Combined Therapy with Insulin Plus Oral Agents. Is there Any Advantage?

Size: px
Start display at page:

Download "Combined Therapy with Insulin Plus Oral Agents. Is there Any Advantage?"

Transcription

1 Combined Therapy with Insulin Plus Oral Agents Is there Any Advantage? Matthew C. Riddle, M.D. Professor of Medicine Oregon Health & Science University Portland, Oregon

2 Is there Any Advantage in Combined Therapy? Gewiss! Yes! Vraiment! Most patients with type 2 diabetes need combination therapy to reach usual glycemic targets... including those who need insulin

3 The Clinical Problem Loss of Control with Monotherapy in the UKPDS 9 Conventional (diet) Intensive (SU or insulin) Median HbA 1c (%) Years From Randomization UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:

4 Monotherapy in the UKPDS Obese Substudy Percent with HbA1c < 7% on monotherapy 3 years 6 years 9 years Diet Sulfonylurea Metformin Insulin Turner RC et al. UKPDS 49. J Am Med Ass 1999;21:2005

5 Monotherapy in the UKPDS Obese Substudy The majority of patients need multiple therapies to attain these target goals in the longer term. Turner RC et al. UKPDS 49. J Am Med Ass 1999;21:2005

6 Why combine oral agents with insulin? Pharmacology Physiology Clinical trials

7 Why combine oral agents with insulin? Pharmacology The ratio of desired to undesired effects may be improved

8 Dose-response Relationships for Effects of Treatments Desired effect % of maximal effect 100 % incidence 100 Undesired effect % of maximal dose

9 Dose-response Relationships for Metformin HbA1c reduction GI symptoms % of maximal effect % incidence h h h h h %?20-30% Mg metformin daily 2500 Garber AJ et al. Am J Med 1997;102:491

10 Dose-response Relationships for Glimepiride HbA1c reduction Hypoglycemia % of maximal effect % incidence 100 h h h Mg glimepiride daily Goldberg RB et al. Diabetes Care 1996;19: 849

11 Why combine oral agents with insulin? Physiology Glycemic variability and hypoglycemia can be reduced by enhancing the effectiveness of endogenous insulin

12 Three Main Oral agent + Insulin Combinations Sulfonylureas + Insulin Metformin + Insulin Thiazolidinediones + Insulin

13 Smooth Transition to Insulin while Continuing Glimepiride Placebo + 70/30 insulin titrated to 140 mg/dl Glimepiride + insulin 300 mg/dl * FPG 100 Units/Day * * * * 75 * * * Insulin Dosage * P <.001 Weeks of treament * P <.001 P <.05 Riddle MC et al. Diabetes Care. 1998;21: Weeks of treament Quicker control with 37% less injected insulin

14 Metformin or Glitazone + CSII in T2DM Effect on Plasma Glucose Continuous insulin infusion Continuous insulin infusion plus metformin Continuous insulin infusion Continuous insulin infusion plus troglitazone mg/dl 150 Metformin 150 Troglitazone Yu et al. Diabetes 1999;48: Time of day Time of day Equivalently excellent glycemic control

15 Metformin or Glitazone + CSII in T2DM Effect on Plasma Insulin Continuous insulin infusion Continuous insulin infusion plus metformin Continuous insulin infusion Continuous insulin infusion plus troglitazone pmol/l 1000 Metformin 1000 Troglitazone % insulin dose reduction % insulin dose reduction Time of day Yu et al. Diabetes. 1999;48: Time of day Reduced exogenous insulin requirement due to enhanced response to endogenous insulin

16 Variability of FPG in 2 Studies of glibenclamide and evening insulin SD of sequential FPG measurements Placebo/Ins Glibenclamide/Ins Bedtime NPH 1.7 ± ± 0.1 Riddle MC et al. P < 0.05 Diabetes Care 1989;12:623-9 Suppertime 70/ ± ± 0.1 Riddle MC et al. P < 0.05 Am J Med Sci 1992;:303: and 43% less variability with combination therapy

17 Glibenclamide is no longer a suitable choice as secretagogue Higher incidence of severe hypoglycemia in a populationbased study 1 Glibenclamide 5.60 per 1000 patient-year Glimepiride 0.86 Interference with cardiac ischemic preconditioning 2 Glibenclamide Glimepiride Abolished preconditioning No effect on preconditioning Higher mortality in a population taking a secretagogue with metformin 3 Glibenclamide 8.7 % per year Repaglinide 3.1 Gliclazide 2.1 Glimepiride Holstein A et al. Diab/Metab Res Rev 2001;17: Lee T-M & Chou T-F. J Clin Endocrinol Metab 2003;88: Monami M et al. Diab/Metab Res Rev 2006;22:

18 Summary of physiologic studies Secretagogues increase the proportion of insulin from endogenous secretion Sensitizers increase the response to endogenous insulin... both improve the effectiveness of remaining endogenous insulin

19 Why combine oral agents with insulin? Clinical trials Better glycemic control achieved Less weight gain

20 Improvement of Glycemic Control with Combination Therapy Previously insulin-treated T2DM patients Regimen Glycated Hb reduction vs insulin alone (despite insulin dose reductions) Insulin + sulfonylurea - 0.4% 7 studies Insulin + metformin - 1.3% 4 studies Insulin + TZD - 1.3% 2 studies Yki-Jarvinen H. Diabetes Care 2001;24:

21 Initiation of Bedtime NPH Insulin ± Glipizide N = 18 T2DM Baseline on Glipizide 20 mg/d After bedtime NPH titrated to FPG 120 mg/dl FPG 248 mg/dl % HbA 1c % 0 Bedtime NPH Bedtime NPH + glipizide 6 Bedtime NPH Bedtime NPH + glipizide Shank M et al. Diabetes. 1995;44: Better control with combination therapy

