Type 2 Diabetes Medications: SGLT2 Inhibitors

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1 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 short for sodium glucose co-transporter 2 inhibitors Taken orally (by mouth) How do they work? Help to stop glucose from being taken in by the kidneys: the kidneys help to remove glucose from the blood. In people with type 2 diabetes, the kidneys can hold on to glucose, which can cause blood glucose levels to increase What are the benefits? Modest weight loss There is a low risk of hypoglycemia (blood glucose that is too low) with SGLT2 inhibitors. Hypoglycemia can cause tiredness/weakness, nervousness, shakiness, confusion, fast heartbeat, problems with vision, and fainting or seizures What are the side effects? Your healthcare provider will partner with you to create a type 2 diabetes management plan that is personalized to your needs and preferences. Take any medications as directed by your healthcare provider and tell your healthcare provider if you have any side effects. Most common: Yeast infections in men and women Urinary tract infection Increased need to urinate Stuffy or runny nose and sore throat There are two SGLT2 inhibitors approved by the U.S. Food and Drug Administration (FDA): Canagliflozin (INVOKANA ) Dapagliflozin (FARXIGA ) Also possible: Low blood pressure (hypotension) Kidney problems (renal impairment) Hypoglycemia if taken with a sulfonylurea or insulin High amounts of potassium in the blood (hyperkalemia; canagliflozin) Increased LDL-C (the bad cholesterol) Bladder cancer (dapagliflozin) Allergic reactions SGLT2 inhibitors are FDA approved for use along with diet and exercise to lower blood glucose in adults with type 2 diabetes. These medications are not FDA approved for weight loss. For informational purposes only. Consult full manufacturer s prescribing information and medication guide for medication s uses, actions, and side by the U.S. FDA..org NATIONAL DIABETES EDUCATION INITIATIVE FOR MORE INFORMATION: T A LK W I T H Y O UR H E A LT H C A RE PR OV I D ER REFERENCES: FARXIGA [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; Hasan FM, Alsahli M, Gerich JE. Diabetes Res Clin Pract. 2014;104(3): INVOKANA [package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc.; Kim Y, Babu AR. Diabetes Metab Syndr Obes. 2012;5: MedlinePlus. Hypoglycemia. Available at: July 2014 Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ. Copyright 2013 KnowledgePoint360 Group, LLC. All rights reserved. This content was created by KnowledgePoint360 Group, LLC, and was not Thisassociated content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest. with funding via an educational grant or a promotional/commercial interest.

2 Type 2 Diabetes Medications: DPP-4 Inhibitors DPP-4 inhibitors are a class of type 2 diabetes medications used along with diet and exercise to lower blood glucose How are they taken? DPP-4 inhibitors is short for dipeptidyl peptidase-4 inhibitors Taken orally (by mouth) How do they work? Help your pancreas to make more insulin: insulin helps to lower blood glucose Lower the amount of glucose made by your liver What are the benefits? DPP-4 inhibitors are weight neutral, meaning they do not cause weight gain There is a low risk of hypoglycemia (blood glucose that is too low) with DPP-4 inhibitors. Hypoglycemia can cause tiredness/weakness, nervousness, shakiness, confusion, fast heartbeat, problems with vision, and fainting or seizures What are the side effects? Your healthcare provider will partner with you to create a type 2 diabetes management plan that is personalized to your needs and preferences. Take any medications as directed by your healthcare provider and tell your healthcare provider if you have any side effects. Most common: Upper respiratory tract infection Stuffy or runny nose and sore throat Headache Upset stomach or diarrhea There are four DPP-4 inhibitors approved by the U.S. Food and Drug Administration (FDA): Alogliptin (NESINA) Linagliptin (TRADJENTA ) Saxagliptin (ONGLYZA ) Sitagliptin (JANUVIA ) Also possible: Inflammation of the pancreas (acute pancreatitis) Hypoglycemia if taken with a sulfonylurea or insulin Liver problems (alogliptin) Kidney problems (renal failure; sitagliptin) Allergic reactions DPP-4 inhibitors are FDA approved for use along with diet and exercise to lower blood glucose in adults with type 2 diabetes. These medications are not FDA approved for weight loss. For informational purposes only. Consult full manufacturer s prescribing information and medication guide for medication s uses, actions, and side by the U.S. FDA..org NATIONAL DIABETES EDUCATION INITIATIVE FOR MORE INFORMATION: T A LK W I T H Y O U R H E A LT H C A RE PR OV I D ER REFERENCES: Brunton S. Int J Clin Pract. 