Practical Strategies for the Clinical Use of Incretin Mimetics CME/CE. CME/CE Released: 09/15/2009; Valid for credit through 09/15/2010
|
|
- Solomon Gray
- 5 years ago
- Views:
Transcription
1 Practical Strategies for the Clinical Use of Incretin Mimetics CME/CE Robert R. Henry, MD Authors and Disclosures CME/CE Released: 09/15/2009; Valid for credit through 09/15/2010 Introduction Type 2 diabetes mellitus (T2DM) occurs as the result of dysregulation in the complex balance of hormonal systems, including insulin secretion and utilization, glucagon secretion, and incretin hormonal effects. The incretin hormones are a relatively new target of both diabetes research and pharmaceutical interest; traditional therapies have often targeted abnormal insulin and glucagon levels and/or their metabolic consequences. However, frequent failure to achieve optimal glycemic control, a high prevalence of medication side effects, and excess cardiovascular (CV) events are prevalent because traditional antihyperglycemic agents only affect 1 or 2 underlying mechanisms of these processes. Data from the UK Prospective Diabetes Study (UKPDS) evaluated the long-term effects of insulin, sulfonylureas, and metformin therapy as monotherapy. Fifty percent of patients achieved an A1C of 7% after 3 years of monotherapy, and only 25% maintained this level of glycemic control after 9 years. [1] These findings illustrate the progressive nature of T2DM and the inability of traditional therapies to substantially impact this progression. Incretin mimetic agents offer a unique approach to the treatment of T2DM due to their ability to improve multiple aspects of hormonal dysregulation. Incretin hormones are secreted from the proximal small bowel, distal small bowel, and colon and stimulate insulin secretion from pancreatic β cells in response to an oral glucose load. [2] Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) are the most widely studied incretin hormones. They increase the amount of insulin secreted up to 80% with an oral compared to an intravenous glucose load. [3] This enhanced insulin secretion after an oral glucose load is termed the "incretin effect" and has important therapeutic implications. While both hormones stimulate glucosedependent insulin secretion from pancreatic β cells, they vary in their pharmacokinetic and therapeutic potential. GLP-1 inhibits gastric emptying, decreases food intake, and inhibits glucagon secretion, while GIP has a minimal effect on gastric emptying and no effect on glucagon secretion or food intake. [4,5]
2 The incretin effect appears to be diminished, at least in some individuals with T2DM. [6] Nauck et al demonstrated this blunted insulin secretion in T2DM in response to an oral glucose load. While GIP concentrations are preserved in T2DM, the insulinotropic effect on the pancreatic receptor is reduced. GLP-1, however, exhibits a preserved insulinotropic effect, even when present in reduced amounts. [7] Nauck et al showed, in a proof-of-concept study, that an infusion of GLP-1 can result in normalization of plasma glucose in T2DM. [7] In addition, infusion of GLP-1 results in an increase in insulin secretion and a decrease in glucagon secretion compared with placebo. This retained insulinotropic effect in T2DM has made GLP-1 a target of pharmaceutical drug development via augmentation of circulating GLP-1 levels. [5] Native GLP-1 is rapidly degraded by the circulating enzyme dipeptidyl peptidase-4 (DPP-4), resulting in a halflife of approximately 2 minutes. [8] Thus, 2 approaches to increasing the circulating levels and effects of GLP-1 have been developed: injection of DPP-4 resistant GLP-1 receptor agonists (ie, incretin mimetics), and increasing the half-life of native GLP-1 through inhibition of DPP-4 (ie, DPP-4 inhibitors) (Figure 1). Figure 1.
3 Exenatide was the first incretin mimetic approved by the Food and Drug Administration (FDA) in It is a synthetic variant of GLP-1, derived from the saliva of the Gila monster (a venomous lizard), that is resistant to degradation by DPP-4, resulting in an extended plasma half-life. [8] Exenatide is approved for the treatment of T2DM that is inadequately controlled by oral antihyperglycemic medications and is administered by subcutaneous injection twice daily. [9] While exenatide is the only FDA-approved incretin mimetic at this time, several other promising therapies all with longer circulating half-lives are in development. Liraglutide is a once-daily, injectable human incretin mimetic awaiting FDA approval. [10] The Endocrinologic and Metabolic Drugs Advisory Committee of the United States FDA has evaluated liraglutide, and final FDA review is pending at this time. [11] Exenatide long-acting release (LAR) is a once-weekly formulation of exenatide, also under FDA review. Taspoglutide and albiglutide are new once-weekly incretin mimetics that are currently in phase 3 clinical testing. Properties of the incretin mimetics that are approved or are nearing market are summarized in Table 1. NOTE: Liraglutide, exenatide long-acting release (LAR), taspoglutide, and albiglutide are not currently FDA approved for this indication. Table 1.
