Beyond Metformin A Primary Care View of Diabetes Treatment. DeAnn Cummings, MD March 12, 2016
|
|
- Norma Benson
- 7 years ago
- Views:
Transcription
1 Beyond Metformin A Primary Care View of Diabetes Treatment DeAnn Cummings, MD March 12, 2016
2 Goals Review safety, tolerability, efficacy and cost of current meds available for treatment of type 2 diabetes mellitus Discuss strategies to figure out what med to use when
3 What I Will Not Cover Classification of DM Diagnosis of DM Type 1 DM Prevention of DM/ Pre-diabetes Lifestyle change Insulin mgt
4 Primary Resources AACE/ACE Comprehensive Type 2 Diabetes Management 2016 ADA Guidelines 2016 Up Do Date
5 Ways to Lower Glucose Decrease intake Diet Decreased gastric motility resulting in satiety Decrease absorption Increase amount of insulin Increase tissue sensitivity to insulin Decrease creation of glucose (gluconeogenesis) Increase excretion of glucose
6 The Alphabet Soup
7
8 Metformin (Biguanides) Actions Decreases creation of glucose in liver, increases insulin sensitivity, decrease intake of glucose Efficacy Decreases A1C by 1.5% UK Prospective Diabetes Study Decreased microvascular and neuropathic complications in intensive glycemic control group (A1C <7). At 10 year follow-up, decreased MI by 33% and decreased all-cause mortality by 27%
9 Metformin (Biguanides) Side effects GI can be mitigated if dose escalated slowly Decreased absorption of B12 Lactic acidosis (limits use in renal disease pts?) 9 cases/100,000 person-years of experience Cost generic, cheap ($)
10 Insulin Actions Increases insulin, decreases hepatic glucose production Efficacy Decreases HgBA1C by Safety Hypoglycemia Weight gain Cost moderate to expensive ($$ - $$$)
11
12 Sulfonylureas and Glinides Action Increase amount of insulin Efficacy Decreases A1C by 1-2 % Safety Lots of experience Hypoglycemia Weight gain Cost cheap (unless using glinide) - $-$$
13 Sulfonylureas and Glinides Meglitinides (glinides) Repaglinide (Prandin) Nateglinide (Starlix) Mitiglinide (Glufast) Sulfonylureas Glipizide (Glucotrol) Glyburide (Glynase, Micronase) Glimepride (Amaryl)
14 Sulfonylureas and Glinides Which do we choose? Glinides don t work quite as well as SFUs but have less hypoglycemia. They are also more costly. SFUs are much cheaper and work well to decrease blood glucose, but are more likely to cause hypoglycemia. Shorter-acting SFUs, like glipizide, are less likely to cause hypoglycemia
15 GLP-1 Receptor Agonists ( The Tides ) Action (Incretin-based) Decreases intake via decreased gastric motility and increased satiety Increases insulin secretion Decreases glucagon secretion Efficacy Decreases A1C by % Weight loss
16 The Tides Side effects GI symptoms?pancreatitis Cost expensive ($$$)
17 The Tides Exenatide (Byetta) Liraglutide (Victoza, Saxenda) Albiglutide (Tanzeum) Dulaglutide (Tulicity) Which one to choose? One has not been shown to be better than another Medicaid will cover Byetta Cannot use Byetta if GFR < 30
18 SGLT2 inhibitors (The Flozins ) Action Blocks glucose reabsorption by kidney Doesn t work if GFR < 45 Efficacy Decreases A1C by % Decreases weight and BP Possible decreased mortality (needs more study)
19 The Flozins Safety Increased genitourinary infections (fungal and bacterial) Polyuria, volume depletion, hypotension Increased LDL Cost Expensive ($$$)
20 The Flozins Canagliflozin (Invokana) Dapagliflozin (Farxiga) Empagliflozin (Jardiance) Which to choose? No difference identified in efficacy or safety Medicaid will cover Invokana
21 DPP-4 inhibitors (The Gliptins ) Action (Incretin-based) Increases insulin secretion Decreases glucagon secretion Efficacy Decreases A1C by % Side effects Not much Need to adjust dose in renal disease Cost Expensive ($$$)
22 The Gliptins Sitagliptin (Januvia) Vildagliptin (Galvus) Saxagliptin (Onglyza) Linagliptin (Tradjenta) Alogliptin (Takeda) Which to choose? No clear differences. Lingagliptin better in renal disease. Medicaid will cover Januvia
23 Thiazolidinediones (The Glitazones ) Action Increases insulin sensitivity Efficacy Decreases A1C by % Side effects Weight gain Increased risk bone fracture Increased risk CHF? Bladder cancer Cost Cheap ($)
24 The Glitazones Pioglitazone (Actos) Rosiglitazone (Avandia) withdrawn from market in Europe due to cardiac concerns
25 Alpha-Glucosidase Inhibitors Action Decreased intestinal absorption of glucose Efficacy Decreases A1C by % Side effects Diarrhea, flatulence Cost low-moderate ($-$$)
26 Alpha-Glucosidase Inhibitors Acarbose (Precose) Miglitol (Glyset) Voglibose No guidelines are excited about these Too frequent dosing Too many side effects Don t work that well
27 Amylin Analog Action Decreases glucagon secretion Slows gastric emptying Efficacy Decreases A1C by % Side effects Hypoglycemia, GI Cost expensive Pramlintide (Symlin) Guidelines not excited
28 Colesevelam Action Bile acid sequestrant? Decreases hepatic glucose production? Increase incretin levels Efficacy Modest Side Effects constipation, increased TG Cost Expensive ($$$)
29 Bromocriptine Action Increases insulin sensitivity Efficacy Modest Side effects Nausea, dizziness, fatigue Cost Expensive ($$$) Definitely bottom-of-the-list
30 Case #1 45 year old female presents to your office for follow-up of routine labs. She has a strong family history of diabetes. PMH is significant for HTN, treated with Lisinopril. She denies any symptoms of hyper or hypoglycemia. HgBA1C = 8.0 Random glucose = 210 Creatinine = 1.0, GFR = 65 All other labs are normal.