2014;68: Davidson JA. Mayo Clinic Proc. 2010;85(12 suppl):s27-s37. Inzucchi SE, et al. Diabetes Care. 2012;35(6): JANUVIA [package insert]. Whitehouse Station, NJ: Merck & Co, Inc.; MedlinePlus. Hypoglycemia. Available at: NESINA [package insert]. Deerfield, IL: Takeda Pharmaceuticals America, Inc.; ONGLYZA [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; TRADJENTA [package insert]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc.; June 2014 Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ. Copyright 2013 KnowledgePoint360 Group, LLC. All rights reserved. This content was created by KnowledgePoint360 Group, LLC, and was not Thisassociated content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest. with funding via an educational grant or a promotional/commercial interest.

3 Type 2 Diabetes Medications: GLP-1 Receptor Agonists GLP-1 receptor agonists are a class of type 2 diabetes medications used along with diet and exercise to lower blood glucose How are they given? Given as an injection: inserted into the fat under your skin GLP-1 receptor agonists is short for glucagon-like peptide-1 receptor agonists How do they work? Help your pancreas to make more insulin: insulin helps to lower blood glucose Lower the amount of glucose made by your liver Help to slow down the breakdown of your food: this slows down increases in blood glucose What are the benefits? Your healthcare provider will partner with you to create a type 2 diabetes management plan that is personalized to your needs and preferences. Take any medications as directed by your healthcare provider and tell your healthcare provider if you have any side effects. Modest weight loss May make you feel less hungry and more full There is a low risk of hypoglycemia (blood glucose that is too low) with GLP-1 receptor agonists. Hypoglycemia can cause tiredness/weakness, nervousness, shakiness, confusion, fast heartbeat, problems with vision, and fainting or seizures There are three GLP-1 receptor What are the side effects? agonists approved by the U.S. Most common: Food and Drug Administration Diarrhea (FDA): Nausea Reactions/itching at the injection site Exenatide (BYETTA ) Vomiting Exenatide extended release Headache (BYDUREON ) Indigestion Liraglutide (Victoza ) Constipation Also possible: Thyroid tumors, including cancer, were seen in rats and mice in studies during the medication testing process Inflammation of the pancreas (acute pancreatitis) Hypoglycemia if taken with a sulfonylurea or insulin Kidney problems (renal impairment) Allergic reactions GLP-1 receptor agonists are FDA approved for use along with diet and exercise to lower blood glucose in adults with type 2 diabetes. These medications are not FDA approved for weight loss. For informational purposes only. Consult full manufacturer s prescribing information and medication guide for medication s uses, actions, and side by the U.S. FDA..org NATIONAL DIABETES EDUCATION INITIATIVE FOR MORE INFORMATION: T A LK W I T H Y O U R H E A LT H C A RE PR OV I D ER REFERENCES: Brunton S. Int J Clin Pract. 2014;68: BYDUREON [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; BYETTA [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; Davidson JA. Mayo Clinic Proc. 2010;85(12 suppl):s27-s37. Inzucchi SE, et al. Diabetes Care. 2012;35(6): MedlinePlus. Hypoglycemia. Available at: Victoza [package insert]. Plainsboro, NJ: Novo Nordisk Inc.; June 2014 Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ. Copyright 2013 KnowledgePoint360 Group, LLC. All rights reserved. This content was created by KnowledgePoint360 Group, LLC, and was not Thisassociated content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest. with funding via an educational grant or a promotional/commercial interest.