4 GLP-1 retains its insulinotropic effects in T2DM In T2DM, GLP-1 retains its insulinotropic effects, even though it is present in diminished concentrations. GIP, however, is present in normal concentrations, while lacking insulinotropic effects. [6] Native GLP-1 is secreted by the proximal and distal small bowel and colon. [5] It is rapidly degraded by DPP-4, resulting in a half-life of approximately 2 minutes, whereas incretin mimetics exhibit a longer half-life due to DPP-4 resistance. [8,9] Enhanced insulin secretion after an oral glucose load is termed the incretin effect. The incretin effect is diminished in T2DM; therefore, the correct answer is GLP-1 retains its insulinotropic effects in T2DM. [3,6] The ADA recommends a general A1C goal of <7% for T2DM, and lower for selected individuals, if it can be safely achieved without significant hypoglycemia or adverse events. [12] Though previous data supported tight glycemic control to prevent or delay the onset of microvascular complications, [13] recent studies, such as the Action to Control Cardiovascular Risk in Diabetes (ACCORD) and the Action in Diabetes and Vascular Disease (ADVANCE) trials, failed to show a CV benefit with A1C targets of <6.0% and <6.5%, respectively. [14] The ACCORD study showed increased mortality with intensive glucose control (mean A1C, 6.4%) compared to standard (mean A1C,
5 7.5%). [12,14] This patient has a short T2DM duration and no historical or active comorbidities. Thus, a goal of <7% may be appropriate. Both Enhanced postprandial insulin secretion and Weight loss Incretin mimetics stimulate post-meal insulin secretion and reduce increased glucagon secretion in T2DM, [9] contributing to improved PPG. [15-17] They also decrease mean body weight by up to 5 kg. [18-20] Recent exenatide data show a reduced mean body weight from baseline by up to 2.1 kg over 30 weeks and by up to 4.7 kg in a 2- year follow-up. [18] In another trial of exenatide vs insulin, a significantly greater proportion of exenatide patients (22% vs 2%, respectively) achieved a 5% weight loss. [21] A 2-year trial of liraglutide vs glimepiride showed significant and maintained liraglutide weight loss ( 2.7 kg vs +1.1 kg, respectively). [19] Likewise, weight reductions of up to 2.8 kg have been seen with the addition of liraglutide to metformin vs adding placebo or glimepiride. [22] Considerable insulin secretion occurs in healthy individuals in the first 10 minutes following a meal. Similarly, an early burst of insulin secretion following intravenous administration of glucose occurs in healthy individuals. This is called the "first-phase insulin response" and is impaired early in the progression of T2DM. [9] Incretin mimetics improve insulin secretion and restore this first-phase insulin response, contributing to improved PPG levels. [15,16] T2DM is associated with numerous pathophysiological defects. In addition to impaired insulin secretion, glucagon secretion is abnormal and excessive. While glucagon secretion is normally present in healthy individuals, excessive amounts lead to increases in glucose production by the liver and hyperglycemia. Glucagon is also inappropriately present in T2DM during times of hyperglycemia when it should be suppressed. [5] Incretin mimetics suppress inappropriate glucagon secretion in a glucose-dependent manner, thereby lowering plasma glucose levels. [9,17] GLP-1 and the incretin mimetics also have indirect effects on glycemic levels through decreased gastric emptying, decreased food intake, and weight loss. The observed weight loss of up to 5 kg with incretin mimetics provides a unique advantage over traditional T2DM therapies. In addition to the previously mentioned weight loss effects seen with exenatide and liraglutide, a 26-week study examining exenatide LAR versus sitagliptin or pioglitazone documented a significant reduction in A1C and weight loss in the exenatide LAR group. [20] Incretin mimetics reduce fasting plasma glucose and PPG levels in T2DM, with A1C reductions ranging from 0.9% to 1.7%. [23] In a 30-week study exenatide 10 mcg bid decreased A1C by 0.78%
6 ±0.10% from a baseline of 8.2% when added to metformin [24] ; in a different study A1C reductions of 1.1% were maintained over 2 years with exenatide therapy. [18] Liraglutide resulted in a mean A1C decrease of 1.0% vs placebo ( 0.1%) when both were added to metformin. [22] In a recent study comparing liraglutide to exenatide, liraglutide resulted in greater A1C reductions ( 1.12% vs 0.79% respectively) when added to metformin or a sulfonylurea. [25] Exenatide LAR also showed significant A1C reductions in a 26-week trial: 66% of exenatide LAR patients achieved A1C target 7.0% vs 42% of sitagliptin patients and 56% of pioglitazone patients. [20] Pancreatic β-cell function in T2DM is impaired and associated with accelerated apoptosis. [26] The loss of β-cell function is progressive over time, with 50% or more of function already lost by the time of T2DM diagnosis. [26] This decrease in β-cell function may be altered, especially when targeted early in the disease process. GLP-1 and its analogs have demonstrated important effects on β cells in animal studies and show promise in maintaining long-term β-cell function and therefore glycemic control. [27] All of the above Agents should be selected based on glucose-lowering abilities, tolerability, safety, and effects on CV disease, BMI, insulin resistance, and insulin secretory capacity. [28,29] Incretin mimetics have positive effects on CV risk factors (blood pressure [BP], cholesterol, and liver enzymes). [30-32] The ADA guidelines emphasize using incretin mimetics in combination therapy when hypoglycemia or weight loss are concerns. [29] Incretin mimetics are not currently approved for monotherapy, so current metformin therapy makes this patient a candidate for addition of an incretin mimetic. [9] This patient's short T2DM duration also increases the likelihood for success with an incretin mimetic because it has recently been demonstrated that liraglutide is more effective than glimepiride at lowering A1C in patients with well-preserved β-cell function. [33] Data from the UKPDS show that 50% of patients will require combination therapy within 3 years of diagnosis. [1] This patient's elevated PPG and A1C require initiation of new and additional therapy, and effects on A1C, PPG, weight loss, hypoglycemia risk and CV risk factors make incretin mimetic therapy an appropriate selection for him when compared to other antihyperglycemic agents (Table 2). Table 2.