31 Case #1 Exam BP = 140/90, HR = 92, BMI = 34 Other than obesity, her exam is normal What is your initial recommendation? Lifestyle change OR Lifestyle change + metformin
32 Initial Management ADA Guidelines Can try lifestyle modification alone for 3-6 months if A1C close to goal (< 7.5%) Should start metformin if it looks like lifestyle changes are not working. AACE Guidelines Start with both metformin and lifestyle intervention
33 Case #1 After 3 months of lifestyle modification and max dose metformin, pt s A1C is still 8.0. What is her target A1C?
34 Target A1C ADA Guidelines For many adults, a goal of 7.0% is appropriate For patients at high risk for hypoglycemia, aim for < 8.0% Older patients Patients with history hypoglycemia Patients with co-morbidities Long duration of DM Aim for < 6.5% in younger, healthier people
35 Target A1C UK Prospective Diabetes Study Intensive glucose control decreased rate of microvascular complications and neuropathic complications (A1C < 7%) No significant difference in CV events during trial HOWEVER, at 10 year follow-up, rate of MI was decreased by 15% in the sulfonylurea group and 33% in metformin group All-cause mortality was decreased by 13% in the sulfonylurea group and by 27% in the metformin group Patients in this study had shorter duration of DM
36 Target A1C ACCORD, ADVANCE and VADT All had increased mortality in the intensive glycemic control arm. ACCORD A1C < 6 ADVANCE A1C < 6.5 VADT 1.5% decrease in A1C ACCORD was halted early due to increased mortality Pt population for these studies different than UKPDS
37 Target A1C ADA guidelines Risks of lower glycemic targets outweigh the potential benefits on microvascular complications in high risk patients.
38
39 Target A1C AACE guidelines Goal A1C of for younger, healthier people Goal A1C of 7-8 in older, high risk people Should definitely NOT try to get these patients < 6.5
40 Target A1C Take Home Message Individualize target A1C to patient Getting the A1C as low as possible may not be a good idea
41 Case #1 What treatment will you add to metformin and lifestyle modification? Sulfonylurea Basal insulin GLP-1 receptor agonist SGLT-2 inhibitors DPP-4 inhibitors Thiazolidinediones (TZDs)
42 Dual Therapy ADA Guidelines If after 3 months of lifestyle intervention plus metformin there is no improvement in A1C, start a second agent They DO NOT specify which one However they do not recommend alpha-glucosidase inhibitors, amylin analogs, bromocriptine or colesevalam They also suggest that the newer drugs may be low-value (BIG price and not much efficacy)
43
44 Dual Therapy AACE Guidelines Rank options GLP-1 agonists (tides) SGLT-2 inhibitors (flozins) DPP-4 inhibitors (gliptins) TZDs Basal insulin Colesevalam Bromocriptine Alpha-glucosidase inhibitors Sulfonylureas/glinides
45 Dual Therapy AACE Guidelines Sulfonylureas and glinides are on the bottom!! Basal insulin close to the bottom! Their rationale is that the high risk of hypoglycemia and weight gain pushes these agents down the list.
46
47 Dual Therapy Up To Date STRONGLY recommends sulfonylurea or basal insulin as the next add-on therapy after metformin Their reasoning is that these agents have the best efficacy and, for sulfonylureas, there may be decrease in CV events (macrovascular complications).
48 Dual Therapy SO WHAT DO WE DO??? There are advantages and disadvantages to all options. Must individualize for each patient A healthy 40 year old might benefit more from insulin or sulfonylurea An elderly, frail patient might be better off with something that causes less hypoglycemia
49 Dual Therapy GRADE Trial On going study comparing sulfonylureas, basal insulin, DPP-4 inhibitors (gliptins), and GLP-1 agonists (tides) as add on therapy to metformin Stay tuned
50 Case #1 After 3 months on metformin and glipizide, her A1C = 9 and her BMI has increased to 38. What do you want to do now? Add another agent and, if so, which one? OR do you want to work on her obesity? OR BOTH
51 Triple Therapy ADA guidelines Any agent is okay but leans toward basal insulin AACE guidelines Basal insulin moves up on the list but is still behind the tides, the flozins and the TZDs Up to Date definitely recommends insulin If starting insulin, should probably stop sulfonylurea.