4 Medications Used to Treat Type 2 Diabetes This handout shows the different medications that your healthcare provider may prescribe to treat your type 2 diabetes, and where and how these medications work in your body to lower blood glucose. Type 2 diabetes medications are taken orally (by mouth), by injection (inserted into the fat under your skin), or inhaled (breathed in). Oral Injectable Amylin mimetic (pramlintide) Alpha-glucosidase inhibitors (acarbose, miglitol) Helps to decrease the amount of glucose made by your liver. Help to slow down the breakdown of starches (such as bread and potatoes) and certain types of sugar (such as table sugar) from your food in your intestines: this slows down increases in blood glucose. Helps to slow down the breakdown of foods in your stomach and intestines: this slows down increases in blood glucose GLP-1 receptor agonists (albiglutide, dulaglutide, exenatide, liraglutide) Help your pancreas to make more insulin: insulin helps to lower blood glucose Biguanide (metformin) Helps to decrease the amount of glucose made by your liver Helps to improve the way that insulin works in your muscles: if your muscles are more sensitive to insulin, it is easier for insulin to bring glucose from your blood into your muscles where glucose can be used for energy Help to decrease the amount of glucose made by your liver Helps to slow down the breakdown of foods in your stomach and intestines: this slows down increases in blood glucose DPP-4 inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin) Fat Tissue Help your pancreas to make more insulin: insulin helps to lower blood glusoce Insulins (aspart, detemir, glargine, glulisine, human, lispro) Replace the insulin made naturally by your body in your pancreas Help to decrease the amount of glucose made by your liver Dopamine receptor agonist (bromocriptine mesylate) The mechanism by which dopamine receptor agonists improve blood sugar is unknown Help to decrease the amount of glucose made by your liver Muscle Liver Help to move glucose from the bloodstream into your muscles and fat where glucose is used for energy Kidneys Some insulin is inhaled See pg. 2 Meglitinides (nateglinide, repaglinide) Help your pancreas to make more insulin: insulin helps to lower blod glucose Stomach SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) Help to stop glucose from being reabsorbed into your kidneys. The kidneys help to remove glucose from your blood. In people with type 2 diabetes, the kidneys can hold on to glucose which can cause blood glucose levels to increase Sulfonylureas (glimepiride, glipizide, gliburide) Helps your pancreas to make more insulin: insulin helps to lower blood glucose Pancreas Intestines Descriptions are provided for informational purposes only. Consult full manufacturer s prescribing information for drug s uses, actions, and side by the U.S. Food and Drug Administration (FDA) unless otherwise noted. Consult individual manufacturer s prescribing information for approved uses outside the United States. REFERENCES ADA. Other injectable medications. Available at: Thiazolidinediones (pioglitazone, rosiglitazone) Helps to decrease the amount of glucose made by your liver Help to improve the way that insulin works in your muscles and fat: if your muscles are more sensitive to insulin, it is easier for insulin to bring glucose from your blood into your muscles and fat where glucose can be used for energy FOR MOREhttp:// INFORMATION: T A LK W I T Hmedication/insulin/other-injectable-medications.html. Y O UR H E A LT H C A RE PR OV I D ER ADA. What are my options? Available at: Inzucchi SE, et al. Diabetes Care. 2012;35(6): Mayo Clinic. Diabetes treatment: medications for type 2 diabetes. Available at: Updated December 2014 For more information, talk to your healthcare provider This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.