7 Several studies have examined the effects of incretin mimetics on CV risk factors. Fabunmi et al studied BP changes following 6 months of exenatide treatment. [30] In patients (n = 760) with a baseline systolic BP (SBP) 130 mm Hg, mean SBP decreased by 8.5 mm Hg. [30] A meta-analysis of 6 phase 3 clinical trials examined the effect of liraglutide on SBP. Liraglutide 1.8 mg reduced SBP by 2.59 mm Hg, whereas there was no change with placebo. The greatest reductions were seen in those with baseline SBP in the highest quartile. [31] Lastly, exenatide LAR reduced SBP, diastolic BP, cholesterol levels, and liver enzymes in a 52-week study. [3 If the patient experiences significant nausea within 1 week of initiating therapy, he should switch therapy Nausea is a common incretin mimetic side effect, occurring in up to 57% of exenatide-treated patients. [23] It is usually mild to moderate, peaks by 4 to 8 weeks, and improves with therapy duration. [25,34] Hypoglycemia risk is increased with combination sulfonylurea use but is generally low due to glucose-dependent insulin secretion. [5,34-35] Pancreatitis has been observed with incretin mimetics. [22,36,37] A recent study evaluating risks of acute pancreatitis found no increased risk with exenatide compared with other T2DM therapies. [38] The FDA cautions against incretin
8 mimetics if there is high risk for pancreatitis and recommends discontinuing therapy without restart if symptoms (abdominal pain and vomiting) occur. [36] The patient is concerned that he has gained some weight recently and cannot take his daily walks because of knee pain. Some of his friends who are taking other medications for their diabetes have put on weight since they started taking the medicine. His wife is worried he will not start a new medicine if it results in more weight gain. Both He may experience some weight loss with an incretin mimetic and Incretin mimetics may make him feel fuller and help him control his appetite Incretin mimetics, unlike most other T2DM agents, are usually associated with modest and sustained weight loss. [18-20] In a 24- week study, patients administered 5 or 10 mcg exenatide achieved greater A1C reductions ( 0.7% and 0.9%, respectively) compared with placebo ( 0.2%) and greater weight loss. [39] The Liraglutide Effect and Actions in Diabetes (LEAD) 6 study showed a similar degree of weight loss with liraglutide ( 3.24 kg) vs exenatide ( 2.87 kg) when added to traditional T2DM therapies. [25] Weight loss with incretin mimetics may be in part due to treatment-associated nausea but also occurs in the absence of nausea and is consistent with the ability of these agents to increase feelings of satiety and decrease food intake. [23] Both The patient should inject his medication before eating and The medication should be injected within a 60-minute period before a meal and is unlikely to cause hypoglycemia during this time. Exenatide and other incretin mimetics achieve glycemic control through several mechanisms, including delayed gastric emptying and weight loss. According to the prescribing information, exenatide should be injected "within a 60-minute period before the morning and evening meals." [9] Injecting before a meal allows the incretin mimetic to exert its effects on postprandial insulin secretion, delayed gastric emptying, and decreased food intake. Because this process is glucose dependent, hypoglycemia is not a typical side effect. [5]
Chief of Endocrinology East Orange General Hospital
Targeting the Incretins System: Can it Improve Our Ability to Treat Type 2 Diabetes? Darshi Sunderam, MD Darshi Sunderam, MD Chief of Endocrinology East Orange General Hospital Age-adjusted Percentage
More informationThe Many Faces of T2DM in Long-term Care Facilities
The Many Faces of T2DM in Long-term Care Facilities Question #1 Which of the following is a risk factor for increased hypoglycemia in older patients that may suggest the need to relax hyperglycemia treatment
More informationData from an epidemiologic analysis of
CLINICAL TRIAL RESULTS OF GLP-1 RELATED AGENTS: THE EARLY EVIDENCE Lawrence Blonde, MD, FACP, FACE ABSTRACT Although it is well known that lowering A 1c (also known as glycated hemoglobin) is associated
More informationNewer Drugs in the Management of Type 2 Diabetes Mellitus
Newer Drugs in the Management of Type 2 Diabetes Mellitus Dr. C. Dinesh M. Naidu Professor of Pharmacology, Kamineni Institute of Medical Sciences, Narketpally. 1 Presentation Outline Introduction Pathogenesis
More informationGLUCAGON LIKE PEPTIDE (GLP) 1 AGONISTS FOR THE TREATMENT OF TYPE 2 DIABETES, WEIGHT CONTROL AND CARDIOVASCULAR PROTECTION.
