we have to keep up. Timothy S. Reid, M.D. Mercy Diabetes Center Janesville, WI Entity Activity Financial Consideration Comments

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "we have to keep up. Timothy S. Reid, M.D. Mercy Diabetes Center Janesville, WI Entity Activity Financial Consideration Comments"

Transcription

1 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 Fees/Honoraria Janssen Speaker/Consultant Speaker Fees/Honoraria Boehringer Ingelheim/Lilly Speaker/Consultant Speaker Fees/Honoraria Lilly Speaker/Consultant Speaker Fees/Honoraria Our understanding of diabetes continues to evolve, the number of tools that we have continue to grow and the environment in which we care for our patients continues to change.. we have to keep up.

2 Introduction Epidemiology Economics Updates in Guidelines Updates in Medications Updates in Organizational Initiatives Final Thoughts Summarize Evolve tional-diabetes-report-web.pdf Evolve pdf

3 Estimated Diabetes Costs in the United States, 2012 Total (Direct and Indirect $245 Billion Direct Medical Costs $176 Billion After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than people without diabetes. Cost Indirect Costs $69 Billion (disability, work loss, premature death) tional-diabetes-report-web.pdf Cost to Patient: Time Burden Cost to of Family/Support: Therapy Food Time Cost Family Home Involvement Modifications Emotion/Stress Meal Quality/Timing Changes in Activity Emotion/Stress Cost tional-diabetes-report-web.pdf Standards of Medical Care in Diabetes

4 Patient Centeredness Diabetes Across The Lifespan Advocacy for Patients with Diabetes American Diabetes Association. Strategies for Improving Care. Sec. 1. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(suppl.1):S5-S7. Standards of Medical Care in Diabetes Name has changed for sections all highly referenced Changes in level of evidence reflects new scholarship American Diabetes Association. Summary of Revisions. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(suppl.1):S4. Standards of Medical Care in Diabetes Important Changes: Section 2: Classification BMI cut point for screening Asians Americans was changed from 25 to 23 kg/m 2 Section 4: Foundations of Care Limit time spent sedentary E-Cigarettes Immunization PCV-13 and PPSV-23 in older adults American Diabetes Association. Summary of Revisions. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(suppl.1):S4.

5 Standards of Medical Care in Diabetes Important Changes: Section 6: Glycemic Targets Premeal mg/dl Assess patient readiness for CGM and suggestions for providing ongoing support for CGM Section 7: Updated (see ahead) American Diabetes Association. Summary of Revisions. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(suppl.1):S4. Standards of Medical Care in Diabetes Important Changes: Section 8: CV Disease and Risk Mgt. Diastolic BP goal of 90 mmhg Statin recommendations were updated in line with the AHA/ACC recommendations to treat based on risk stratification Assess Lipids at Dx, age 40 and periodically thereafter American Diabetes Association. Summary of Revisions. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(suppl.1):S4. Standards of Medical Care in Diabetes Important Changes: Section 9: Microvascular Complications and Foot Care Those with insensate feet, foot deformity or Hx of foot ulceration should have their feet examined each visit Section 11: Children and adolescents Target A1c of 7.5%, individualization is encouraged. American Diabetes Association. Summary of Revisions. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(suppl.1):S4.

6 Standards of Medical Care in Diabetes Important Changes: Section 12: Management of Diabetes in Pregnancy New Section Preconception Counseling, medications, blood glucose targets and monitoring American Diabetes Association. Summary of Revisions. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(suppl.1):S4. Standards of Medical Care in Diabetes Important Changes: Management Individualization of Therapy American Diabetes Association. Summary of Revisions. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(suppl.1):S4. Patient/Disease Features Approach to the management of Hyperglycemia More stringent A1c 7% Less stringent Risks potentially associated with hypoglycemia and other drug adverse events low high Disease Duration Newly diagnosed long-standing Life Expectancy long short Usually Not Modifiable Important Comorbidities absent few/mild severe Established Vascular Complications absent few/mild severe Patient Attitude and expected treatment efforts Resources and Support System Highly motivated.adherent, Less motivated, nonadherent, poor self Potentially excellent self-care capacities care capacities Modifiable Readily limited available American Diabetes Association. Summary of Revisions. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(suppl.1):S37.