5 Medications Used to Treat Type 2 Diabetes Oral Injectable Alpha-glucosidase inhibitors (acarbose, miglitol) Available as Glyset (miglitol); PRECOSE (acarbose) Amylin mimetic (pramlintide) Available as SYMLIN (pramlintide) Biguanide (metformin) Available as Fortamet, GLUCOPHAGE, GLUCOPHAGE XR, Glumetza, Riomet (metformin) ACTOplus met, ACTOplus met XR (pioglitazone and metformin); Avandamet (rosiglitazone and metformin); GLUCOVANCE (gliburide and metformin); Janumet, Janumet XR (metformin and sitagliptin); Jentadueto (linagliptin and metformin); KAZANO (alogliptin and metformin); KOMBIGLYZE XR (saxagliptin and metformin); METAGLIP (glipizide and metformin); PrandiMet (metformin and repaglinide); XIGDUO XR (dapagliflozin and metformin) Glucagon-like peptide-1 (GLP-1) receptor agonists (albiglutide, dulaglutide, exenatide, liraglutide) Available as BYDUREON (extended-release exenatide); BYETTA (regular exenatide); TANZEUM (albiglutide); TRULICITY (dulaglutide); Victoza (liraglutide) Dipeptidyl peptidase-4 (DPP-4) inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin) Available as Januvia (sitagliptin); NESINA (alogliptin); Onglyza (saxagliptin); Tradjenta (linagliptin) Janumet, Janumet XR (metformin and sitagliptin); Jentadueto (linagliptin and metformin); Juvisync (sitagliptin and simvastatin); KAZANO (alogliptin and metformin); KOMBIGLYZE XR (saxagliptin and metformin); OSENI (alogliptin and pioglitazon) Insulins (aspart, detemir, glargine, glulisine, human, lispro) Available as Apidra (glulisine); Humalog, Humalog Mix50/50, Humalog Mix75/25 (lispro); Humulin N, Humulin R, Humulin 70/30 (human); Lantus (glargine); Levemir (detemir); Novolin N, Novolin R, Novolin 70/30 (human); NovoLog, NovoLog Mix 70/30 (aspart) Dopamine receptor agonist (bromocriptine mesylate) Available as CYCLOSET Inhaled Meglitinides (nateglinide, repaglinide) Available as Prandin (repaglinide); Starlix (nateglinide) PrandiMet (metformin and repaglinide) Insulin (human) Available as AFREZZA (insulin human) Sodium-glucose co-transporter 2 (SGLT2) inhibitors (canagliflozin, dapagliflozin, empagliflozin) Availble as FARXIGA (dapagliflozin), INVOKANA (canagliflozin), Jardiance (empagliflozin) XIGDUO XR (dapagliflozin and metformin) Sulfonylureas (glimepiride, glipizide, gliburidae) Available as Amaryl (glimepiride); DiaBeta, Glynase PresTab, or Micronase (gliburide); Glucotrol, Glucotrol XL (glipizide) Avandaryl (glimepiride and rosiglitazone); duetact (pioglitazone and glimepiride); GLUCOVANCE (gliburide and metformin); METAGLIP (glipizide and metformin) Thiazolidinediones (pioglitazone, rosiglitazone) Available as ACTOS (pioglitazone); Avandia (rosiglitazone) ACTOplus met, ACTOplus met XR (pioglitazone and metformin); Avandamet (rosiglitazone and metformin); Avandaryl (rosiglitazone and glimepiride); duetact (pioglitazone and glimepiride); OSENI (alogliptine and pioglitazone) This list of medications is provided for informational purposes only. Talk with your healthcare provider before starting or stopping any medications. The medications discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise noted. Consult individual manufacturer s prescribing information for approved uses outside the United States. Updated December 2014 This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.