GLUCAGON LIKE PEPTIDE (GLP) 1 AGONISTS FOR THE TREATMENT OF TYPE 2 DIABETES, WEIGHT CONTROL AND CARDIOVASCULAR PROTECTION. Patricia Garnica MS, ANP-BC, CDE, CDTC Inpatient Diabetes Nurse Practitioner North
More informationType 2 DM in Adolescents: Use of GLP-1 RA. Objectives. Scope of Problem: Obesity. Background. Pathophysiology of T2DM
Type 2 DM in Adolescents: Use of GLP-1 RA Objectives Identify patients in the pediatric population with T2DM that would potentially benefit from the use of GLP-1 RA Discuss changes in glycemic outcomes
More informationSitagliptin: first DPP-4 inhibitor to treat type 2 diabetes Steve Chaplin MSc, MRPharmS and Andrew Krentz MD, FRCP
Sitagliptin: first DPP-4 inhibitor to treat type 2 diabetes Steve Chaplin MSc, MRPharmS and Andrew Krentz MD, FRCP KEY POINTS sitagliptin (Januvia) is a DPP-4 inhibitor that blocks the breakdown of the
More informationModulating the Incretin System: A New Therapeutic Strategy for Type 2 Diabetes
Modulating the Incretin System: A New Therapeutic Strategy for Type 2 Diabetes Geneva Clark Briggs, PharmD, BCPS Adjunct Professor at University of Appalachia College of Pharmacy Clinical Associate, Medical
More informationTargeting Incretins in Type 2 Diabetes: Role of GLP-1 Receptor Agonists and DPP-4 Inhibitors. Richard E. Pratley and Matthew Gilbert
REVIEW Targeting Incretins in Type 2 Diabetes: Role of GLP-1 Receptor Agonists and DPP-4 Inhibitors Richard E. Pratley and Matthew Gilbert Diabetes and Metabolism Translational Medicine Unit, University
More informationDisclosure. Learning Objectives. Case. Diabetes Update: Incretin Agents in Diabetes-When to Use Them? I have no disclosures to declare
Disclosure Diabetes Update: Incretin Agents in Diabetes-When to Use Them? I have no disclosures to declare Spring Therapeutics Update 2011 CSHP BC Branch Anar Dossa BScPharm Pharm D CDE April 20, 2011
More informationIncretin-based Therapies for Type 2 Diabetes Comparisons Between Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors
Incretin-based Therapies for Type 2 Diabetes Comparisons Between Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors Timothy Bailey, MD, FACE, CPI Director, AMCR Institute,
More informationMultiple Factors Should Be Considered When Setting a Glycemic Goal
Multiple Facts Should Be Considered When Setting a Glycemic Goal Patient attitude and expected treatment effts Risks potentially associated with hypoglycemia, other adverse events Disease duration Me stringent
More informationNew Treatment Options for Type 2 Diabetes: Incretin-Based Therapy
New Treatment Options for Type 2 Diabetes: Incretin-Based Therapy New Treatment Options for Type 2 Diabetes: Incretin-Based Therapy is supported by an educational grant from Novo Nordisk Inc. This program
More informationRole of incretins in the treatment of type 2 diabetes
Role of incretins in the treatment of type 2 diabetes Jens Juul Holst Department of Medical Physiology Panum Institute University of Copenhagen Denmark Diabetes & Obesity Spanish Society of Internal Medicine
More informationGLP-1 agonists. Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK
GLP-1 agonists Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK What do GLP-1 agonists do? Physiology of postprandial glucose regulation Meal ❶ ❷ Insulin Rising plasma
More informationNewer and Expensive treatment of diabetes. Endocrinology Visiting Associate Professor Institute of Medicine TUTH
Newer and Expensive treatment of diabetes Jyoti Bhattarai MD Endocrinology Visiting Associate Professor Institute of Medicine TUTH Four out of every five people with diabetes now live in developing countries.
More informationGLP 1 agonists Winning the Losing Battle. Dr Bernard SAMIA. KCS Congress: Impact through collaboration
GLP 1 agonists Winning the Losing Battle Dr Bernard SAMIA KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email: kcardiacs@gmail.com Web: www.kenyacardiacs.org Disclosures I have
More informationEffect of macronutrients and mixed meals on incretin hormone secretion and islet cell function
Effect of macronutrients and mixed meals on incretin hormone secretion and islet cell function Background. Following meal ingestion, several hormones are released from the gastrointestinal tract. Some
More informationGLP-1 (glucagon-like peptide-1) Agonists (Byetta, Bydureon, Tanzeum, Trulicity, Victoza ) Step Therapy and Quantity Limit Criteria Program Summary
OBJECTIVE The intent of the GLP-1 (glucagon-like peptide-1) s (Byetta/exenatide, Bydureon/ exenatide extended-release, Tanzeum/albiglutide, Trulicity/dulaglutide, and Victoza/liraglutide) Step Therapy
More informationMechanisms and Clinical Efficacy of Lixisenatide for the Management of Type 2 Diabetes
Adv Ther (2013) 30(2):81 101. DOI 10.1007/s12325-013-0009-4 REVIEW Mechanisms and Clinical Efficacy of Lixisenatide for the Management of Type 2 Diabetes Michael Horowitz Christopher K. Rayner Karen L.
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Single Technology Appraisal. Canagliflozin in combination therapy for treating type 2 diabetes
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Single Technology Appraisal Canagliflozin in combination therapy for Final scope Remit/appraisal objective To appraise the clinical and cost effectiveness
More informationAchieving and maintaining good glycemic control is an
Glycemic Efficacy, Weight Effects, and Safety of Once-Weekly Glucagon-Like Peptide-1 Receptor Agonists Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE; Kathleen Wyne, MD, PhD, FACE, FNLA; Anthony Cannon,
More informationManagement of Type 2 Diabetes
Management of Type 2 Diabetes Pathophysiology Insulin resistance and relative insulin deficiency/ defective secretion Not immune mediated No evidence of β cell destruction Increased risk with age, obesity
More informationNew and Emerging Therapies for Type 2 DM
Dale Clayton MHSc, MD, FRCPC Dalhousie University/Capital Health April 28, 2011 New and Emerging Therapies for Type 2 DM The science of today, is the technology of tomorrow. Edward Teller American Physicist
More informationTreating Type 2 Diabetes with Bariatric Surgery. Goal of Treating T2DM. Remission of T2DM with Bariatric
Treating Type 2 Diabetes with Bariatric Surgery Number (in Millions) of Persons with Diagnosed Diabetes, United States, 198 25 The number of Americans with diabetes increased from 5.6 to 15.8 million Guilherme
More informationVICTOSA and Renal impairment DR.R.S.SAJAD
VICTOSA and Renal impairment DR.R.S.SAJAD February 2019 Main effect of GLP-1 is : Stimulating glucose dependent insulin release from the pancreatic islets. Slow gastric emptying Inhibit inappropriate
More informationWhat s New on the Horizon: Diabetes Medication Update
What s New on the Horizon: Diabetes Medication Update Outline of Talk Newly released and upcoming medications: the incretins, DPP-IV inhibitors, and what s coming Revised ADA/EASD and AACE guidelines:
More informationGLP-1 Receptor Agonists and SGLT-2 Inhibitors. Debbie Hicks
GLP-1 Receptor Agonists and SGLT-2 Inhibitors Debbie Hicks Prescribing and Adverse Event reporting information is available at this meeting from the AstraZeneca representative The views expressed by the
More informationNEW DIABETES CARE MEDICATIONS
NEW DIABETES CARE MEDICATIONS James Bonucchi DO, ECNU, FACE Adult Medicine and Endocrinology Specialists Disclosures Speakers bureau Sanofi AZ BI Diabetes Diabetes cost ADA 2017 data Ever increasing disorder.
