimately, I don’t go home with you at night; you need to take charge of your diabetes.

Biggest challenge for me and my colleagues: Defining ourselves as NP/PAs. I have fought that battle since beginning of my career and feel like I am on the winning side. But others still have to define themselves.

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