22 Metformin + Intensified N + R Insulin Insulin + Placebo Insulin + Metformin N = 22 N = 21 Insulin dosage (U/d) Baseline months Weight (kg) Baseline months HbA1c (%) -3 kg Baseline months Aviles-Santa et al. Ann Intern Med 1999;131: % Better control and no weight gain with combination therapy

23 Intensive Insulin Therapy ± Metformin 390 type 2 patients on insulin or insulin + metformin Mean age 61 yr, duration 13 yr, BMI 30, A1c 7.9% Randomized to Insulin 2 to 4 injections + Placebo Insulin 2 to 4 injections + metformin mg Endpoints At 48 months CV morbidity and mortality At 16 weeks glycemic control An early report after 16 weeks:... unexpected favorable effects of metformin Wulffele MG et al. Diabetes Care 2002;25:

24 Intensive Insulin Therapy ± Metformin Insulin + placebo Insulin + metformin Insulin u/d Metformin mg/d A1c % Endpoint Placebo adj < Weight kg Placebo adj < Hypoglycemia/pt-mo NS Wulffele MG et al. Diabetes Care 2002;25:

25 Unanswered questions Will limitation of weight-gain accompanying insulin treatment improve CV outcomes? What are the roles of pramlintide and exenatide combined with insulin? Will using all available agents to get to A1c 6% improve outcomes?

26 Pramlintide + Basal-prandial Insulin in T2DM Open-label clinical experience study 230 Baseline 6 Months 210 Glucose mg/dl * * * * * * * acb pcb acl pcl acd pcd hs *P <0.05 Karl D et al. Diabetes 2005; 54(S1):A12; in press Diab Res Clin Pract

27 The ACCORD Trial Can we get to 6% A1c and will that improve outcomes? 10,000 type 2 patients -- to be followed ~ 5.5 yr Primary endpoint -- major cardiovascular events Double 2x2 factorial design Intensive vs standard glycemic policy (n=10,000) Intensive vs standard blood pressure policy (n=5800) Statin treatment with or without added fibrate (n=4200) HbA1c target for intensive glycemic arm -- 6%, using any combination of agents, including intensive insulin

Role of Pramlintide in Diabetes Care

Role of Pramlintide in Diabetes Care Role of Pramlintide in Diabetes Care Matthew C. Riddle, MD Professor of Medicine Oregon Health & Science University Practical Ways to Achieve Targets in Diabetes Care Keystone, Colorado 17 July 2014 Duality

More information

Does Diabetes Control Matter?

Does Diabetes Control Matter? Does Diabetes Control Matter? Laurence Kennedy, MD, FRCP Endocrinology Department Cleveland Clinic, OH Disclosures None Does Diabetes Control Matter? Generality of patients Relative Risk Complications

More information

Harmony Clinical Trial Medical Media Factsheet

Harmony Clinical Trial Medical Media Factsheet Overview Harmony is the global Phase III clinical trial program for Tanzeum (albiglutide), a product developed by GSK for the treatment of type 2 diabetes. The comprehensive program comprised eight individual

More information

Oral Hypoglycemic Agents and Heart Disease

Oral Hypoglycemic Agents and Heart Disease Oral Hypoglycemic Agents and Heart Disease Marwan Hamaty, MD, MBA Endocrinology and Metabolism Institute Cleveland Clinic Foundation Cleveland, OH Disclosures None to Disclose Objectives Review cardiac

More information

Explanation for the ACCORD outcomes?

Explanation for the ACCORD outcomes? Explanation for the ACCORD outcomes? Matthew C. Riddle, MD Professor of Medicine Oregon Health & Science University Practical Ways to Achieve Targets in Diabetes Care Keystone, Colorado 18 July 2014 Duality

More information

IMPROVED METABOLIC CONTROL WITH A FAVORABLE WEIGHT PROFILE IN PATIENTS WITH TYPE 2 DIABETES TREATED WITH INSULIN GLARGINE (LANTUS ) IN CLINICAL

IMPROVED METABOLIC CONTROL WITH A FAVORABLE WEIGHT PROFILE IN PATIENTS WITH TYPE 2 DIABETES TREATED WITH INSULIN GLARGINE (LANTUS ) IN CLINICAL 464 IMPROVED METABOLIC CONTROL WITH A FAVORABLE WEIGHT PROFILE IN PATIENTS WITH TYPE 2 DIABETES TREATED WITH INSULIN GLARGINE (LANTUS ) IN CLINICAL PRACTICE STEPHAN A SCHREIBER AND ANIKA RUßMAN ABSTRACT

More information

Is hypoglycemia an issue in type 2 diabetes?

Is hypoglycemia an issue in type 2 diabetes? King s Diabetes Research Group Is hypoglycemia an issue in type 2 diabetes? Stephanie A Amiel RD Lawrence Professor of Diabetic Medicine King s College London Conflicts of interest None! (Currently working

More information

The basal plus strategy. Denis Raccah, MD, PhD Professor of Medicine University Hospital Sainte Marguerite Marseille FRANCE

The basal plus strategy. Denis Raccah, MD, PhD Professor of Medicine University Hospital Sainte Marguerite Marseille FRANCE The basal plus strategy Denis Raccah, MD, PhD Professor of Medicine University Hospital Sainte Marguerite Marseille FRANCE ADA/EASD guidelines recommend use of basal insulin as early as the second step

More information

Review of Diabetes Therapies: Key Drivers of Disease Progression

Review of Diabetes Therapies: Key Drivers of Disease Progression Review of Diabetes Therapies: Key Drivers of Disease Progression David M. Kendall, MD Medical Director and Chief of Clinical and Professional Services Associate Professor of Medicine University of Minnesota

More information

Management of new type II diabetes diagnosis

Management of new type II diabetes diagnosis Management of new type II diabetes diagnosis Case 31yr old healthy black man who presents to clinic with polyuria and polydipsia, small amount of weight loss. Family history: DM in grandmothers Social