More informationWhat s New on the Horizon: Diabetes Medication Update. Michael Shannon, MD Providence Endocrinology, Olympia WA
What s New on the Horizon: Diabetes Medication Update Michael Shannon, MD Providence Endocrinology, Olympia WA 1 Outline of Talk Newly released and upcoming medications: the incretins, DPP-IV inhibitors,
More informationErtugliflozin (Steglatro ) 5 mg daily. May increase to 15 mg daily. Take in the morning +/- food. < 60: Do not initiate; discontinue therapy
Sodium-glucose Cotransporter-2 (SGLT2) s Inhibit SGLT in proximal renal tubules, reducing reabsorption of filtered glucose from tubular lumen Lowers renal threshold for glucose à increase urinary excretion
More informationUpdate on Diabetes Mellitus
Update on Diabetes Mellitus Treatment: Targeting the Incretin System Overview Underlying defects with Type 2 diabetes Importance of managing postprandial glucose control Amylin Incretin Hormones New therapies
More informationYOU HAVE DIABETES. Angie O Connor Community Diabetes Nurse Specialist 25th September 2013
YOU HAVE DIABETES Angie O Connor Community Diabetes Nurse Specialist 25th September 2013 Predicated 2015 figures are already met 1 in 20 have diabetes:1in8 over 60years old Definite Diagnosis is key Early
More informationGLP-1 receptor agonists for type 2 diabetes currently available in the U.S.
GLP-1 receptor agonists for type 2 diabetes currently available in the U.S. GLP-1 agonists are a class of antidiabetic agents that mimic the actions of the glucagon-like peptide. GLP-1 is one of several
More informationLiraglutide: First Once-Daily Human GLP-1 Analogue
DRUG PROFILE KERALA MEDICAL JOURNAL Liraglutide: First Once-Daily Human GLP-1 Analogue Sreejith N Kumar Research Cell, IMA Kerala State, K-5, Kochar Road, Sasthamangalam Thiruvananthapuram* ABSTRACT Published
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Proposed Health Technology Appraisal
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Proposed Health Technology Appraisal Dapagliflozin in combination therapy for the Final scope Remit/appraisal objective To appraise the clinical and
More informationCase Report Off-Label Use of Liraglutide in the Management of a Pediatric Patient with Type 2 Diabetes Mellitus
Case Reports in Pediatrics Volume 2013, Article ID 703925, 4 pages http://dx.doi.org/10.1155/2013/703925 Case Report Off-Label Use of Liraglutide in the Management of a Pediatric Patient with Type 2 Diabetes
More informationexenatide 2mg powder and solvent for prolonged-release suspension for injection (Bydureon ) SMC No. (748/11) Eli Lilly and Company Limited
exenatide 2mg powder and solvent for prolonged-release suspension for injection (Bydureon ) SMC No. (748/11) Eli Lilly and Company Limited 09 December 2011 The Scottish Medicines Consortium (SMC) has completed
More informationNew Drug Evaluation: Dulaglutide
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 informationAbstract. Effect of sitagliptin on glycemic control in patients with type 2 diabetes. Introduction. Abbas Mahdi Rahmah
Effect of sitagliptin on glycemic control in patients with type 2 diabetes Abbas Mahdi Rahmah Correspondence: Dr. Abbas Mahdi Rahmah Consultant Endocrinologist, FRCP (Edin) Director of Iraqi National Diabetes
More informationDPP-4 Inhibitors: Strategies for PPG Control
Issue 2 Clinical Use o f In c r e t i n-based Therapies to Tr e at Type 2 Diabetes Term of Approval Release date: August 2009 Expiration date: August 31, 2010 DPP-4 Inhibitors: Strategies for PPG Control
More informationModulating the Incretin System: A New Therapeutic Strategy for Type 2 Diabetes. Overview. Prevalence of Overweight in the U.S.