7 Type 1 DM MDI or CSII Match insulin to pre-meal BGM, carbohydrate intake and anticipated activity Analogue insulins preferred to reduce hypoglycemia risk Medications: s Pramlintide Investigational GLP-1 agonists SGLT-2 inhibitors American Diabetes Association. Approaches to glycemic treatment. Sec. 7. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(Suppl. 1):S41-S48. Pharmacological Therapy for Type 2 DM is preferred if tolerated and not contraindicated Consider insulin if symptomatic or blood sugars high Advance therapy q3 months if not at goal Patient centered approach to therapy T2DM is progressive. therapy will eventually be needed in most cases American Diabetes Association. Approaches to glycemic treatment. Sec. 7. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(Suppl. 1):S41-S48. Healthy eating, wt. control, increased physical activity & diabetes education Efficacy Hypo Risk.. Weight.... Side Effects... Cost. High Efficacy Low Hypoglycemic Risk Weight Neutral Lactic Acidosis/GI intolerance Low Cost If A1c target not achieved after ~3 months of monotherapy, proceed to 2-drug combination (order not meant to denote any specific preference choice dependent on a variety of patient and disease specific factors). Sulfonylurea Thiazolidinedione DPP-4 Inhibitor SGLT-2 Inhibitor GLP-1 Receptor (basal) Efficacy. High.. high. Intermediate.. Intermediate.. Agonist Hypo Risk. Moderate risk. low Risk.. high.. Highest Low risk.. Low risk Low risk High risk Weight.. gain... Gain. neutral.. losing Side Effects. hypoglycemia. Edema,CHF,Fx s losing.. gain rare GU, dehydration. GI.. hypoglycemia Cost Low. Cost high high high variable If A1c target not achieved after ~3 months of dual therapy, proceed to 3-drug combination (order not meant to denote any specific preference choice dependent on a variety of patient and disease-specific factors). American Diabetes Association. Approaches to glycemic treatment. Sec. 7. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(Suppl. 1):S41- S48. Sulfonylurea Thiazolidinedione DPP-4 Inhibitor SGLT-2 Inhibitor GLP-1 Receptor Agonist TZD SU SU SU SU DPP-4 i TZD DPP-4 i TZD TZD SGLT-2 i SGLT-2 i SGLT-2 i DPP-4 i GLP-1 RA GLP-1 RA (basal) TZD DPP-4 i SGLT-2 i GLP-1 RA If A1c target not achieved after ~3 months of triple therapy and patient (1) on oral combination, move to injectables; (2) on GLP- RA, add basal insuin; or (3) on optimally titrated basal insulin, add GLP-1 RA or mealtime insulin. In refractory patients, consider adding TZD or SGLT-2i: (basal) Mealtime or GLP-1 RA American Diabetes Association. Approaches to glycemic treatment. Sec. 7. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(Suppl. 1):S41-S48.

8 Number of Medication Classes The Good: Structured way to think about the therapy available for glucose control The Bad: They do not adequately address patient population with significant co-morbid conditions The Ugly: They give no direction regarding when to discontinue medication Potentially promote poly-pharmacy 9 classes of oral medication 4 classes of subcutaneous medications New classes coming.. HTN and Diabetes Drug Classes in the US over the past 90 Years SGLT-2 Renin Inhibitors Inhibitors Angiotensin II Dopamine Agonists Receptor Blockers Bile Acid Sequestrants ACE Inhibitors DPP-4 Receptor Antagonists Amylinomimetics Calcium Channel Peripheral a-1 Blockers GLP-1 Receptor Blockers Agonists B-blockers Meglitinides Diuretics Adrenergic neuronal blockers Sulfonylureas Vasodialators Central a-2 Thiazolidinediones Agonists (Phenformin) Withdrawn 1978 a-glucosidase Inhibitors Biguanides 1920 s 1950 s 1960 s 1970 s 1980 s 1990 s 2000 s 2010 s

9 Oral Antihyperglycemic Agents dapagliflozin metformin alogliptin miglitol glimepiride repaglinide saxagliptin bromocriptine pioglitazone glyburide empagliflozin sitagliptin glipizide linagliptin colesevelam acarbose rosiglitazone nateglinide canagliflozin Acarbose Miglitol Bromocriptine Colesevelam Glimepiride Glipizide Glyburide Nateglinide Repaglinide Pioglitazone Rosiglitazone Alogliptin Linagliptin Saxagliptin Sitagliptin Canagliflozin Dapagliflozin Emapgliflozin GLP-1 GLP-1 GLP-1 GLP-1 GLP-1 DeFronzo RA. Diabetes (4):