52 Case #2 80 year old male presents for follow-up DM. He has been on max dose metformin for 15 years and his latest A1C is 8. He has no hyper or hypoglycemia symptoms. PMH HTN, DM, Hyperlipidemia BMI = 29, GFR = 65 What would you like to add? OR are you happy with A1C of 8?
53 Case #2 According to guidelines, you could keep him at an A1C of 8 It really depends on the patient A GOOD 80 year old might benefit from lower A1C but need to watch closely for hypoglycemia. Probably would not select a sulfonylurea and some concern with insulin as well. Would this patient be better off with one of the newer agents that does not cause hypoglycemia??
54 Case #3 65 year old female with DM treated with lifestyle intervention up to this point. Now with A1C = 9.0 Her BMI = 33, GFR = 40 Can we use metformin?
55 Metformin in Renal Insufficiency Package insert Contraindicated in women with creatinine of 1.4 or more and in men with creatinine of 1.5 or more (= GFR < 60 in older adults) However, lactic acidosis is very rare if GFR > 30 and no acute progression of renal disease. Therefore many recommend use of metformin at half dose (max 1000 mg/day) in pts with GFR 30-60
56 Metformin Contraindications Anything causing hypoperfusion and/or hypoxia Acute or progressive renal failure Acute or progressive heart failure Acute pulmonary decompensation Sepsis Dehydration Basically, pts should stop metformin if acutely ill
57 Case #4 55 year old female, with no PMH, presents due to abnormal labs. No symptoms. Her A1C = 13 and random blood sugar = 310 Her BMI = 40. Normal renal function. What do you want to do?
58 Initial Severe Hyperglycemia ADA Guidelines Start basal insulin initially if A1C >10 and/or random blood sugar of AACE Guidelines Consider starting basal insulin initially if A1C > 9 Both guidelines suggest taking patient off insulin once blood sugars controlled.
Pharmaceutical Management of Diabetes Mellitus
1 Pharmaceutical Management of Diabetes Mellitus Diabetes Mellitus (cont d) Signs and symptoms 2 Elevated fasting blood glucose (higher than 126 mg/dl) or a hemoglobin A1C (A1C) level greater than or equal
More informationType 2 Diabetes Medicines: What You Need to Know
Type 2 Diabetes Medicines: What You Need to Know Managing diabetes is complex because many hormones and body processes are at work controlling blood sugar (glucose). Medicines for diabetes include oral
More informationNoninsulin Diabetes Medications Summary Chart Medications marked with an asterisk (*) can cause hypoglycemia MED GROUP DESCRIPTOR
Noninsulin Diabetes Medications Summary Chart Medications marked with an asterisk (*) can cause MED GROUP DESCRIPTOR INSULIN SECRETAGOGUES Sulfonylureas* GLYBURIDE* (Diabeta) (Micronase) MICRONIZED GLYBURIDE*
More informationTargeting the Kidney. Renal Glucose Transport 11/4/2015. Non insulin Agents Available IBITORS. Chao EC, et al. Nat Rev Drug Discovery. 2010;9:551 559.
SGLT-2i and DPP-IVi in the Management of Diabetes Mellitus Type 2 Abel Alfonso, D.O., F.A.C.E. Endocrinologist November 5, 2015 DIABETES: CURRENT RATES AND PROJECTIONS CDC Press Release 2010: 1 in 3 adults
More informationHow To Treat Diabetes
Overview of Diabetes Medications Marie Frazzitta DNP, FNP c, CDE, MBA Senior Director of Disease Management North Shore LIJ Health Systems Normal Glucose Metabolism Insulin is produced by beta cells in
More informationAcarbose INITIAL: 25 mg PO TID ($45) Miglitol INITIAL: 25 mg PO TID ($145)
PL Detail-Document #310601 This PL Detail-Document gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER June 2015 Drugs for Type 2
More informationComparing 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 informationDIABETES EDUCATION. *Read package insert each time you refill your medications in case there is new information SULFONYLUREAS
DIABETES EDUCATION *Read package insert each time you refill your medications in case there is new information SULFONYLUREAS ACTION: Sulfonylureas stimulate the pancreas to make more insulin (pancreas
More informationVolume 01, No. 08 November 2013
State of New Jersey Department of Human Services Division of Medical Assistance & Health Services New Jersey Drug Utilization Review Board Volume 01, No. 08 November 2013 TO: SUBJECT: PURPOSE: Physicians,
More information10/30/2012. Anita King, DNP, RN, FNP, CDE, FAADE Clinical Associate Professor University of South Alabama Mobile, Alabama
