U.S. Doctors Resources, L.L.C.
PROTOCOL DIABETES MELLITUS
SUMMARY: THREE STEP PROGRAM
1. DIETARY THERAPY AND EXERCISE:
Small, frequent, high protein, high omega-3 fats (fish) diet with fresh green/white vegetables. Omit all grains, fruit, red meat, dairy and processed foods and drinks. 'Weight Watcher's or equivalent program'[1].
2. DIAGNOSTIC TESTING
The 3-hour Insulin Glucose Tolerance Test[2] differentiates those individuals whom may benefit from oral, non-insulin requiring medication versus those requiring insulin for glycemic control. Order Laboratory Services.
3. STANDARD MEDICATIONS:
DRUG THERAPY
Medications Approved and Disallowed:
Choice based largely on Adverse Effect
(a). While daily insulin with biguanides (metformin) will benefit (lower) Hemoglobin A1c from 0.7 to 2.5%, the minor risks of weight gain and low blood sugars make this the standard of medical care.
(b). The addition of sulfonylureas (Micronase©/ Glucotrol©, Amaryl©) can lower Hemoglobin A1c by 1.5% when used alone and by 0.8-1.0% when added to metformin. They are not applicable when the individual shows an inability to increase insulin release (see Insulin Glucose Tolerance Test[2] under Order Laboratory Services) and might increase all cause mortality.
(c). All diabetic men are hypogonadal (low testosterone). Replacement with weekly testosterone 100mg intramuscular injections[3] may lower glycogenated hemoglobin 2% and should be evaluated (see H.I.S. profile under Order Laboratory Services)
PROTOCOL for the MANAGEMENT OF DIABETES
1. In the treatment of DIABETES[1], the medical literature agrees that treatment is to follow the 3-step protocol [diet/exercise, medication, hormone replacement] outlined above.
2. Based on the medical literature, risks of the oral and injectable medications (except insulin and metformin) are not offset by any proven clinical efficacy patients should therefore not be exposed to these drugs.
3. Contact Benefit Manager for Referral for Second Opinion for anabolic steroid replacement for men and women. |
Pending (1.), (2.) and (3.) the employee/ dependent may continue the medication as prescribed by the treating physician by attaching a valid 3-month prescription with up to 12-months of refills to the Cover Page and mailing it back to:
ATTN: Benefit Manager
City of Hazel Park Self-Insurance Health Program
111 East Nine Mile Road
Hazel Park, Michigan 48030
Please send the demographics about the patient that appear on the Cover Page of the Prior Authorization form and the Credit Card Information from the Flexible Spending Account in the boxes below.
IDENTIFICATION:
| Demographics |
|
Health Insurance/ Credit Card | |
Member Name: | ____________________________________ | Member Name on the Card: | _____________________________________ |
Insurance ID: | ____________________________________ | Issuing Service: | VISA, MC, Discover _________________ |
Date of Birth: | ____________________________________ | Number: | ____________________________________
|
Street Address: | ____________________________________ | Expiration: | ____________________________________
|
City/ State/ Zip code: | ____________________________________ | CVV Code: | ____________________________________ |
Telephone Number: | ____________________________________ |
| | Signature of Employee/ Insured: |
| | | _________________________________ |
Signature of Treating Physician: | ___________________________________ |
ADDITIONAL INFORMATION:
Medication Rejections until Prior Authorization Review
(1). Biguanides
(2). Sulfonylureas: Glipizide, Glyburide, Glimepiride
(3). Acarbose, Prandin®/repaglinide
(4). Glitazones: Actos®, Avandia®, Duetact®, Onglyza®
(5). Alpha Glucosidase Inhibitors: Glycet®
(6). Gliptins[4]: Kazano®,Januvia®, Farxiga®,Oseni®, Nesina®
(7). SPLT2: Tradjenta®, Invokana®, Xigduo®, Jariance®
(8). Amlyn Analogues: Symlinpen®, Glyxambi®, Trulivity®
(9). GLP-1 Agonist: Victoza®, Tanzeum®, Byetta®, Bydureon®, Saxenda®
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References:
1. High Fat Diet. [http://www.ncbi.nlm.nih.gov/pubmed/24666665]
2. Insulin Glucose Tolerance Test Roger W. Turkington, MD; Howard K. Weindling, MD..Insulin Secretion in the Diagnosis of Adult-Onset Diabetes Mellitus. JAMA. 1978;240(9):833-836. doi:10.1001/jama.1978.03290090027011. [http://jama.jamanetwork.com/article.aspx?articleid=361005]
3. Kapoor D. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol. 2006 Jun;154(6):899-906.
4.
Glucose-lowering treatment of type 2 diabetes. Part II--Glucose-lowering drugs after metformin: a choice based largely on adverse effects. Prescrire Int. 2015 May;24(160):130-5.
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Signed b.n.r. Benefit Manager ___________________________________ date:__________
Copyrighted® 2016