More information

Metformin: Its Non-Glycemic Effects and Cardiovascular Risk Reduction. J. M. Miles, MD

Metformin: Its Non-Glycemic Effects and Cardiovascular Risk Reduction. J. M. Miles, MD Metformin: Its Non-Glycemic Effects and Cardiovascular Risk Reduction J. M. Miles, MD Case Study 73 y. o. woman, followed closely for Type 2 DM of 25 y duration. She has NYHA class 3 CHF. Echo shows HFpEF

More information

Developing a Type 2 Diabetes Treatment Algorithm. The Problem. Worsening Trends in Diabetes and Obesity

Developing a Type 2 Diabetes Treatment Algorithm. The Problem. Worsening Trends in Diabetes and Obesity Developing a Type 2 Diabetes Treatment Algorithm Marc Cornier, MD Division of Endocrinology, Metabolism and Diabetes University of Colorado Denver Denver Health Medical Cener marc.cornier@ucdenver.edu

More information

INSULIN TREATMENT FOR TYPE 2 DIABETES MANAGEMENT

INSULIN TREATMENT FOR TYPE 2 DIABETES MANAGEMENT INSULIN TREATMENT FOR TYPE 2 DIABETES MANAGEMENT APIRADEE SRIWIJITKAMOL DIVISION OF ENDOCRINOLOGY AND METABOLISM DEPARTMENT OF MEDICINE FACULTY OF MEDICINE SIRIRAJ HOSPITOL QUESTION 1 1. ท านเคยเป นแพทย

More information

Diabetes increased 70% among people age in approximately the last decade

Diabetes increased 70% among people age in approximately the last decade Hypoglycemia: A Complication When Targeting Type 2 Diabetes Jeffrey S. Freeman DO FACOI Professor of Internal Medicine Chairman Division of Endocrinology and Metabolism Philadelphia College of Osteopathic

More information

Controlling Diabetes: Successfully Using Oral Agents, Insulins,, Exenatide and Pramlintide

Controlling Diabetes: Successfully Using Oral Agents, Insulins,, Exenatide and Pramlintide Controlling Diabetes: Successfully Using Oral Agents, Insulins,, Exenatide and Pramlintide C. W. Spellman, Ph.D., D.O. Assist Dean, Dual Degree Programs Assoc. Prof. Medicine Head, Endocrinology and Dir.

More information

Algorithms for Glycemic Management of Type 2 Diabetes KENTUCKY DIABETES NETWORK, INC.

Algorithms for Glycemic Management of Type 2 Diabetes KENTUCKY DIABETES NETWORK, INC. Algorithms for Glycemic Management of Type 2 Diabetes KENTUCKY DIABETES NETWORK, INC. The Diabetes Care Algorithms for Type 2 Diabetes included within this document are taken from the American Association

More information

Agenda. LAF237 Oral DPP4 1 Inhibitor with Potential for Sustainable Diabetes Control LAF237

Agenda. LAF237 Oral DPP4 1 Inhibitor with Potential for Sustainable Diabetes Control LAF237 Agenda Disease background and unmet need LAF237 background and New MoA data LAF237 review of new phase IIb/III data Study 239 Phase III monotherapy (52 week) vs. metformin Study 2329 Phase III monotherapy

More information

Basal/Bolus Insulin: Better Pattern Control in Type 2 Diabetes. Kim L Kelly, PharmD, BCPS, FCCP, CDTC, CPC, CEC

Basal/Bolus Insulin: Better Pattern Control in Type 2 Diabetes. Kim L Kelly, PharmD, BCPS, FCCP, CDTC, CPC, CEC Basal/Bolus Insulin: Better Pattern Control in Type 2 Diabetes Kim L Kelly, PharmD, BCPS, FCCP, CDTC, CPC, CEC What we ll cover Basal Insulin Basal initiation Basal alone vs. biphasic vs. prandial alone

More information

Diabetes and ramadan. K. Abdallah (Egypt)

Diabetes and ramadan. K. Abdallah (Egypt) Diabetes and ramadan K. Abdallah (Egypt) Diabetes and Ramadan Khalifa Abdallah Professor of Internal Medicine Unit of Diabetes & Metabolic Diseases Alexandria Faculty of Medicine Istanbul 9 MAY 2015 Disclosure

More information

Initiation and Titration of Insulin in Diabetes Mellitus Type 2

Initiation and Titration of Insulin in Diabetes Mellitus Type 2 Initiation and Titration of Insulin in Diabetes Mellitus Type 2 Greg Doelle MD, MS April 6, 2016 Disclosure I have no actual or potential conflicts of interest in relation to the content of this lecture.

More information

Antihyperglycemic Agents in Type 2 Diabetes

Antihyperglycemic Agents in Type 2 Diabetes Class Antihyperglycemic Agents in Type 2 Diabetes A1C Reduction Fasting vs PPG Hypoglycemia Weight Change Dosing (times/day) Outcome Studies Metformin 1.5 Fasting No Neutral 2 UKPDS Insulin, Long-acting

More information

Algorithms for Glycemic Management of Type 2 Diabetes

Algorithms for Glycemic Management of Type 2 Diabetes KENTUCKY DIABETES NETWORK, INC. Algorithms for Glycemic Management of Type 2 Diabetes The Diabetes Care Algorithms for Type 2 Diabetes included within this document are taken from the American Association

More information

Workshop A Tara Kadis

Workshop A Tara Kadis Workshop A Tara Kadis Considerations/barriers in decision making about insulin verses GLP-1 use in people with type 2 diabetes Which Insulin regimes should we consider? Diabetes is a progressive multi-system

More information

Insulin or GLP1 How to make this choice in Practice. Tara Kadis Lead Nurse - Diabetes & Endocrinology Mid Yorkshire Hospitals NHS Trust

Insulin or GLP1 How to make this choice in Practice. Tara Kadis Lead Nurse - Diabetes & Endocrinology Mid Yorkshire Hospitals NHS Trust Insulin or GLP1 How to make this choice in Practice Tara Kadis Lead Nurse - Diabetes & Endocrinology Mid Yorkshire Hospitals NHS Trust Workshop Over View Considerations/barriers to treatments in type 2

More information

Question 3: What are the new and emerging basal insulins and their features?