Faculty Medications for Diabetes Satellite Conference and Live Webcast Wednesday, November 7, 2012 2:00 4:00 p.m. Central Time Anita King, DNP, RN, FNP, CDE, FAADE Clinical Associate Professor University
More informationUpdate on the management of Type 2 Diabetes
Update on the management of Type 2 Diabetes Mona Nasrallah M.D Assistant Professor, Endocrinology American University of Beirut 10 th Annual Family Medicine Conference October 14,2011 Global Prevalence
More informationAdd: 2 nd generation sulfonylurea or glinide or Add DPP-4 inhibitor Start or intensify insulin therapy if HbA1c goals not achieved with the above
Guidelines for Type Diabetes - Diagnosis Fasting Plasma Glucose (confirm results if borderline) HbAIC Normal FPG < 00 < 5.5 Impaired Fasting Glucose (IFG) 00 to < 5.7%-.5% Diabetes Mellitus (or random
More informationDIABETES MEDICATION-ORAL AGENTS AND OTHER HYPOGLYCEMIC AGENTS
Section Two DIABETES MEDICATION-ORAL AGENTS AND OTHER HYPOGLYCEMIC AGENTS This section will: Describe oral agents (pills) are specific for treating type 2 diabetes. Describe other hypoglycemic agents used
More informationMedicines Used to Treat Type 2 Diabetes
Goodman Diabetes Service Medicines Used to Treat Type 2 Diabetes People who have type 2 diabetes may need to take medicine to help lower their blood glucose, in addition to being active & choosing healthy
More informationMary Bruskewitz APN, MS, RN, BC-ADM Clinical Nurse Specialist Diabetes
Mary Bruskewitz APN, MS, RN, BC-ADM Clinical Nurse Specialist Diabetes Objectives Pathophysiology of Diabetes Acute & Chronic Complications Managing acute emergencies Case examples 11/24/2014 UWHealth
More informationMedicines for Type 2 Diabetes A Review of the Research for Adults
Medicines for Type 2 Diabetes A Review of the Research for Adults Is This Information Right for Me? Yes, if: Your doctor or health care provider has told you that you have type 2 diabetes and have high
More informationGuidelines for Type 2 Diabetes Diagnosis
Guidelines for Type 2 Diabetes Diagnosis Fasting Plasma Glucose (in asymptomatic individuals, repeat measurement to confirm the test) Normal FPG < 100 2-hr OGTT < 140 HbA1C < 5.5% Impaired Fasting Glucose
More information25 mg QD-TID @ meals w/1st bite of. food, titrate Q 4 8 weeks; adjust based on 1 postprandial glucose; 100 mg TID max
Table Selected Non-Insulin Antihyperglycemic Agents Class Drug (Brand) Dosing Comments -Glucosidase inhibitors Acarbose a (Precose) 25 mg QD-TID @ meals w/1st bite of MOA: Enzyme inhibitor, delays hydrolysis
More informationPills for Type 2 Diabetes. A Guide for Adults
Pills for Type 2 Diabetes A Guide for Adults December 2007 Fast Facts on Diabetes Pills n Different kinds of diabetes pills work in different ways to control blood sugar (blood glucose). n All the diabetes
More informationwe have to keep up. Timothy S. Reid, M.D. Mercy Diabetes Center Janesville, WI Entity Activity Financial Consideration Comments
Timothy S. Reid, M.D. Mercy Diabetes Center Janesville, WI Entity Activity Financial Consideration Comments Novo Nordisk Speaker/Consultant Speaker Fees/Honoraria Sanofi-Aventis Speaker/Consultant Speaker
More informationManagement 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 informationDiabetes Mellitus Pharmacology Review
Diabetes Mellitus Pharmacology Review Hien T. Nguyen, Pharm.D., BCPS Clinical Pharmacist Specialist AtlantiCare Regional Medical Center E-Mail: HienT.Nguyen@atlanticare.org Objectives 1. Review the epidemiology
More informationMaking Clinical Sense of Diabetes Medications. Types of Diabetes. Pathophysiology. Beta Cell Function & Glucagon
Making Clinical Sense of Diabetes Medications Kathy Reily, RD, CDE Prince William Hospital Diabetes Program Coordinator Virginia Dietetic Association April 4, 2011 Types of Diabetes Type 1 DM = Beta Cell
More informationDiabetes Medications. Minal Patel, PharmD, BCPS
Diabetes Medications Minal Patel, PharmD, BCPS Objectives Examine advantages and disadvantages of oral anti-hyperglycemic medications Describe the differences between different classes of insulin Explore
More informationType 2 Diabetes. Aims and Objectives. What did you consider? Case Study One: Miss S. Which to choose?!?! Modes of Action
Aims and Objectives This session will outline the increasing complexities of diabetes care, and the factors that differentiate the combinations of therapy, allowing individualisation of diabetes treatment.
More informationFYI: (Acceptable range for blood glucose usually 70-110 mg/dl. know your institutions policy.)