10 asdf Class Generic Name Trade Name α-glucosidase Inhibitor acarobose, miglitol Precose, Glyset amylinomimetics amylin Symlin biguanides metformin Glucophage, Riomet Bile Acid Sequestrants colesevelam WelChol Dopamine Agonists bromocriptine Cycloset DPP-4i GLP-1 Agonists alogliptin, linagliptin saxagliptin, sitagliptin albiglutide, dulaglutide exenatide, liraglutide Nesina, Tradjenta Onglyza, Januvia Tanzeum, Trulicity, Byetta Victoza Glucagon glucagon Glucagon meglitinides SGLT-2i Sulfonylureas Thiazolidinediones insulin (various) nateglinide, repaglinide canagliflozin, dapagliflozin, empagliflozin glimepiride, glipizide glyburide pioglitazone, rosiglitazone Humulin, Novolin, Humalog, Novolog, Apidra, Lantus, Levemir Starlix, Prandin Invokana, Farxiga, Jardiance Amaryl, Glucotrol, Diabeta, Micronase Actos, Avandia Secretion Hepatic Glucose Production Pancreatic Glucagon Secretion Peripheral Glucose Uptake GI CHO Absorption Renal β-cell Reabsorp-tion Function of Glucose a-glucosidase Inhibitor Biguanide Bromocriptine Colesevelam Unknown Unknown DPP-4 Inhibitor Improve * Glinide SGLT-2 Inhibitor SU TZD Improve National Diabetes Education Program. Available at: Accessed August 10, Nathan DM, et al. Diabetes Care. 2009;32: Rodbard HW, et al. Endocr Pract. 2009;15(6): Januvia [prescribing information]. Whitehouse Station, NJ: Merck & Co., Inc.; Onglyza [prescribing information]. Princeton, NJ: Bristol- Myers Squibb Co.; Welchol [prescribing information]. Parsippany, NJ: Daiichi Sankyo Inc.; Cycloset [prescribing information]. San Diego, CA: Santarus, Inc.; * In vitro and rodent data; preliminary human data

11 Liver: Reduces hepatic glucose output by inhibiting glucagon release CNS: Promotes satiety and reduction of appetite a cell: Inhibits glucagon secretion in a glucosedependent fashion cell: Stimulates glucosedependent insulin secretion; Increases cell mass Mixed meal Intestinal GLP-1 release Plasma GLP-1 Active DPP-4 Inhibitors DPP-4 Rapid inactivation (>80% of pool) GLP-1 Inactive GLP-1 Agonists GLP-1 Actions DPP-4 = Dipeptidyl peptidase-4 GLP-1 = Glucagon-like Peptide-1 Excreted by kidneys Deacon CF, et al. Diabetes. 1995;44: Preinjection Dosing Mixing Generic Trade Dosing Schedule Required waiting time Tanzeum Yes mg, Albiglutide QW Yes minutes 50mg 0.75mg, Dulaglutide Trulicity QW No None 1.5mg 5mcg, Exenatide Byetta BID No None 10mcg Exenatide Bydureon extended QW Yes None 2mg Kit release Exenatide Bydureon extended QW Yes None 2mg Pen release.6, 1.2, Liraglutide Victoza QD No None 1.8mg Smallest Use with Needles Auto Needle basal included Injector Size insulin 29-gauge, 5mm thinwalled Yes Yes No needle Built in to No device Yes part of Currently Yes 29g, 5 mm device studies are needle evaluating 32 gauge, 4mm No Yes No needle No 23-gauge, Currently 8mm Yes No studies are needle evaluating No 23-gauge, Currently 7mm Yes No studies are needle evaluating 32 gauge, 4mm Yes Yes No needle

12 Generic Trade Dosing Schedule Weeks of Study A1c Reduction (Monotherapy) Fasting Blood Sugar Reduction Albiglutide Tanzeum QW mg = -0.7% 50 mg = -0.9% 30 mg = -16 mg/dl 50 mg = -25 mg/dl Dulaglutide Trulicity QW 26 Exenatide Byetta BID mg = -0.7% 1.5mg = -0.8% 5 mcg = -0.7% 10 mcg = -0.9% 0.75mg = -26mg/dl 1.5mg = -29mg/dl 5 mcg = -17mg/dl 10 mcg = -19mg/dl Exenatide extended release Exenatide extended release Bydureon Kit Bydureon Pen QW 24 2mg = -1.6% 2mg = -25 mg/dl QW Liraglutide Victoza QD mg = -0.8% 1.8 mg = -1.1% 1.2 mg = -15 mg/dl 1.8 mg = -26 mg/dl Nausea and diarrhea are possible (early) Hypoglycemia more likely if used with secretogogues Injection site reactions Pregnancy Category C Pancreatitis risk (low but identifiable) Risk of Thyroid C-cell Tumors Renal Precautions Contraindications: Medullary Thyroid Carcinoma Hypersensitivity Multiple Endocrine Neoplasia Type 2 Thyroid Parathyroid Adrenal