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7 Medicamentos para el tratamiento de la diabetes tipo 2 Medicamentos para el tratamiento de la diabetes tipo 2 A continuación se indican los nombres de los medicamentos disponibles para la diabetes tipo 2. Orales Inhibidores de la alfa-glucosidasa (acarbosa, miglitol) Ejemplos: Glyset (miglitol); PRECOSE (acarbosa) Biguanida (metformina) Ejemplos: Fortamet, GLUCOPHAGE, GLUCOPHAGE XR, Glumetza, Riomet (metformina) ACTOplus met, ACTOplus met XR (pioglitazona y metformina); Avandamet (rosiglitazona y metformina); GLUCOVANCE (gliburida y metformina); Janumet, Janumet XR (metformina y sitagliptina); Jentadueto (linagliptina y metformina); KAZANO (alogliptina y metformina); KOMBIGLYZE XR (saxagliptina y metformina); METAGLIP (glipizida y metformina); PrandiMet (metformina y repaglinida) Inhibidores de la dipeptidil peptidasa-4 (DPP-4) (alogliptina, linagliptina, saxagliptina, sitagliptina) Ejemplos: Januvia (sitagliptina); NESINA (alogliptina); Onglyza (saxagliptina); Tradjenta (linagliptina) Janumet, Janumet XR (metformina y sitagliptina); Jentadueto (linagliptina y metformina); Juvisync (sitagliptina y simvastatina); KAZANO (alogliptina y metformina); KOMBIGLYZE XR (saxagliptina y metformina); OSENI (alogliptina y pioglitazona) Meglitinidas (nateglinida, repaglinida) Ejemplos: Prandin (repaglinida); Starlix (nateglinida) Producto combinado: PrandiMet (metformina y repaglinida) Inhibidores del cotransportador sodio-glucosa 2 (SGLT2) (canagliflozina, dapagliflozina) Ejemplos: FARXIGA (dapagliflozina), INVOKANA (canagliflozina) Sulfonilureas (glimepirida, glipizida, gliburida) Ejemplos: Amaryl (glimepirida); DiaBeta, Glynase PresTab, o Micronase (gliburida); Glucotrol, Glucotrol XL (glipizida) Avandaryl (glimepirida y rosiglitazona); duetact (pioglitazona y glimepirida); GLUCOVANCE (gliburida y metformina); METAGLIP (glipizida y metformina) Tiazolidindionas (pioglitazona, rosiglitazona) Ejemplos: ACTOS (pioglitazona); Avandia (rosiglitazona) ACTOplus met, ACTOplus met XR (pioglitazona y metformina); Avandamet (rosiglitazona y metformina); Avandaryl (rosiglitazona y glimepirida); duetact (pioglitazona y glimepirida); OSENI (alogliptina y pioglitazona) Mimético de la amilina (pramlintida) Ejemplo: SYMLIN (pramlintida) Inyectables Agonistas del receptor del péptido 1 análogo al glucagón (GLP-1) (exenatida, liraglutida) Ejemplos: BYETTA (exenatida corriente); BYDUREON (exenatida de liberación prolongada); Victoza (liraglutida) Insulinas (aspártica, detemir, glargina, glulisina, humana, lispro) Ejemplos: Apidra (glulisina); Humalog, Humalog Mix50/50, Humalog Mix75/25 (lispro); Humulin N, Humulin R, Humulin 70/30 (humana); Lantus (glargina); Levemir (detemir); Novolin N, Novolin R, Novolin 70/30 (humana); NovoLog, NovoLog Mix 70/30 (aspártica) Esta lista de medicamentos se ofrece únicamente con fines informativos. Consulte con su profesional de la salud antes de iniciar o suspender cualquier tratamiento con medicamentos. Los medicamentos descritos están aprobados para su uso en los Estados Unidos por la Administración de Alimentos y Medicamentos (FDA) a menos que se indique lo contrario. Consulte la información de prescripción de cada fabricante para saber los usos aprobados en el exterior de los Estados Unidos. Julio de 2014 Patrocinado por KnowledgePoint360 Group, LLC, Lyndhurst, NJ. Copyright 2014 KnowledgePoint360 Group, LLC. Reservados todos los derechos. El contenido de esta hoja fue creado por KnowledgePoint360 Group, LLC, y no estuvo asociado a ningún financiamiento a través de una subvención educativa o un interés publicitario o comercial.