Question 3: What are the new and emerging basal insulins and their features? Question 3: What are the new and emerging basal insulins and their features? Case Vignette for Question 3 62-year-old white female with T2DM for 8 years Current diabetes medications: Metformin 1000 mg

More information

SLOWING DISEASE PROGRESSION IN TYPE 2 DIABETES: LATEST ADVANCES. DR. C.F. OTIENO Dept. of medicine, U.O.N

SLOWING DISEASE PROGRESSION IN TYPE 2 DIABETES: LATEST ADVANCES. DR. C.F. OTIENO Dept. of medicine, U.O.N SLOWING DISEASE PROGRESSION IN TYPE 2 DIABETES: LATEST ADVANCES DR. C.F. OTIENO Dept. of medicine, U.O.N UKPDS: progressive hyperglycemia on monotherapy in type 2 diabetes HbA 1c (%) 10 9 8 Conventional

More information

Comparative study of insulin glargine and NPH insulin in poorly controlled type 2 diabetic patients on OHA

Comparative study of insulin glargine and NPH insulin in poorly controlled type 2 diabetic patients on OHA Original article: Comparative study of insulin glargine and NPH insulin in poorly controlled type 2 diabetic patients on OHA Dr. Anurag Prasad,* Dr. Muzaffari Yasmeen,** Dr. Suchitra G Prasad,*** Dr. Md

More information

Case Vignette for Question 5

Case Vignette for Question 5 Question 5: What are the options for intensifying therapy when basal insulin has not achieved target glycemia? Case Vignette for Question 5 64-year-old man with 9-year history of T2DM Current diabetes

More information

GLP-1 Agonists And Insulin Therapy

GLP-1 Agonists And Insulin Therapy GLP-1 Agonists And Insulin Therapy Steven V. Edelman, MD Professor of Medicine University of California San Diego School of Medicine Veterans Affairs Medical Center Founder and Director, Taking Control

More information

Hypoglycemia as a risk factor for cardiovascular disease and mortality

Hypoglycemia as a risk factor for cardiovascular disease and mortality Hypoglycemia as a risk factor for cardiovascular disease and mortality Dong-Jun Kim, M.D.,PhD. Department of Internal Medicine, Inje University College of Medicine Hypoglycemia: the most important complication

More information

Comparing Medications for Adults With Type 2 Diabetes Focus of Research for Clinicians

Comparing Medications for Adults With Type 2 Diabetes Focus of Research for Clinicians Clinician Research Summary Diabetes Type 2 Diabetes Comparing Medications for Adults With Type 2 Diabetes Focus of Research for Clinicians A systematic review of 166 clinical studies published between

More information

Cardiovascular Outcomes With Alogliptin in Patients With Type 2 Diabetes Mellitus and Recent Acute Coronary Syndromes

Cardiovascular Outcomes With Alogliptin in Patients With Type 2 Diabetes Mellitus and Recent Acute Coronary Syndromes Cardiovascular Outcomes With Alogliptin in Patients With Type 2 Diabetes Mellitus and Recent Acute Coronary Syndromes William B. White, MD for the EXAMINE Investigators Cardiology Center, University of

More information

UPDATE ON MANAGEMENT OF TYPE 2 DIABETES NEW AND OLD TREATMENT OPTIONS

UPDATE ON MANAGEMENT OF TYPE 2 DIABETES NEW AND OLD TREATMENT OPTIONS UPDATE ON MANAGEMENT OF TYPE 2 DIABETES NEW AND OLD TREATMENT OPTIONS Mayer B. Davidson, MD Professor of Medicine Charles Drew University & David Geffen School of Medicine at UCLA CURRENT AMERICAN DIABETES

More information

Insulin Analogues versus Pump Therapy in Type 2 Diabetes: Benefits from Pump Therapy

Insulin Analogues versus Pump Therapy in Type 2 Diabetes: Benefits from Pump Therapy Insulin Analogues versus Pump Therapy in Type 2 Diabetes: Benefits from Pump Therapy Eric RENARD, MD, PhD Endocrinology Dept, Lapeyronie Hospital Montpellier, France e-renard@chu-montpellier.fr Type 2

More information

Glycemic Control and the Impact on CVD Risk in Diabetes

Glycemic Control and the Impact on CVD Risk in Diabetes Glycemic Control and the Impact on CVD Risk in Diabetes The Case for Intensive Glucose Control David M. Kendall, MD Chief Scientific and Medical Officer Glucose and CVD Risk: From UGDP to ACCORD Glycemic

More information

GLP-1 Receptor Agonists (Byetta /Victoza ) Step Therapy Criteria

GLP-1 Receptor Agonists (Byetta /Victoza ) Step Therapy Criteria GLP-1 Receptor Agonists (Byetta /Victoza ) Step Therapy Criteria Brand Generic Dosage Form Byetta exenatide subcutaneous injection Victoza liraglutide subcutaneous injection PROGRAM OBJECTIVES The intent

More information

Cardiovascular Effects of Drugs to Treat Diabetes

Cardiovascular Effects of Drugs to Treat Diabetes Cardiovascular Effects of Drugs to Treat Diabetes Steven E. Nissen MD Chairman, Department of Cardiovascular Medicine Cleveland Clinic Disclosure Consulting: Many pharmaceutical companies Clinical Trials:

More information

The majority of patients destined to develop

The majority of patients destined to develop RATIONALE FOR DIFFERENT AND EFFECTIVE TREATMENT APPROACHES IN TYPE 2 DIABETES * Martin J. Abrahamson, MD ABSTRACT The most common cause of mortality in diabetes is macrovascular disease, specifically coronary

More information

Prediabetes Treatment Algorithm

Prediabetes Treatment Algorithm Prediabetes Treatment Algorithm T2DM = type 2 diabetes mellitus BP = blood pressure CVD = cardiovascular disease TZD = thiazolidinedione GLP-1 RA= glucagon-like peptide-1 receptor agonist Weight-loss agents

More information

Britni Hebert, MD PGY-1

Britni Hebert, MD PGY-1 Britni Hebert, MD PGY-1 Importance of Diabetes treatment Types of treatment Comparison of treatment/article Review Summary Example cases 1 out of 13 Americans have diabetes Complications include blindness,

More information

Treating Diabetes Mellitus

Treating Diabetes Mellitus Focus on CME at the University of Alberta Tips for Type 2: Treating Diabetes Mellitus Edmond A. Ryan, MD, FRCPI, FRCPC How should I approach Type 2 diabetes? The approach to Type 2 diabetes encompasses

More information

When It s Time to Intensify What Are The Options?

When It s Time to Intensify What Are The Options? When It s Time to Intensify What Are The Options? with a focus on injectable options Prof. Bernard Charbonnel, University of Nantes - France Disclosures Bernard Charbonnel has received fees for consultancy,

More information

Insulin Therapy In Type 2 DM. Sources of support. Agenda. Michael Fischer, M.D., M.S. The underuse of insulin Insulin definition and types

Insulin Therapy In Type 2 DM. Sources of support. Agenda. Michael Fischer, M.D., M.S. The underuse of insulin Insulin definition and types Insulin Therapy In Type 2 DM Michael Fischer, M.D., M.S. Sources of support NaRCAD is supported by a grant from the Agency for Healthcare Research and Quality My current research projects are funded by

More information

Insulin Algorithm for Type 2 Diabetes Mellitus in Children and Adults

Insulin Algorithm for Type 2 Diabetes Mellitus in Children and Adults Insulin Algorithm for Type 2 Diabetes Mellitus in Children and Adults Stock # 45-11647 Revised 10/28/10 Glycemic Goals 1,2 Individualize goal based on patient risk factors A1c 6%

More information

Farmaci iniettivi e SGLT-2 inibitori

Farmaci iniettivi e SGLT-2 inibitori Farmaci iniettivi e SGLT-2 inibitori Giorgio Sesti Università Magna Graecia di Catanzaro Il Prof Giorgio Sesti dichiara di aver ricevuto negli ultimi due anni compensi o finanziamenti dalle seguenti Aziende

More information

Diabetes: An Introduction. UT Health Science Center

Diabetes: An Introduction. UT Health Science Center Diabetes: An Introduction UT Health Science Center DIABETES MELLITUS A metabolic disorder with multiple causes characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein

More information

Chromium and Diabetes. Thomas Morrow MD

Chromium and Diabetes. Thomas Morrow MD Chromium and Diabetes Thomas Morrow MD 1 Presentation Objectives Diabetes statistics What is chromium? What is biotin? What is Diachrome? Discuss the role of chromium (Cr +3 ) and biotin in insulin and

More information

Randomized Trial of Fructosamine Home Monitoring in Patients with Diabetes. ) and can be monitored in the home. absolute decrease of HbA 1c

Randomized Trial of Fructosamine Home Monitoring in Patients with Diabetes. ) and can be monitored in the home. absolute decrease of HbA 1c ORIGINAL ARTICLE DIANA B. PETITTI, MD, MPH RICHARD CONTRERAS, MS Kaiser Permanente Southern California Research and Evaluation Pasadena, Calif JAMES DUDL, MD Kaiser Permanente Southern California Department

More information

Novel Trial Designs in T2D to Satisfy Regulatory Requirements for CV Safety

Novel Trial Designs in T2D to Satisfy Regulatory Requirements for CV Safety Novel Trial Designs in T2D to Satisfy Regulatory Requirements for CV Safety Anders Svensson MD, PhD Head of Global Clinical Development Metabolism, F Hoffmann LaRoche Ltd. Basel, Switzerland Overview of

More information

Rationale for ADA Treatment Guidelines for CVD Prevention. Robert E. Ratner, MD American Diabetes Association

Rationale for ADA Treatment Guidelines for CVD Prevention. Robert E. Ratner, MD American Diabetes Association Rationale for ADA Treatment Guidelines for CVD Prevention Robert E. Ratner, MD American Diabetes Association 1 No Financial Disclosures 2 Trends in age-standardized rates of diabetes-related complications

More information

MANAGEMENT OF HYPERGLYCEMIA IN THE NONCRITICAL CARE SETTING

MANAGEMENT OF HYPERGLYCEMIA IN THE NONCRITICAL CARE SETTING MANAGEMENT OF HYPERGLYCEMIA IN THE NONCRITICAL CARE SETTING 1 RECOGNITION AND DIAGNOSIS OF HYPERGLYCEMIA IN NONCRITICALLY ILL PATIENTS 2 RECOGNITION AND DIAGNOSIS OF HYPERGLYCEMIA AND DIABETES IN THE HOSPITAL

More information

Synopsis. Name of the sponsor Name of the finished product Name of active ingredient Study ID. Title of the study. Investigators and study centers:

Synopsis. Name of the sponsor Name of the finished product Name of active ingredient Study ID. Title of the study. Investigators and study centers: Synopsis Name of the sponsor Name of the finished product Name of active ingredient Study ID Title of the study Investigators and study centers: Related publications Takeda Global Research & Development