13 More medications Lixisenatide once-daily injectable Oral GLP-1 Eligen Technology using low molecular weight compounds increase lipophilicity 1. Combinations with number of companies working on this Very Long Acting GLP-1 s - on the order of 3,6, and 12 months (Accessed 1/24/2015 Actions SGLT-2 inhibitors work to competetively inhibit glucose reabsorption in the proximal convoluted tubules in the nephron Glucose is subsequently spilled in the urine and is unavailable for metabolism Approximately 180 gm of glucose is filtered by the kidney daily

14 SGLT-2 Free Filtration of Solute Active Reabsorption Glucose SGLT-1 Glucose 90% 10% Normal Juxtoglomerular Complex Proximal Convoluted Tubules No Detectable Glucose Loop of Henle works/14495-sglt2-inhibitors-a-new-class-of-diabetesmedications (Accessed ) Drug Trade Name Dosing Schedule Weeks of Study Dosing Monotherapy Fasting Blood A1c Reduction Sugar Reduction 2-hour Postprandial Glucose Reduction canagliflozin 1 Invokana QD 26 wks 100mg -0.77% -27 mg/dl -43 mg/dl 300mg -1.03% -35 mg/dl -59 mg/dl dapagliflozin 2 Farxiga QD 24 wks 5mg -0.8% mg/dl 10mg -0.9% mg/dl empagliflozin 3 Jardiance QD 24 wks 10mg -0.7% -19 mg/dl 25mg -0.8% -25 mg/dl Ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing Information/PIs/Jardiance/jardiance.pdfhttp://bidocs.boehringeringelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing Information/PIs/Jardiance/jardiance.pdf Trade Dosing Drug Name Schedule canagliflozin Invokana QD dapagliflozin Farxiga QD empagliflozin Jardiance QD Dosing 100mg 300mg 5mg 10mg 10mg 25mg egfr LDL Chol Cutoffs mg/dl < <30 2.9% for <60 10 mg dose 10mg = 4.6% <45 25mg = 6.5% Use with basal insulin Yes Basal Yes Special UGT Enzyme Inducer øcyp Effects Pgp substrate Urinary Pregnancy Glucose Category Excretion mg/day C 70 mg/day C mg/day C Medication A Medication B Combinations Dose Strength Dose Frequency Canagliflozin IR Invokamet Dapagliflozin XR Xigduo XR 50/500, 50/1000, 150/500, 150/1000 5/500, 5/1000, 10/500, 10/1000 BID QD Empagliflozin IR TBD (FDA Review) TBD TBD Ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing Information/PIs/Jardiance/jardiance.pdfhttp://bidocs.boehringeringelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing Information/PIs/Jardiance/jardiance.pdf

15 Once Daily Medication for T2DM Taken irrespective of food intake Works synergistically with other antihyperglycemic classes Potential for weight loss Expensive, no generic equivalents Ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing Information/PIs/Jardiance/jardiance.pdfhttp://bidocs.boehringeringelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing Information/PIs/Jardiance/jardiance.pdf Observe patient for volume depletion Risk of hypotension Increased Urination Small increases in LDL cholesterol Renal Insufficiency/Failure Limitations Risk of UTI Risk of Genital Mycotic Infections Ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing Information/PIs/Jardiance/jardiance.pdfhttp://bidocs.boehringeringelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing Information/PIs/Jardiance/jardiance.pdf Contraindications: Hypersensitivity Severe Renal Impairment, ESRD or Dialysis Ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing Information/PIs/Jardiance/jardiance.pdfhttp://bidocs.boehringeringelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing Information/PIs/Jardiance/jardiance.pdf

16 Now: Inhaled Future: Glucokinase Activators Ultra-Long Acting s Ultra-Rapid Acting s Concentrated s Biosimilar s Garber AJ et al. Endocr Pract. 2013;19(Suppl 2):1-48. Program developed by CMS as part of Affordable Care Act ObamaCare Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. Payment/ACO/index.html?redirect=/aco/ (Accessed )

17 Three Programs 1 : Medicare Shared Savings Program Advanced Payment ACO Model Pioneer ACO Model (now closed) Who Can Be an ACO? An ACO can be nearly any combination of group practices, networks of practices, hospitals, hospitals employing other providers, hospital-physician joint ventures, etc., as long as it is legally capable of receiving and distributing payments Payment/ACO/index.html?redirect=/aco/ (Accessed ) 2. (Accessed ) Financial Impact Coordination of Care across System Quality Measures Reporting Financial Impact Risk Shared Savings/Loss for Medicare Beneficiaries Health System Investment Coordination of Care across System Quality Measures Reporting