Modulating the Incretin System: A New Therapeutic Strategy for Type 2 Diabetes Geneva Clark Briggs, PharmD, BCPS Overview Underlying defects with Type 2 diabetes Importance of managing postprandial glucose
More informationSELECTED ABSTRACTS AND POSTER PRESENTATIONS
SELECTED ABSTRACTS AND POSTER PRESENTATIONS The following summaries are based on abstracts and posters presented at the American Diabetes Association s 65th Annual Scientific Sessions held in San Diego,
More informationDrug Class Monograph
Drug Class Monograph Class: Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drugs: alogliptin, alogliptin/metformin, Januvia (sitagliptin), Janumet (sitagliptin/metformin), Janumet XR (sitagliptin/metformin),
More informationGLP-1-based therapies in the management of type 2 diabetes
GLP-1-based therapies in the management of type 2 diabetes Makbul Aman Mansyur Division Endocrine & Metabolism Department of Internal Medicine Faculty of Medicine Hasanuddin University/ RSUP Dr. Wahidin
More informationImproving Clinical Outcomes: The Role of Incretin-Based Therapies
Issue 4 Clinical Use of Incretin-Based Therapies to Treat Type 2 Diabetes Term of Approval Release date: April 2010 Expiration date: April 30, 2011 Improving Clinical Outcomes: The Role of Incretin-Based
More informationIt is estimated that approximately 20.8 million Americans
FORMULARY MANAGEMENT Managed Care Perspective on Three New Agents for Type 2 Diabetes Shawna VanDeKoppel, PharmD; Hae Mi Choe, PharmD, CDE; and Burgunda V. Sweet, PharmD, FASHP ABSTRACT BACKGROUND: Despite
More informationMy Journey in Endocrinology. Samuel Cataland M.D
My Journey in Endocrinology Samuel Cataland M.D. 1968-2015 Drs Berson M.D. Yalow phd Insulin Radioimmunoassay Nobel Prize Physiology or Medicine 1977 Rosalyn Yalow: Radioimmunoassay Technology Andrew Schally
More informationDiabesity. Metabolic dysfunction that ranges from mild blood glucose imbalance to full fledged Type 2 DM Signs
Diabesity Metabolic dysfunction that ranges from mild blood glucose imbalance to full fledged Type 2 DM Signs Abdominal obesity Low HDL, high LDL, and high triglycerides HTN High blood glucose (F>100l,
More informationPROCEEDINGS CLINICAL RESEARCH AND EXPERIENCE WITH INCRETIN-BASED THERAPIES * Vivian A. Fonseca, MD, FRCP ABSTRACT
CLINICAL RESEARCH AND EXPERIENCE WITH INCRETIN-BASED THERAPIES Vivian A. Fonseca, MD, FRCP ABSTRACT Despite proven lifestyle recommendations and the availability of a range of oral antidiabetic agents,
More informationEvolution of Exenatide as a Diabetes Therapeutic
Send Orders of Reprints at reprints@benthamscience.net Current Diabetes Reviews, 2013, 9, 161-193 161 Evolution of Exenatide as a Diabetes Therapeutic Sunil Bhavsar, 1,* Sunder Mudaliar 2,* and Alan Cherrington
More informationT2DM is a global epidemic with
: a new option for the management of type 2 diabetes Marc Evans MRCP, MD, Consultant Diabetologist, Llandough Hospital, Cardiff Incretin-based therapies for the treatment of diabetes mellitus (T2DM) present
More information22 Emerging Therapies for
22 Emerging Therapies for Treatment of Type 2 Diabetes Siddharth N Shah Abstract: The prevalence of Diabetes is progressively increasing world-wide and the growth of the disease in our country is phenomenal.
More informationWhat s New in Diabetes Treatment. Disclosures
What s New in Diabetes Treatment Shiri Levy M.D. Henry Ford Hospital Senior Staff Physician Service Chief, West Bloomfield Hospital Endocrinology, Metabolism, Bone and Mineral Disorders Disclosures None
More informationType 2 Diabetes: Where Do We Start with Treatment? DIABETES EDUCATION. Diabetes Mellitus: Complications and Co-Morbid Conditions
Diabetes Mellitus: Complications and Co-Morbid Conditions ADA Guidelines for Glycemic Control: 2016 Retinopathy Between 2005-2008, 28.5% of patients with diabetes 40 years and older diagnosed with diabetic
More informationOptimizing Treatment Strategies to Improve Patient Outcomes in the Management of Type 2 Diabetes
Optimizing Treatment Strategies to Improve Patient Outcomes in the Management of Type 2 Diabetes Philip Raskin, MD Professor of Medicine The University of Texas, Southwestern Medical Center NAMCP Spring
More informationDiabetes: Three Core Deficits
Diabetes: Three Core Deficits Fat Cell Dysfunction Impaired Incretin Function Impaired Appetite Suppression Obesity and Insulin Resistance in Muscle and Liver Hyperglycemia Impaired Insulin Secretion Islet
More informationDrug Class Monograph
Class: Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Monograph Drugs: alogliptin, Januvia (sitagliptin), Janumet (sitagliptin/metformin), Janumet XR (sitagliptin/metformin), Jentadueto (linagliptin/metformin),
More informationA New Therapeutic Strategey for Type II Diabetes: Update 2008
Live, One Hour Webinar A New Therapeutic Strategey for Type II Diabetes: Update 2008 Geneva Clark Briggs, PharmD, BCPS Adjunct Professor at University of Appalachia College of Pharmacy in Grundy, Virginia.