How Insulin Works: Each type of insulin has an onset, a peak, and a duration time. Onset is the length of time before insulin reaches the bloodstream and begins lowering blood Peak is the time during which
More informationApproximate Cost Reference List i for Antihyperglycemic Agents
Alpha Glucosidase Inhibitor Acarbose (Glucobay ) Biguanides Metformin (Glucophage, generic) Metformin ER (Glumetza ) Approximate Cost Reference List i for Antihyperglycemic Agents Incretin Agents - DPP-4
More informationTreatment of Type 2 Diabetes
Improving Patient Care through Evidence Treatment of Type 2 Diabetes This information is based on a comprehensive review of the evidence for best practices in the treatment of type 2 diabetes and is sponsored
More informationClinical Assistant Professor. Clinical Pharmacy Specialist Wesley Family Medicine Residency Program. Objectives
What s New in Diabetes Medications? Matthew Kostoff, PharmD, BCPS, BCACP Clinical Assistant Professor Clinical Pharmacy Specialist Wesley Family Medicine Residency Program Objectives Discuss new literature
More informationSHORT CLINICAL GUIDELINE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SHORT CLINICAL GUIDELINE SCOPE 1 Guideline title Type 2 diabetes: newer agents for blood glucose control in type 2 diabetes 1.1 Short title Type 2
More informationAntidiabetic Drugs. Mosby items and derived items 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Antidiabetic Drugs Mosby items and derived items 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Diabetes Mellitus Two types Type 1 Type 2 Type 1 Diabetes Mellitus Lack of insulin production
More informationDiabetes: Medications
Diabetes: Medications Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (APS HCQU) May 2008 sh Disclaimer Information or education provided by the HCQU is not intended to replace medical
More informationCASE 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 informationFundamentals of Diabetes Care Module 5, Lesson 1
Module 5, Lesson 1 Fundamentals of Diabetes Care Module 5: Taking Medications Healthy Eating Being Active Monitoring Taking Medication Problem Solving Healthy Coping Reducing Risks Foundations For Control
More informationDiabetes Mellitus Type 2
Diabetes Mellitus Type 2 What is it? Diabetes is a common health problem in the U.S. and the world. In diabetes, the body does not use the food it digests well. It is hard for the body to use carbohydrates
More informationAntihyperglycemic Agents Comparison Chart
Parameter Metformin Sulfonylureas Meglitinides Glitazones (TZD s) Mechanism of Action Efficacy (A1c Reduction) Hepatic glucose output Peripheral glucose uptake by enhancing insulin action insulin secretion
More informationDiabetes Medications at the End of Life. Goals and Objectives. Diabetes. Type 2 Diabetes Mellitus. Types of Diabetes
Diabetes Medications at the End of Life Paul J. Schmidt Jr., R.Ph., M.S. Clinical Supervisor HospiScript Services pschmidt@hospiscript.com Goals and Objectives Describe the Current Impact of Diabetes Mellitus
More information6/22/2015. New medicines for type 2 diabetes when do you use them
New medicines for type 2 diabetes when do you use them 1. Oral Secretagogues (e.g. sulfonylureas) 2. Metformin 3. Alpha glucosidase inhibitors 4. Thiazolidinediones 5. GLP-1 receptor agonists 6. DPP-4
More informationCara Liday, PharmD, CDE Associate Professor, Idaho State University Clinical Pharmacist and CDE, InterMountain Medical Center Pocatello, ID The planners and presenter have disclosed no conflict of interest,
More informationHow To Help People With Diabetes
Diabetes Medications and Medication Management Christopher Lamer, PharmD, MHS, BCPS, CDE November 2013 Okay, great. Well, I want to say thank you very much for giving me the opportunity to present and
More informationDiabetes Mellitus 1. Chapter 43. Diabetes Mellitus, Self-Assessment Questions
Diabetes Mellitus 1 Chapter 43. Diabetes Mellitus, Self-Assessment Questions 1. A 46-year-old man presents for his annual physical. He states that he has been going to the bathroom more frequently than
More informationThe prevalence of diabetes in the United States in
Medical Management of Type 2 Diabetes Celia Levesque, CNS-BC ABSTRACT More than 20 million Americans have type 2 diabetes. Managing blood glucose is an important component in delaying, slowing, or preventing
More informationOral Therapy for Type 2 Diabetes
Oral Therapy for Type 2 Diabetes Diabetes pills can help to manage your blood sugar. These pills are not insulin. They work to manage your blood sugar in several ways. You may be given a combination of
More informationType 2 Diabetes Medications: SGLT2 Inhibitors
Type 2 Diabetes Medications: SGLT2 Inhibitors SGLT2 inhibitors are a class of type 2 diabetes medications used along with diet and exercise to lower blood glucose How are they taken? SGLT2 inhibitors is
More informationPrimary Care Type 2 Diabetes Update
Primary Care Type 2 Diabetes Update May 16, 2014 Presented by: Barb Risnes APRN, BC-ADM, CDE Objectives: Discuss strategies to address common type 2 diabetes patient management challenges Review new pharmacological
More informationClass Update: Diabetes Medications. Month/Year of Review: September 2014 End date of literature search: August 2014
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationDiabetes Update Lanita S. Shaverd, Pharm.D. Director, UAMS 12 th Street Health and Wellness Center Assistant Professor, UAMS College of Pharmacy
Objectives Review oral medications used for the treatment of diabetes Explain how to effectively combine oral diabetes medications for optimal results Discuss insulins and non-insulin injectable diabetes
More informationtrends in the treatment of Diabetes type 2 - New classes of antidiabetic drugs. IAIM, 2015; 2(4): 223-
Review Article Pharmacological trends in the treatment of Diabetes type 2 - New classes of antidiabetic Silvia Mihailova 1*, Antoaneta Tsvetkova 1, Anna Todorova 2 1 Assistant Pharmacist, Education and
More informationALL IN THE FAMILY 75 YEARS OF DIABETES TREATMENT OPTIONS FROM GLASS SYRINGES TO SGLT2 INHIBITORS PETER A. KRECKEL, R.PH.