18 Financial Impact Coordination of Care across System Align the Care Experience for Patients to maximize efficiency and cost savings Care Coordinators Quality Measures Reporting Financial Impact Coordination of Care across System Quality Measures 33 Measures of Quality Reporting Financial Impact Coordination of Care across System Quality Measures Reporting 3 year contract cycle Quality/Financials reported annually

19 Domain Patient/Caregiver Experience Care Coordination/ Patient Safety Preventative Health At Risk Population Total in all Domains # of Individual Measures 7 6 Total Measures for Scoring Purposes 7 individual survey module measures 6 measures plus the EHR measure doubleweighted 4 points Total Possible Points Domain Weight 14 25% measures measures, including the 5-component diabetes composite measure and 2- component CVD composite measure 14 25% 25% 25% % Large, growing population Expensive Disease Process Significant Unmet Need Defined Interventions Many times with known benefits Pre-existing Care Structures in Place us. Payment/sharedsavingsprogram/Downloads/MSSP-QM-Benchmarks.pdf (Accessed ) Payment/sharedsavingsprogram/Downloads/MSSP-QM- Benchmarks.pdf

20 Society has to grapple with high volume, expensive disease processes Will ACO s be here in 5 years? Focus on Diabetes Use this as opportunity Our understanding of diabetes continues to evolve, the number of tools that we have continue to grow and the environment in which we care for our patients continues to change.. we have to keep up. Timothy S. Reid, M.D. Mercy Diabetes Center Janesville WI

Targeting 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.

Targeting 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 information

Type 2 Diabetes Medicines: What You Need to Know

Type 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 information

Overview of Diabetes Medications

Overview of Diabetes Medications 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 information

A NEW TAKE ON DIABETES MEDICATIONS: RISKS AND BENEFITS, OLD MEDICATIONS VERSUS NEW, AND NEW INFORMATION ON OLD MEDICATIONS

A NEW TAKE ON DIABETES MEDICATIONS: RISKS AND BENEFITS, OLD MEDICATIONS VERSUS NEW, AND NEW INFORMATION ON OLD MEDICATIONS A NEW TAKE ON DIABETES MEDICATIONS: RISKS AND BENEFITS, OLD MEDICATIONS VERSUS NEW, AND NEW INFORMATION ON OLD MEDICATIONS JESSICA CONKLIN, PHARMD, PHC, BCACP, CDE VISITING ASSISTANT PROFESSOR UNM COLLEGE

More information

Mary Bruskewitz APN, MS, RN, BC-ADM Clinical Nurse Specialist Diabetes

Mary 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 information

Medication Policy Manual

Medication Policy Manual Medication Policy Manual Topic: Branded SGLT2-Inhibitor-Containing Medications: - canagliflozin (Invokana, Invokamet ); - dapagliflozin (Farxiga, Xigduo XR); - empagliflozin (Jardiance, Glyxambi, Synjardy

More information

Noninsulin 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 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 information

DIABETES 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 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 information

Volume 01, No. 08 November 2013

Volume 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 information

Pharmaceutical Management of Diabetes Mellitus

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 information

Add: 2 nd generation sulfonylurea or glinide or Add DPP-4 inhibitor Start or intensify insulin therapy if HbA1c goals not achieved with the above

Add: 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 information

Acarbose INITIAL: 25 mg PO TID ($45) Miglitol INITIAL: 25 mg PO TID ($145)

Acarbose 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 information

10/30/2012. Anita King, DNP, RN, FNP, CDE, FAADE Clinical Associate Professor University of South Alabama Mobile, Alabama

10/30/2012. 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 information

25 mg QD-TID @ meals w/1st bite of. food, titrate Q 4 8 weeks; adjust based on 1 postprandial glucose; 100 mg TID max

25 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 information

11/6/2015. Disclosures. Objectives. What We Will Do. Mechanisms of Type 2 Diabetes. Natural History of Type 2 Diabetes

11/6/2015. Disclosures. Objectives. What We Will Do. Mechanisms of Type 2 Diabetes. Natural History of Type 2 Diabetes Guideline Introduction: Management of Hyperglycemia in Type 2 Diabetes Eric L. Johnson, M.D. Assistant Medical Director Altru Diabetes Center Altru Health System Associate Professor Department of Family

More information

Clinical Assistant Professor. Clinical Pharmacy Specialist Wesley Family Medicine Residency Program. Objectives

Clinical 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 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