More informationCurrent Status of Incretin Based Therapies in Type 2 Diabetes
Current Status of Incretin Based Therapies in Type 2 Diabetes DR.M.Mukhyaprana Prabhu Professor of Internal Medicine Kasturba Medical College, Manipal, Manipal University, India 2 nd International Endocrine
More informationDipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Prior Authorization Protocol
Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed
More informationApproaches to Addressing Incretin Deficiency. Non-Insulin Injectable Agents. Incretin Mimetics. Exendin-4 in the Gila Monster
Non-Insulin Injectable Agents Approaches to Addressing Incretin Deficiency Longer-acting analogs? (Incretin mimetics) GLP-1 Analogs Inhibition of inactivation? (Incretin enhancers) DPP-4 Inhibitors Drucker
More informationla prise en charge du diabète de
N21 XIII Congrès National de Diabétologie, 29 mai 2011, Alger Intérêt et place des Anti DPP4 dans la prise en charge du diabète de type 2 Nicolas PAQUOT, MD, PhD CHU Sart-Tilman, Université de Liège Belgique
More informationNon-insulin treatment in Type 1 DM Sang Yong Kim
Non-insulin treatment in Type 1 DM Sang Yong Kim Chosun University Hospital Conflict of interest disclosure None Committee of Scientific Affairs Committee of Scientific Affairs Insulin therapy is the mainstay
More informationTREATMENTS FOR TYPE 2 DIABETES. Susan Henry Diabetes Specialist Nurse
TREATMENTS FOR TYPE 2 DIABETES Susan Henry Diabetes Specialist Nurse How can we improve outcomes in Type 2 diabetes? Earlier diagnosis Better patient education Stress central role of lifestyle management
More informationTherapeutic strategy to reduce Glucagon secretion
Clinical focus on glucagon: α-cell as a companion of β-cell Therapeutic strategy to reduce Glucagon secretion Sunghwan Suh Dong-A University Conflict of interest disclosure None Committee of Scientific
More informationChanging Diabetes: The time is now!
Midwest Cardiovascular Research Foundation Welcomes DANITA HARRISON, ARNP Ms. Harrison discloses speaking relationships with Lilly, Novo Nordisk and Pfizer. Changing Diabetes: The time is now! Danita Harrison
More informationOral Hypoglycemics and Risk of Adverse Cardiac Events: A Summary of the Controversy
Oral Hypoglycemics and Risk of Adverse Cardiac Events: A Summary of the Controversy Jeffrey Boord, MD, MPH Advances in Cardiovascular Medicine Kingston, Jamaica December 7, 2012 VanderbiltHeart.com Outline
More informationNovel anti-diabetic therapies
Prof. Manfredi Rizzo, MD, PhD ASSOCIATE PROFESSOR OF INTERNAL MEDICINE School of Medicine University of Palermo, Italy & ASSOCIATE PROFESSOR OF INTERNAL MEDICINE School of Medicine University of South
More informationRPCC Pharmacy Forum. The Type 2 Diabetes Issue. Type 2 Diabetes: The Basics
Nov/Dec 2015 Issue 11 RPCC Pharmacy Forum Special Interest Articles: Diabetes Medication Chart Insulin Chart Afreeza Did you know? Exanatide, marketed as Byetta, is the synthetic form of exendin-4, which
More informationGlucose Control drug treatments
Glucose Control drug treatments It should be noted that glitazones are under suspicion of precipitating acute cardiac events and current recommendations contraindicate the use of glitazones in patients
More informationNew Treatments for Type 2 diabetes. Nandini Seevaratnam April 2016 Rushcliffe Patient Forum
New Treatments for Type 2 diabetes Nandini Seevaratnam April 2016 Rushcliffe Patient Forum Overview Growing population of Type 2 diabetes Basic science on what goes wrong Current treatments Why there is
More informationDiabetes Update: Intensifying Insulin Therapy Nuts, Bolts and Other Items
Diabetes Update: Intensifying Insulin Therapy Nuts, Bolts and Other Items Hayley A. Miller, MD Physician, Internal Medicine, Diabetes and Metabolism, Sandy Clinic, Intermountain Healthcare Objectives:
More informationEarly treatment for patients with Type 2 Diabetes
Israel Society of Internal Medicine Kibutz Hagoshrim, June 22, 2012 Early treatment for patients with Type 2 Diabetes Eduard Montanya Hospital Universitari Bellvitge-IDIBELL CIBERDEM University of Barcelona
More informationTreatment Options for Diabetes: An Update
Treatment Options for Diabetes: An Update A/Prof. Marg McGill Manager, Diabetes Centre Dr. Ted Wu Staff Specialist Endocrinologist Diabetes Centre Centre of Health Professional Education Education Provider
More informationINJECTABLE THERAPY FOR THE TREATMENT OF DIABETES
INJECTABLE THERAPY FOR THE TREATMENT OF DIABETES ARSHNA SANGHRAJKA DIABETES SPECIALIST PRESCRIBING PHARMACIST OBJECTIVES EXPLORE THE TYPES OF INSULIN AND INJECTABLE DIABETES TREATMENTS AND DEVICES AVAILABLE
More information6/1/2018. Lou Haenel, IV, DO, FACE, FACOI Endocrinology Roper St Francis Charleston, SC THE OMINOUS OCTET: HOW PATHOPHYSIOLOGY AND THERAPY MERGE
Lou Haenel, IV, DO, FACE, FACOI Endocrinology Roper St Francis Charleston, SC THE OMINOUS OCTET: HOW PATHOPHYSIOLOGY AND THERAPY MERGE 1 2 3 Sulfonylureas Glipizide Glyburide Glimeperide 4 Metformin Gold
More informationScottish Medicines Consortium
Scottish Medicines Consortium liraglutide 6mg/mL prefilled pen for injection (3mL) (Victoza ) Novo Nordisk Ltd. No. (585/09) 06 November 2009 The Scottish Medicines Consortium (SMC) has completed its assessment
More informationGLP-1 RECEPTOR AGONIST SHOULD I TRY IT? VERONICA BRADY, PHD, BC-ADM, CDE PROJECT ECHO JUNE 21, 2018
GLP-1 RECEPTOR AGONIST SHOULD I TRY IT? VERONICA BRADY, PHD, BC-ADM, CDE PROJECT ECHO JUNE 21, 2018 SOMETHING TO CONSIDER IF YOU COULD PRESCRIBE A MEDICATION FOR YOUR PATIENT WITH DIABETES THAT: DECREASED
More informationGLP-1 Agonists Therapy in Individuals with Type 2 Diabetes Mellitus: A Review of Safety and Tolerability