ALL IN THE FAMILY 75 YEARS OF DIABETES TREATMENT OPTIONS FROM GLASS SYRINGES TO SGLT2 INHIBITORS PETER A. KRECKEL, R.PH. ALL IN THE FAMILY 75 YEARS OF DIABETES TREATMENT OPTIONS FROM GLASS SYRINGES TO
More informationSecond- and Third-Line Approaches for Type 2 Diabetes Workgroup: Topic Brief
Second- and Third-Line Approaches for Type 2 Diabetes Workgroup: Topic Brief March 7, 2016 Session Objective: The objective of this workshop is to assess the value of undertaking comparative effectiveness
More informationManagement of Clients with Diabetes Mellitus
Management of Clients with Diabetes Mellitus Black, J.M. & Hawks, J.H. (2005) Chapters 47, (pp 1243-1288) 1288) Baptist Health School of Nursing NSG 4037: Adult Nursing III Carole Mackey, MNSc,, RN, PNP
More informationDiabetes, Type 2. RelayClinical Patient Education Sample Topic Diabetes, Type 2. What is type 2 diabetes? How does it occur?
What is type 2 diabetes? Type 2 diabetes is a disorder that happens when your body does not make enough insulin or is unable to use its own insulin properly. The inability to use insulin is called insulin
More informationMedications for Type 2 Diabetes
Main Page Risk Factors Symptoms Diagnosis Treatment Screening Complications Reducing Your Risk Talking to Your Doctor Living With Type 2 Diabetes Resource Guide Medications for Type 2 Diabetes by Karen
More informationTreatment Approaches to Diabetes
Treatment Approaches to Diabetes Dr. Sarah Swofford, MD, MSPH & Marilee Bomar, GCNS, CDE Quick Overview Lifestyle Oral meds Injectables not insulin Insulin Summary 1 Lifestyle & DM Getting to the point
More informationComparative 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 informationEffective pharmacological treatment regimens for diabetes usually require
Medications Used in Diabetes in Patients Presenting for Anesthesia By Gabrielle O Connor, M.D., M.Sc., CCD, MRCP, FACP Dr. Gabrielle O Connor, a board certified endocrinologist who graduated from University
More informationDiabetes Treatments: Options for Insulin Delivery. Bonnie Pepon, RN, BSN, CDE Certified Diabetes Educator Conemaugh Diabetes Institute
Diabetes Treatments: Options for Insulin Delivery Bonnie Pepon, RN, BSN, CDE Certified Diabetes Educator Conemaugh Diabetes Institute Diabetes 21 million people in the U.S. have diabetes $132 billion each
More informationNewer Anticoagulants and Newer Diabetic Drug Classes. Nicole N. Nguyen, PharmD Senior Clinical Pharmacist Health Care Services August 21, 2013
Newer Anticoagulants and Newer Diabetic Drug Classes Nicole N. Nguyen, PharmD Senior Clinical Pharmacist Health Care Services August 21, 2013 Apixaban Newer Anticoagulants Dabigatran etexilate Rivaroxaban
More informationTREATMENT STRATEGIES FOR MANAGING TYPE 2 DIABETES MELLITUS. Friday, August 16, 13
TREATMENT STRATEGIES FOR MANAGING TYPE 2 DIABETES MELLITUS 1 Heather Healy, FNP-BC Martha Shelver, CS, ACNP-BC Saint Alphonsus Regional Medical Center 2 OBJECTIVES 3 Review the current management algorithms
More informationIt is estimated that 25.8 million people or 8.3% of the US
1.0 CPEUs and 2.0 ANCC Contact Hours An Overview of Glycemic Goals and Medications Used to Manage Type 2 Diabetes Mary-Kathleen Grams, PharmD Suzanne Dinsmore, PharmD, CGP Jennifer Goldman-Levine, PharmD,
More informationdiabetes and I think things are pretty much what they were but there have been some confusion that
MARY T. KORYTKOWSKI,, M.D. 1 Good morning. Thank you very much for inviting me to speak at this year s conference, update in internal medicine. And as was said, I will talk to you about what may not be
More informationManagement of Diabetes in the Elderly. Sylvia Shamanna Internal Medicine (R1)
Management of Diabetes in the Elderly Sylvia Shamanna Internal Medicine (R1) Case 74 year old female with frontal temporal lobe dementia admitted for prolonged delirium and frequent falls (usually in the
More informationThere seem to be inconsistencies regarding diabetic management in
Society of Ambulatory Anesthesia (SAMBA) Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery Review of the consensus statement and additional
More informationType 2 diabetes Definition
Type 2 diabetes Definition Type 2 diabetes is a lifelong (chronic) disease in which there are high levels of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes. Causes Diabetes
More informationHarmony 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 informationINSULIN INTENSIFICATION: Taking Care to the Next Level
INSULIN INTENSIFICATION: Taking Care to the Next Level By J. Robin Conway M.D., Diabetes Clinic, Smiths Falls, ON www.diabetesclinic.ca Type 2 Diabetes is an increasing problem in our society, due largely
More informationCME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus
CME Test for AMDA Clinical Practice Guideline Diabetes Mellitus Part I: 1. Which one of the following statements about type 2 diabetes is not accurate? a. Diabetics are at increased risk of experiencing
More informationNew and Standard Treatment Options for Patients With
New and Standard Treatment Options for Patients With Type 2 Diabetes Jointly sponsored by The Dulaney Foundation and DIABETIC MICROVASCULAR COMPLICATIONS TODAY. Release Date: October 2006. Expiration Date:
More informationCASE 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 informationDiabetes and stroke. What is diabetes? What are the symptoms of diabetes? Stroke Helpline: 0303 3033 100 Website: stroke.org.uk
Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Diabetes and stroke Diabetes is a condition caused by too much sugar in your blood. There are over three million people in the UK who have diabetes.