More information

Perioperative Diabetes management. Meera Luthra MD, FRCP(C) Endocrinology and Metabolism Assistant Professor of Medicine McMaster University

Perioperative Diabetes management. Meera Luthra MD, FRCP(C) Endocrinology and Metabolism Assistant Professor of Medicine McMaster University Perioperative Diabetes management Meera Luthra MD, FRCP(C) Endocrinology and Metabolism Assistant Professor of Medicine McMaster University Objectives To discuss the evidence for perioperative glycemic

More information

ABHB CEPP 2013/14 GLP-1 agonists for the treatment of type 2 diabetes Clinical audit tool

ABHB CEPP 2013/14 GLP-1 agonists for the treatment of type 2 diabetes Clinical audit tool ABHB CEPP 2013/14 GLP-1 agonists for the treatment of type 2 diabetes Clinical audit tool This document can be used as a local clinical audit project that aims to ensure that treatment with glucagon-like

More information

Type 2 Diabetes Mellitus Incretin Based Therapy

Type 2 Diabetes Mellitus Incretin Based Therapy Type 2 Diabetes Mellitus Incretin Based Therapy Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Type 2 Diabetes Mellitus

More information

When and how to start insulin: strategies for success in type 2 diabetes

When and how to start insulin: strategies for success in type 2 diabetes 1 When and how to start insulin: strategies for success in type diabetes Treatment of type diabetes in 199: with each step treatment gets more complex Bruce H.R. Wolffenbuttel, MD PhD Professor of Endocrinology

More information

Fifty years of type 2 diabetes clinical trials: a short review

Fifty years of type 2 diabetes clinical trials: a short review Principles and Practice of Clinical Research Journal http://ppcr.org/journal/home-current ISSN: 2378-1890 Short Review Fifty years of type 2 diabetes s: a short review Thiago Bosco Mendes¹, Iago Navas

More information

This article is a CME certified activity. To earn credit for this activity visit:

This article is a CME certified activity. To earn credit for this activity visit: This article is a CME certified activity. To earn credit for this activity visit: http://cme.medscape.com/viewarticle/707234 cme.medscape.com From MedscapeCME Family Medicine > Best Evidence Review Metformin

More information

Management of Diabetes: A Primary Care Perspective. Presentation Outline

Management of Diabetes: A Primary Care Perspective. Presentation Outline Management of Diabetes: A Primary Care Perspective Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Presentation Outline

More information

Hyperglycemia and Diabetic Microvascular Complications (DMC)

Hyperglycemia and Diabetic Microvascular Complications (DMC) Hyperglycemia and Diabetic Microvascular Complications (DMC) Lois Jovanovic, MD CEO & Chief Scientific Officer Sansum Diabetes Research Institute Santa Barbara, California 1 Hyperglycemia and DMC: Outline

More information

Sponsor. Novartis Generic Drug Name. Vildagliptin. Therapeutic Area of Trial. Type 2 diabetes. Approved Indication. Investigational.

Sponsor. Novartis Generic Drug Name. Vildagliptin. Therapeutic Area of Trial. Type 2 diabetes. Approved Indication. Investigational. Clinical Trial Results Database Page 1 Sponsor Novartis Generic Drug Name Vildagliptin Therapeutic Area of Trial Type 2 diabetes Approved Indication Investigational Study Number CLAF237A2386 Title A single-center,

More information

Insulin and Oral Agents for Management of Diabetes in Pregnancy

Insulin and Oral Agents for Management of Diabetes in Pregnancy Insulin and Oral Agents for Management of Diabetes in Pregnancy Sandy Ramos, MD Associate Clinical Professor Division of Perinatology Department of Reproductive Medicine Outline Glycemic control goals

More information

DM Management in Elderly- What are the glucose targets?

DM Management in Elderly- What are the glucose targets? DM Management in Elderly- What are the glucose targets? AFSHAN ZAHEDI, BASC, MD, FRCP(C) ENDOCRINOLOGY WOMEN S COLLEGE HOSPITAL ASSISTANT PROFESSOR OF MEDICINE UNIVERSITY OF TORONTO NOVEMBER 2, 2011 Disclosures

More information

嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯

嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯 The Clinical Efficacy and Safety of Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors in Adults with Type 2 Diabetes Mellitus 嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯 Diabetes Mellitus : A group of diseases characterized

More information

CASE B1. Newly Diagnosed T2DM in Patient with Prior MI

CASE B1. Newly Diagnosed T2DM in Patient with Prior MI Newly Diagnosed T2DM in Patient with Prior MI 1 Our case involves a gentleman with acute myocardial infarction who is newly discovered to have type 2 diabetes. 2 One question is whether anti-hyperglycemic

More information

INPATIENT DIABETES MANAGEMENT Robert J. Rushakoff, MD Professor of Medicine Director, Inpatient Diabetes University of California, San Francisco

INPATIENT DIABETES MANAGEMENT Robert J. Rushakoff, MD Professor of Medicine Director, Inpatient Diabetes University of California, San Francisco INPATIENT DIABETES MANAGEMENT Robert J. Rushakoff, MD Professor of Medicine Director, Inpatient Diabetes University of California, San Francisco CLINICAL RECOGNITION Background: Appropriate inpatient glycemic

More information

Cardiovascular Disease in Diabetes

Cardiovascular Disease in Diabetes Cardiovascular Disease in Diabetes Where Do We Stand in 2012? David M. Kendall, MD Distinguished Medical Fellow Lilly Diabetes Associate Professor of Medicine University of MInnesota Disclosure - Duality

More information

Treatment of Type 2 Diabetes with Special Consideration to Reduce Hypoglycemia

Treatment of Type 2 Diabetes with Special Consideration to Reduce Hypoglycemia Treatment of Type 2 Diabetes with Special Consideration to Reduce Hypoglycemia Learning Objectives After participating in this educational activity, participants should be able to: 1. Apply strategies