Guidelines for Type 2 Diabetes Diagnosis

Guidelines 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 information

Diabetes Medications. Minal Patel, PharmD, BCPS

Diabetes 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 information

Medicines for Type 2 Diabetes A Review of the Research for Adults

Medicines 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 information

A Personalized Approach for A1C Goals

A Personalized Approach for A1C Goals PL Detail-Document #280708 This PL Detail-Document gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER July 2012 A Personalized Approach

More information

Medicines Used to Treat Type 2 Diabetes

Medicines 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 information

Approximate Cost Reference List i for Antihyperglycemic Agents

Approximate 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 information

DIABETES MEDICATION-ORAL AGENTS AND OTHER HYPOGLYCEMIC AGENTS

DIABETES 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 information

FYI: (Acceptable range for blood glucose usually 70-110 mg/dl. know your institutions policy.)

FYI: (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 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

Cara 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 information

Type 2 Diabetes Medications: SGLT2 Inhibitors

Type 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 information

Type 2 Diabetes Mellitus 2014

Type 2 Diabetes Mellitus 2014 Type 2 Diabetes Mellitus 2014 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Disclosure Michael McDermott MD No Conflict

More information

Making Clinical Sense of Diabetes Medications. Types of Diabetes. Pathophysiology. Beta Cell Function & Glucagon

Making 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 information

Diabetes Mellitus Pharmacology Review

Diabetes 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 information

Primary Care Type 2 Diabetes Update

Primary 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 information

Treatment of Type 2 Diabetes

Treatment 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 information

4/23/2015. Conflict of Interest Disclosure

4/23/2015. Conflict of Interest Disclosure Endocrine/Diabetes Pharmacology Review May 8, 2015 Chris Winslow, PharmD, MBA and Amanda Brown, PharmD Conflict of Interest Disclosure A conflict of interest exists when an individual is in a position

More information

Antihyperglycemic Agents Comparison Chart

Antihyperglycemic 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 information

TREATMENT STRATEGIES FOR MANAGING TYPE 2 DIABETES MELLITUS. Friday, August 16, 13

TREATMENT 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 information

Antidiabetic 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. 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 information

New Drugs in the Management of Type 2 Diabetes. Daniel K. Short MD, PhD, FACP, FACE

New Drugs in the Management of Type 2 Diabetes. Daniel K. Short MD, PhD, FACP, FACE New Drugs in the Management of Type 2 Diabetes Daniel K. Short MD, PhD, FACP, FACE Disclosure I am or have been on the speaker s bureaus for multiple pharmaceutical companies: Abbvie Astra-Zeneca Boehringer

More information

Update on the management of Type 2 Diabetes

Update 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 information

Managing Hyperglycemia in Type 2 Diabetes

Managing Hyperglycemia in Type 2 Diabetes Managing Hyperglycemia in Type 2 Diabetes Eric L. Johnson, M.D. Assistant Medical Director Altru Diabetes Center Altru Health System Associate Professor Department of Family and Community Medicine University

More information

Fundamentals of Diabetes Care Module 5, Lesson 1

Fundamentals 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 information

Diabetes Update Lanita S. Shaverd, Pharm.D. Director, UAMS 12 th Street Health and Wellness Center Assistant Professor, UAMS College of Pharmacy

Diabetes 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 information

Diabetes Mellitus: Pharmacology and Disease Management

Diabetes Mellitus: Pharmacology and Disease Management Diabetes Mellitus: Pharmacology and Disease Management Michael King, MD Assistant Professor Residency Program Director University of Kentucky Dept. of Family & Community Medicine Objectives 1. Compare

More information

6/22/2015. New medicines for type 2 diabetes when do you use them

6/22/2015. 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 information

Chapter 41. Pancreatic Hormones & Antidiabetic Drugs

Chapter 41. Pancreatic Hormones & Antidiabetic Drugs Chapter 41 Pancreatic Hormones & Antidiabetic Drugs Contents Pancreatic Hormones & Antidiabetic Drugs The endocrine pancreas Antidiabetic Drugs The Pancreas An organ that makes insulin and enzymes for

More information

Diabetes 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 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 information

It is estimated that 25.8 million people or 8.3% of the US

It 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 information

New and Emerging Diabetes Medications. What do Advanced Practice Nurses Need to Know? Lorraine Nowakowski-Grier,MSN,APRN,BC,CDE

New and Emerging Diabetes Medications. What do Advanced Practice Nurses Need to Know? Lorraine Nowakowski-Grier,MSN,APRN,BC,CDE New and Emerging Diabetes Medications What do Advanced Practice Nurses Need to Know? Lorraine Nowakowski-Grier,MSN,APRN,BC,CDE Objectives 1) Describe the clinical indications on select emerging novel diabetes