More informationMANAGEMENT OF TYPE 2 DIABETES: REVIEW OF DRUG THERAPY
MANAGEMENT OF TYPE 2 DIABETES: REVIEW OF DRUG THERAPY AND THE ROLE OF THE PHARMACIST NINA BEMBEN, PHARMD MARY LYNN MCPHERSON, PAHRMD, MA, BCPS, CDE ZEMEN HABTEMARIAM, STUDENT PHARMACIST MANAGEMENT OF TYPE
More informationMEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES
MEDICAL ASSISTANCE HBOOK I. Requirements for Prior Authorization of Incretin Mimetic/Enhancer Hypoglycemics (formerly referred to as Other Hypoglycemics) A. Thresholds for Prior Authorization All prescriptions
More informationNew Non-Insulin Therapies for Type 2 Diabetes Mellitus
New Non-Insulin Therapies for Type 2 Diabetes Mellitus Ally P.H. Prebtani Associate Professor of Medicine Internal Medicine, Endocrinology & Metabolism McMaster University Canada Disclosure Relationships
More informationYou might know your STAR. going to do with them? Medications and Management
You might know your STAR ratings, now what are you going to do with them? A focus on Diabetes Medications and Management Jonathan G. Marquess, PharmD, CDE Vice-President, APCI & Multiple Pharmacy Owner
More informationWhat I need to know about. Diabetes Medicines. National Diabetes Information Clearinghouse
What I need to know about Diabetes Medicines National Diabetes Information Clearinghouse What I need to know about Diabetes Medicines Contents What do diabetes medicines do?... 1 What targets are recommended
More informationDiabetes: Beyond the D50. Leslie Huntington, BS, Paramedic Mobile Training Unit Oregon OHA-EMS and Trauma Systems
Diabetes: Beyond the D50 Leslie Huntington, BS, Paramedic Mobile Training Unit Oregon OHA-EMS and Trauma Systems The EMS View of Diabetes Management BG low? Give some form of sugar. Hero! BG somewhere
More informationmedications for type 2 diabetes
Talking diabetes No.25 Revised August 2010 medications for type 2 diabetes People with type 2 diabetes are often given medications including insulin to help control their blood glucose levels. Most of
More informationExenatide (Byetta) for type 2 diabetes
Exenatide (Byetta) for type 2 diabetes This Medicine Update is for people who are using, or thinking about using, exenatide. Summary Exenatide is a new injectable medicine that reduces blood glucose levels.
More informationManagement of Type 2 Diabetes Mellitus in the Elderly
Management of Type 2 Diabetes Mellitus in the Elderly ANDREA FERENCZI, M.D. BANNER ARIZONA MEDICAL CLINIC DEPARTMENT OF ENDOCRINOLOGY Incidence and Prevalence of Diabetes in the United States County-level
More informationChapter 4 Type 2 Diabetes
Chapter 4 Type 2 Diabetes (previously referred to as adult onset diabetes or non-insulin dependent diabetes) H. Peter Chase, MD Cindy Cain, RN, CDE Philip Zeitler, MD This is the most common type of diabetes
More informationBritni 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 informationEndocrine Disorders. Diabetes Meds Objectives. Diabetes Type 1 and Type 2. Insulin Dynamics. Insulin is all about timing! Rapid acting insulin O P D
Endocrine Disorders Diabetes Meds Objectives Explain the action of the various types of insulin currently available Identify the relationship between insulin peak and risk for hypoglycemia Discuss rationale
More informationmedications for type 2 diabetes
Talking diabetes No.25 Revised 2012 medications for type 2 diabetes People with type 2 diabetes are often given medications including insulin to help manage their blood glucose levels. Most of these medications
More information2013 International Diabetes Center
Day to Day Management of Diabetes Part 1 Review of Diabetes and Therapies Diane Reader RD, CDE Manager, Diabetes Professional Training International Diabetes Center Overview of Diabetes lucose and Insulin
More informationNew Treatments for Type 2 Diabetes
New Treatments for Type 2 Diabetes Dr David Hopkins Clinical Director, Division of Ambulatory Care King s College Hospital NHS Foundation Trust Treatments for type 2 diabetes - old & new insulin sulphonylureas
More informationTreatment of Type 2 Diabetes: One Size Does Not Fit All
Treatment of Type 2 Diabetes: One Size Does Not Fit All Lisa Kroon, PharmD, CDE, FCSHP Professor and Chair, Clinical Pharmacy School of Pharmacy, University of California San Francisco Disclosure No conflict
More informationTake a moment Confer with your neighbour And try to solve the following word picture puzzle slides.