More information

CASE A1 Hypoglycemia in an Elderly T2DM Patient with Heart Failure

CASE A1 Hypoglycemia in an Elderly T2DM Patient with Heart Failure Hypoglycemia in an Elderly T2DM Patient with Heart Failure 1 I would like to introduce you to Sophie, an elderly patient with long-standing type 2 diabetes, who has a history of heart failure, a common

More information

Diabetes: When To Treat With Insulin and Treatment Goals

Diabetes: When To Treat With Insulin and Treatment Goals Diabetes: When To Treat With Insulin and Treatment Goals Lanita. S. White, Pharm.D. Director, UAMS 12 th Street Health and Wellness Center Assistant Professor of Pharmacy Practice, UAMS College of Pharmacy

More information

A Pediatrician s Perspective of the Current State of Diabetes Management

A Pediatrician s Perspective of the Current State of Diabetes Management A Pediatrician s Perspective of the Current State of Diabetes Management Desmond Schatz, MD Professor of Pediatrics Medical Director, Diabetes Center University of Florida Financial Disclosure There are

More information

A Simplified Approach to Initiating Insulin. 4. Not meeting glycemic goals with oral hypoglycemic agents or

A Simplified Approach to Initiating Insulin. 4. Not meeting glycemic goals with oral hypoglycemic agents or A Simplified Approach to Initiating Insulin When to Start Insulin: 1. Fasting plasma glucose (FPG) levels >250 mg/dl or 2. Glycated hemoglobin (A1C) >10% or 3. Random plasma glucose consistently >300 mg/dl

More information

Self-Monitoring Blood Glucose (SMBG) Frequency & Pattern Tool

Self-Monitoring Blood Glucose (SMBG) Frequency & Pattern Tool Self-Monitoring Blood Glucose () Basal Insulin Only (To Target) NPH or long-acting analogue, typically given at. at least as often as is being given. Optional, less frequent can be done at other times

More information

Trends in Prescribing of Drugs for Type 2 Diabetes in General Practice in England (Chart 1) Other intermediate and long-acting insulins

Trends in Prescribing of Drugs for Type 2 Diabetes in General Practice in England (Chart 1) Other intermediate and long-acting insulins Type 2 Diabetes Type 2 diabetes is the most common form of diabetes, accounting for 90 95% of cases. 1 Charts 1 and 2 reflect the effect of increasing prevalence on prescribing and costs of products used

More information

Statins and Risk for Diabetes Mellitus. Background

Statins and Risk for Diabetes Mellitus. Background Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration

More information

GLP-1 analogs and DPP-4 inhibitors

GLP-1 analogs and DPP-4 inhibitors GLP-1 analogs and DPP-4 inhibitors Saturday 16 July, 2011 Keystone, Colorado Matthew C. Riddle Professor of Medicine Oregon Health & Science University Oregon Presenter Disclosure I have received the following

More information

CURRENT ISSUES IN DIABETES MANAGEMENT

CURRENT ISSUES IN DIABETES MANAGEMENT MANAGEMENT OF DIABETES: A Primary Care Perspective Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of Screening for Diabetes 2012

More information

CDA CPG 2016 Interim Update. Preferences & access to treatment. Program Director Knowledge Translation & Optimizing Care Models

CDA CPG 2016 Interim Update. Preferences & access to treatment. Program Director Knowledge Translation & Optimizing Care Models Safety of New Antihyperglycemics in Patients with Cardiovascular Disease Lori MacCallum, BScPhm, PharmD, RPh, CDE Assistant Professor, Leslie Dan Faculty of Pharmacy Sun Life Financial Professor in Wellness

More information

II: Results 1. General and laboratory data of objects: 2. Efficacy of glargine in the treatment of type 2 DM patients:

II: Results 1. General and laboratory data of objects: 2. Efficacy of glargine in the treatment of type 2 DM patients: Insulin Therapy and Blood Glucose Monitoring Evaluation of the Superiority of Glargine as Basal Insulin Replacement by Continuous Glucose Monitoring System WANG Xian-ling,Lu Ju-ming,PAN Chang-yu,MU Yi-ming,DOU

More information

Comparative Review of Oral Hypoglycemic Agents in Adults

Comparative Review of Oral Hypoglycemic Agents in Adults SECTION 18.5 Comparative Review of Oral Hypoglycemic Agents in Adults Harinder Chahal For WHO Secretariat Table of Contents Acronyms:... 3 I. Background and Rationale for the review:... 4 II. Medications

More information

Insulin pump therapy: then and now. Multiple cardiovascular risk intervention. Oxford Medicine Online

Insulin pump therapy: then and now. Multiple cardiovascular risk intervention. Oxford Medicine Online Oxford Medicine Online You are looking at 1-10 of 28 items for: evidence-based AND medicine MED00250 oxford_diabetes_library Insulin pump therapy: then and now John Pickup (ed.) DOI: 10.1093/med/9780199568604.003.0001

More information

Achieving Optimal Control In Type 2 Diabetes

Achieving Optimal Control In Type 2 Diabetes Achieving Optimal Control In Type 2 Diabetes Case Study 58 Year Old Journalist Type 2 DM Just Diagnosed HbA1C 7.3% Natural History of Type 2 Diabetes Glucose (mg/dl) Relative Function (%) 350 300 250 200

More information

Insulin therapy in type 2 diabetes

Insulin therapy in type 2 diabetes Med Clin N Am 88 (2004) 865 895 Insulin therapy in type 2 diabetes Trent Davis, MD, Steven V. Edelman, MD* Section of Diabetes/Metabolism, Veterans Affairs San Diego HealthCare System, 3350 La Jolla Village