More information

Type 2 Diabetes Update For 2015

Type 2 Diabetes Update For 2015 Type 2 Diabetes Update For 2015 Jerry Meece, RPh, CDE, FACA, FAADE Plaza Pharmacy and Wellness Center jmeece12@cooke.net Learning Objectives At the conclusion of this presentation, the participant will

More information

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES

MEDICAL 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 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

Diabetes: Medications

Diabetes: 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 information

The prevalence of diabetes in the United States in

The 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 information

SHORT CLINICAL GUIDELINE SCOPE

SHORT 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 information

New medicines for type 2 diabetes when do you use them

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 information

Up 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 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 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

Pills for Type 2 Diabetes. A Guide for Adults

Pills 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 information

Medications for Diabetes

Medications 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 information

Medications for Type 2 Diabetes

Medications 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 information

Oral Drugs For Type2. Diabetes. Getting the Most Value for Your Healthcare Dollar

Oral Drugs For Type2. Diabetes. Getting the Most Value for Your Healthcare Dollar 1 Oral Drugs For Type2 Diabetes Getting the Most Value for Your Healthcare Dollar 2 Contents What is Type 2 Diabetes? Page 2 Diagnosing Diabetes Page 4 Treating Type 2 Diabetes Page 6 Oral Drugs for Diabetes

More information

trends in the treatment of Diabetes type 2 - New classes of antidiabetic drugs. IAIM, 2015; 2(4): 223-

trends 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 information

How do oral medications work?...50 How many pills will I have to take?...51

How do oral medications work?...50 How many pills will I have to take?...51 taking medication taking medication medication medication medication medication medication Diabetes medications come in two broad categories, oral medications (pills) and injectable medications (shots).

More information

Treatment Approaches to Diabetes

Treatment 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 information

Type 2 Diabetes. Aims and Objectives. What did you consider? Case Study One: Miss S. Which to choose?!?! Modes of Action

Type 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 information

New Non-Insulin Therapies for Type 2 Diabetes Mellitus

New 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 information

Diabetes Medications and Medication Management. Christopher Lamer, PharmD, MHS, BCPS, CDE November 2013

Diabetes Medications and Medication Management. Christopher Lamer, PharmD, MHS, BCPS, CDE November 2013 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 information

2013 International Diabetes Center

2013 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 information

Endocrine 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. 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 information

Diabetes, Type 2. RelayClinical Patient Education Sample Topic Diabetes, Type 2. What is type 2 diabetes? How does it occur?

Diabetes, 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 information

Guidelines for Care of the Hospitalized Patient with Hyperglycemia and Diabetes

Guidelines for Care of the Hospitalized Patient with Hyperglycemia and Diabetes Guidelines for Care of the Hospitalized Patient with Hyperglycemia and Diabetes Kate Crawford, RN, MSN, ANP-C, BC-ADM KEYWORDS Diabetes Hyperglycemia Diabetes medications Insulin Hypoglycemia KEY POINTS

More information

Diabetes Medications at the End of Life. Goals and Objectives. Diabetes. Type 2 Diabetes Mellitus. Types of Diabetes

Diabetes 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 information

Effective pharmacological treatment regimens for diabetes usually require

Effective 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 information

INSULIN INTENSIFICATION: Taking Care to the Next Level

INSULIN 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 information

Anti-Diabetic Agents. Chapter. Charles Ruchalski, PharmD, BCPS. Drug Class: Biguanides. Introduction. Metformin

Anti-Diabetic Agents. Chapter. Charles Ruchalski, PharmD, BCPS. Drug Class: Biguanides. Introduction. Metformin Chapter Anti-Diabetic Agents 2 Charles Ruchalski, PharmD, BCPS Drug Class: Biguanides The biguanide metformin is the drug of choice as initial therapy for a newly diagnosed patient with type 2 diabetes

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

WORKING TOGETHER TO MANAGE DIABETES

WORKING TOGETHER TO MANAGE DIABETES WORKING TOGETHER TO MANAGE DIABETES DIABETES MEDICATIONS SUPPLEMENT SECTION A DIABETES MEDICATIONS Agent Class Primary Action Typical Dosage Side Effects Tolbutamide (Ornase TM ) Tolazamide (Tolinase TM

More information

PHARMACOTHERAPY OF TYPE 2 DIABETES 2015

PHARMACOTHERAPY OF TYPE 2 DIABETES 2015 PHARMACOTHERAPY OF TYPE 2 DIABETES 2015 Richard Clarens, PharmD UND School of Medicine & Health Sciences Altru Family Medicine Residency NDSU College of Pharmacy, Nursing, & Allied Sciences OBJECTIVES