GLP-1 Agonists Therapy in Individuals with Type 2 Diabetes Mellitus: A Review of Safety and Tolerability Reprinted with permission of the authors and the Indiana Pharmacists Alliance where this article
More informationSoliqua (insulin glargine and lixisenatide), Xultophy (insulin degludec and liraglutide)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.48 Subject: Insulin GLP-1 Combinations Page: 1 of 5 Last Review Date: September 15, 2017 Insulin GLP-1
More informationWhat s New in Diabetes Medications. Jena Torpin, PharmD
What s New in Diabetes Medications Jena Torpin, PharmD 1 Objectives Discuss new medications in the management of diabetes Understand the mechanism of the medications discussed Understand the side effects
More informationFARXIGA (dapagliflozin) Jardiance (empagliflozin) tablets. Synjardy (empagliflozin and metformin hydrochloride) tablets. GLUCOPHAGE* (metformin)
Type 2 Medications Drug Class How It Works Brand and Generic Names Manufacturers Usual Starting Dose The kidneys filter sugar and either absorb it back into your body for energy or remove it through your
More informationCURRENT CONTROVERSIES IN DIABETES CARE
CURRENT CONTROVERSIES IN DIABETES CARE Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Diabetes Mellitus: U.S. Impact
More informationDM Fundamentals Class 4 Meds for Type 2
DM Fundamentals Class 4 Meds for Type 2 Beverly Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Copyright 1999 2015, Diabetes Education Services, All Rights Reserved. Diabetes Meds
More informationGlucagon-like peptide-1 (GLP-1) is an
THE NEW SCIENCE OF GLP-1: EFFECTS BEYOND GLUCOSE CONTROL Richard E. Pratley, MD ABSTRACT The incretin hormone, glucagon-like peptide- 1 (GLP-1) has well-characterized effects on glucose homeostasis that
More informationDrug Class Review Newer Diabetes Medications and Combinations
Drug Class Review Newer Diabetes Medications and Combinations Final Update 2 Report July 2016 The purpose reports is to make available information regarding the comparative clinical effectiveness and harms
More informationAge-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes
Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI 30 kg/m 2 ) 1994 2000 2009 No Data 26.0% Diabetes 1994 2000 2009
More informationA Practical Approach to the Use of Diabetes Medications
A Practical Approach to the Use of Diabetes Medications Juan Pablo Frias, M.D., FACE President, National Research Institute, Los Angles, CA Clinical Faculty, University of California, San Diego, CA OUTLINE
More informationAdlyxin. (lixisenatide) New Product Slideshow
Adlyxin (lixisenatide) New Product Slideshow Introduction Brand name: Adlyxin Generic name: Lixisenatide Pharmacological class: Glucagon-like peptide-1 (GLP-1) receptor agonist Strength and Formulation:
More informationType 2 Diabetes Mellitus 2011
2011 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Diabetes Mellitus Diagnosis 2011 Diabetes Mellitus Fasting Glucose
More informationGLP-1. GLP-1 is produced by the L-cells of the gut after food intake in two biologically active forms It is rapidly degraded by DPP-4.
GLP-1 GLP-1 is produced by the L-cells of the gut after food intake in two biologically active forms It is rapidly degraded by DPP-4 Food intake éinsulin Gut églucose uptake Pancreas Beta cells Alpha cells
More informationUpdate on GLP-1 Agonists in Type 2 Diabetes is supported by an educational grant from Novo Nordisk Inc. It has been accredited by the American
Update on GLP-1 Agonists in Type 2 Diabetes is supported by an educational grant from Novo Nordisk Inc. It has been accredited by the American Association of Diabetes Educators (AADE) for nurses, dietitians,
More informationDiabetes 2013: Achieving Goals Through Comprehensive Treatment. Session 2: Individualizing Therapy
Diabetes 2013: Achieving Goals Through Comprehensive Treatment Session 2: Individualizing Therapy Joshua L. Cohen, M.D., F.A.C.P. Professor of Medicine Interim Director, Division of Endocrinology & Metabolism
More informationGlucagon-like peptide-1 (GLP-1) Agonists Drug Class Prior Authorization Protocol
Glucagon-like peptide-1 (GLP-1) Agonists Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed
More informationOptimal glucose control. DM Treatment. Glucose Control one out of many. Many guidelines: Confusing. Theorectically easy
DM Treatment How to Achieve Optimal Glycaemic Control The Tung Wah Eastern Hospital Experience of DM Share Care Experience Optimal glucose control Theorectically easy More challenging in the real world
More informationDM Fundamentals Class 4 Meds for Type 2
DM Fundamentals Class 4 Meds for Type 2 Beverly Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Copyright 1999 2015, Diabetes Education Services, All Rights Reserved. Diabetes Meds
More informationNon-Insulin Parenteral Therapies
30 Non-Insulin Parenteral Therapies Jens Juul Holst, 1 Sten Madsbad 2 & Ole Schmitz 3 1 Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, Copenhagen, Denmark 2 Department
More informationSociety for Ambulatory Anesthesia Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery
Society for Ambulatory Anesthesia Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery Girish P. Joshi, MB BS, MD, FFARCSI Anesthesia & Analgesia
More information3/8/2011. Julie M. Sease, Pharm D, BCPS, CDE Associate Professor of Pharmacy Practice Presbyterian College School of Pharmacy
Summarize revisions to the 2011 American Diabetes Association clinical practice guidelines. Evaluate bromocriptine as a therapeutic option in the management of type 2 diabetes. Compare and contrast the
More information