More information

ADJUSTING INSULIN DOSES CONFLICTS OF INTEREST

ADJUSTING INSULIN DOSES CONFLICTS OF INTEREST ADJUSTING INSULIN DOSES CONFLICTS OF INTEREST Vahid Mahabadi, MD Research grants from Sanofi and Amylin Pharmaceutical Companies Mayer B. Davidson, MD Advisory Board Sanofi Pharmaceutical Company Chief

More information

Why and how to intensify diabetes treatment in Type 2 diabetes

Why and how to intensify diabetes treatment in Type 2 diabetes Why and how to intensify diabetes treatment in Type 2 diabetes Strategic choices to be made... Päivi Maria Paldánius Novartis Pharmaceuticals My disclosures Employee and share-owner of Novartis Worldwide

More information

Intensifying Insulin Therapy

Intensifying Insulin Therapy Intensifying Insulin Therapy Rick Hess, PharmD, CDE, BC-ADM Associate Professor Gatton College of Pharmacy, Department of Pharmacy Practice East Tennessee State University Johnson City, Tennessee Learning

More information

St. Michael's Hospital Research Ethics Board Guidance Document for Reviewing Clinical Trials in Diabetes

St. Michael's Hospital Research Ethics Board Guidance Document for Reviewing Clinical Trials in Diabetes St. Michael's Hospital Research Ethics Board Guidance Document for Reviewing Clinical Trials in Diabetes 1.0 Introduction This document provides guidance for members of the Research Ethics Board (REB)

More information

Diabetes Workshop. Type 1 Diabetic. In 2003 at age 42

Diabetes Workshop. Type 1 Diabetic. In 2003 at age 42 Diabetes Workshop September 30, 2014 Mark Schutta, M.D. G. Clayton Kyle Associate Professor of Diabetes Medical Director Penn Rodebaugh Diabetes Center Division of Endocrinology, Diabetes and Metabolism

More information

Type 2 diabetes is a progressive. status

Type 2 diabetes is a progressive. status Type 2 diabetes is a progressive disease: its treatment the current status Associate Professor Jonathan Shaw Why is type 2 diabetes so hard to treat? How to choose the right glucose-lowering g drug? Page

More information

Canadian Diabetes Association Clinical Practice Guidelines. Pharmacologic Management of Type 2 Diabetes

Canadian Diabetes Association Clinical Practice Guidelines. Pharmacologic Management of Type 2 Diabetes Canadian Diabetes Association Clinical Practice Guidelines Pharmacologic Management of Type 2 Diabetes Chapter 13 (Updated March 2016) William Harper, Maureen Clement, Ronald Goldenberg, Amir Hanna, Andrea

More information

IIMPROVED METABOLIC CONTROL IN PATIENTS WITH TYPE 1 AND TYPE 2 DIABETES FOLLOWING THE INITIATION/SWITCHING TO INSULIN GLARGINE (LANTUS ) IN CLINICAL

IIMPROVED METABOLIC CONTROL IN PATIENTS WITH TYPE 1 AND TYPE 2 DIABETES FOLLOWING THE INITIATION/SWITCHING TO INSULIN GLARGINE (LANTUS ) IN CLINICAL 465 IIMPROVED METABOLIC CONTROL IN PATIENTS WITH TYPE 1 AND TYPE 2 DIABETES FOLLOWING THE INITIATION/SWITCHING TO INSULIN GLARGINE (LANTUS ) IN CLINICAL PRACTICE STEPHAN A SCHREIBER AND ANIKA RUßMANN ABSTRACT

More information

Diabetes Weight Management in Clinical Practice: Why WAIT Program

Diabetes Weight Management in Clinical Practice: Why WAIT Program Diabetes Weight Management in Clinical Practice: Why WAIT Program Osama Hamdy, MD, PhD, FACE Medical Director, Obesity Clinical Program, Joslin Diabetes Center, Harvard Medical School Weight control in

More information

Reconciling Current Diabetes Guidelines

Reconciling Current Diabetes Guidelines Reconciling Current Diabetes Guidelines Jaime A. Davidson, MD, FACP. FACE Part 1. Diagnosis Welcome. I am Dr. Jaime Davidson, a clinical professor of medicine in the Department of Internal Medicine, Division

More information

Present and Future of Insulin Therapy: Research Rationale for New Insulins

Present and Future of Insulin Therapy: Research Rationale for New Insulins Present and Future of Insulin Therapy: Research Rationale for New Insulins Current insulin analogues represent an important advance over human insulins, but clinically important limitations of these agents

More information

Primary prevention of chronic kidney disease: managing diabetes mellitus to reduce the risk of progression to CKD

Primary prevention of chronic kidney disease: managing diabetes mellitus to reduce the risk of progression to CKD Primary prevention of chronic kidney disease: managing diabetes mellitus to reduce the risk of progression to CKD Date written: July 2012 Author: Kate Wiggins, Graeme Turner, David Johnson GUIDELINES We

More information

T2D in Children and Adolescents. William Tamborlane, M.D Professor and Chief of Pediatric Endocrinology Yale School of Medicine

T2D in Children and Adolescents. William Tamborlane, M.D Professor and Chief of Pediatric Endocrinology Yale School of Medicine T2D in Children and Adolescents William Tamborlane, M.D Professor and Chief of Pediatric Endocrinology Yale School of Medicine T2D Pathophysiology Pediatric vs Adult T2D The basic pathophysiology of T2D

More information

Lilly Diabetes: Pipeline Update

Lilly Diabetes: Pipeline Update Lilly Diabetes: Pipeline Update June 24, 2013 Safe Harbor Provision This presentation contains forward-looking statements that are based on management's current expectations, but actual results may differ

More information

Presented By: Dr. Nadira Husein

Presented By: Dr. Nadira Husein Presented By: Dr. Nadira Husein I have no conflict of interest Disclosures I have received honoraria/educational grants from the following: Novo Nordisk, Eli Lilly, sanofi-aventis, Novartis, Astra Zeneca,

More information