Take a moment Confer with your neighbour And try to solve the following word picture puzzle slides. Example: = Head Over Heels Take a moment Confer with your neighbour And try to solve the following word
More informationDavid Shu, MD, FRCPC Endocrinology, Royal Columbian Hospital October 8 th, 2010
David Shu, MD, FRCPC Endocrinology, Royal Columbian Hospital October 8 th, 2010 Objectives At the end of the talk, the participants will be able to: 1. Identify the increasing prevalence of type 2 diabetes
More informationCardiac Rehabilitation New Brunswick: Tutorial Series. Diabetes Mellitus Overview, pharmacotherapy and exercise considerations
Cardiac Rehabilitation New Brunswick: Tutorial Series Diabetes Mellitus Overview, pharmacotherapy and exercise considerations Overview Prevalence of diabetes Definition and Diagnosis Risk factors and complications
More informationDiabetes DIABETES MELLITUS. Types of Diabetes. Classification of Diabetes 6. 10. 2013. Prediabetes: IFG, IGT, Increased A1C
Diabetes Diabetes mellitus is a chronic disease characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. A state of raised blood glucose (hyperglycaemia)
More informationTreating Type 2 Diabetes
The Oral Diabetes Drugs Treating Type 2 Diabetes Comparing Effectiveness, Safety, and Price Contents Our Recommendations........................................... 3 Welcome....................................................
More informationDrug Class Review. Newer Diabetes Medications and Combinations
Drug Class Review Newer Diabetes Medications and Combinations Final Streamlined Update 1 Report June 2014 The purpose of Drug Effectiveness Review Project reports is to make available information regarding
More informationMedications for Diabetes
AGS Diab Med Brochure 4/18/03 3:43 PM Page 1 Medications for Diabetes An Older Adult s Guide to Safe Use of Diabetes Medications THE AGS FOUNDATION FOR HEALTH IN AGING AGS Diab Med Brochure 4/18/03 3:43
More informationOBJECTIVES MEDICATIONS TO TREAT DIABETES MELLITUS. History of Diabetes Care. Barriers To Normalizing BG 2/11/2014. Significant Developments in DM
MEDICATIONS TO TREAT DIABETES MELLITUS R. Keith Campbell*, RPh, FAADE, FASHP, CDE Distinguished Professor of Diabetes Care/Pharmacotherapy, Emeritus Washington State University College of Pharmacy *No
More informationTreating Type 2 Diabetes
The Oral Diabetes Drugs Treating Type 2 Diabetes Comparing Effectiveness, Safety, and Price Our Recommendations Six classes of oral medicines (and 12 individual drugs) are now available to help the 25.8
More informationWhich drugs should be used to treat diabetes in cirrhotic patients?
Which drugs should be used to treat diabetes in cirrhotic patients? Frankfurt am Main 10-12 September 2015 Jörg Bojunga Medizinische Klinik I Johann Wolfgang Goethe-Universität Frankfurt am Main Significance
More informationINSULIN AND INCRETIN THERAPIES: WHAT COMBINATIONS ARE RIGHT FOR YOUR PATIENT?
INSULIN AND INCRETIN THERAPIES: WHAT COMBINATIONS ARE RIGHT FOR YOUR PATIENT? MARTHA M. BRINSKO, MSN, ANP-BC CHARLOTTE COMMUNITY HEALTH CLINIC CHARLOTTE, NC Diagnosed and undiagnosed diabetes in the United
More informationSubmitted to Expert Opinion on Drug Metabolism & Toxicology
Submitted to Expert Opinion on Drug Metabolism & Toxicology Pharmacokinetic and toxicological considerations for the treatment of diabetes in patients with liver disease André J. Scheen University of Liège,
More informationUp to Date for Diabetes: Veronica Piziak MD, PhD Professor of Medicine Texas A&M Emeritus Director of Endocrinology Baylor Scott and White
Up to Date for Diabetes: Veronica Piziak MD, PhD Professor of Medicine Texas A&M Emeritus Director of Endocrinology Baylor Scott and White Objectives: What is New in Therapy How to select medications Disclosures:
More informationSaxagliptin (Onglyza) for type 2 diabetes
Saxagliptin (Onglyza) for type 2 diabetes This Medicine Update is for people who are taking, or thinking about taking, saxagliptin. Summary Saxagliptin (brand name Onglyza) is a tablet that can be used
More information