More information

PHARMACOTHERAPY OF TYPE 2 DIABETES 2015

PHARMACOTHERAPY OF TYPE 2 DIABETES 2015 PHARMACOTHERAPY OF TYPE 2 DIABETES 2015 Richard Clarens, PharmD UND School of Medicine & Health Sciences Altru Family Medicine Residency NDSU College of Pharmacy, Nursing, & Allied Sciences OBJECTIVES

More information

Diabetes Mellitus Type 2

Diabetes 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 information

Class Update: Diabetes Medications. Month/Year of Review: September 2014 End date of literature search: August 2014

Class 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 information

Diabetes: In the United States and in Your Dialysis Unit

Diabetes: In the United States and in Your Dialysis Unit Diabetes: In the United States and in Your Dialysis Unit Douglas Shemin, MD Divison of Kidney Diseases and Hypertension Rhode Island Hospital, Alpert Medical School of Brown University Objectives 1. Definition

More information

OBJECTIVES MEDICATIONS TO TREAT DIABETES MELLITUS. History of Diabetes Care. Barriers To Normalizing BG 2/11/2014. Significant Developments in DM

OBJECTIVES 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 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

Management of Diabetes in the CKD Patient

Management of Diabetes in the CKD Patient Management of Diabetes in the CKD Patient Heather Naylor, BScPharm, ACPR Clinical Pharmacy Practice Leader, Nephrology Saint John Regional Hospital Horizon Health Network, Zone 2 May 26, 2012 Learning

More information

TYPE 2 DIABETES ADA-EASD TREATMENT GUIDELINES AND 2015 NEW UPDATES 1,2

TYPE 2 DIABETES ADA-EASD TREATMENT GUIDELINES AND 2015 NEW UPDATES 1,2 TYPE 2 DIABETES ADA-EASD TREATMENT GUIDELINES AND 2015 NEW UPDATES 1,2 The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) released a position statement

More information

Diabetes Mellitus 1. Chapter 43. Diabetes Mellitus, Self-Assessment Questions

Diabetes 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 information

Diabetes Fundamentals

Diabetes Fundamentals Diabetes Fundamentals Prevalence of Diabetes in the U.S. Undiagnosed 10.7% of all people 20+ 23.1% of all people 60+ (12.2 million) Slide provided by Roche Diagnostics Sources: ADA, WHO statistics Prevalence

More information

SUBJECT: DIABETES MEDICATION MANAGEMENT PROTOCOLS

SUBJECT: DIABETES MEDICATION MANAGEMENT PROTOCOLS SUBJECT: DIABETES MEDICATION MANAGEMENT PROTOCOLS PURPOSE To establish a process that will enable Certified Diabetes Educators (CDE) and/or staff with Board Certification in Advanced Diabetes Management

More information

Second- and Third-Line Approaches for Type 2 Diabetes Workgroup: Topic Brief

Second- 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 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

Medication Therapy for Heart Disease. Bhamini Patel, PharmD, BCPS Clinical Pharmacist

Medication Therapy for Heart Disease. Bhamini Patel, PharmD, BCPS Clinical Pharmacist Medication Therapy for Heart Disease Bhamini Patel, PharmD, BCPS Clinical Pharmacist Objectives Review Conditions that affect the Heart High Blood Pressure, Hyperlipidemia and Diabetes Review Medications

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

Management of Type 2 Diabetes Mellitus in the Elderly

Management 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 information

Drug Class Review. Newer Diabetes Medications and Combinations

Drug 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 information

There seem to be inconsistencies regarding diabetic management in

There 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 information

Newer 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 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 information

Diabetes Medications: Insulin Therapy

Diabetes Medications: Insulin Therapy Diabetes Medications: Insulin Therapy Courtesy Univ Texas San Antonio Eric L. Johnson, M.D. Department of Family and Community Medicine Diabetes and Insulin Type 1 Diabetes Autoimmune destruction of beta

More information

Type 2 diabetes Definition

Type 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 information

New Diabetes Drugs: Where do they fit? Kathleen Dungan, MD 3/10/2012

New Diabetes Drugs: Where do they fit? Kathleen Dungan, MD 3/10/2012 New Diabetes Drugs: Where do they fit? Kathleen Dungan, MD 3/10/2012 Case 1 49 YO male with a 3 year history of T2DM PMH: osteoarthritis unable to exercise PE: weight 120 kg, 5 10, BP 152/90, acanthosis

More information