ประช มว ชาการสาหร บแพทย ท ปฏ บ ต งานในหน วยบร การปฐมภ ม
|
|
- Elijah Ryan
- 5 years ago
- Views:
Transcription
1 ประช มว ชาการสาหร บแพทย ท ปฏ บ ต งานในหน วยบร การปฐมภ ม Update DM 21 ส งหาคม 2558 พญ.ร งนภา ลออธนก ล, พบ
2 2015
3
4 Outlines DM OPD management Case scenario
5 Case Somjit is a 43-year-old woman Check-up No abnormal symptom Laboratory FBS Cholesterol Triglyceride HDL LDL Creatinine 102 mg/dl 245 mg/dl 230 mg/dl 45 mg/dl 123 mg/dl 1.0 mg/dl
6 ADA 2015
7 Criteria for the diagnosis of diabetes FPG 126 mg/dl Fasting is defined as no caloric intake for at least 8 h 2-h plasma glucose 200 mg/dl during an 75g.OGTT Random plasma glucose 200 mg/dl In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis Hemoglobin A1C 6.5 In the absence of unequivocal hyperglycemia Result should be confirmed by repeat testing
8
9 Prediabetes FPG 100 to 125 mg/dl = IFG 2-h plasma glucose 140 to 199 mg/dl during an 75g.OGTT = IGT A1C % Prediabetes should be tested yearly
10 Case Somjit is a 43-year-old woman Check-up No abnormal symptom Laboratory Repeat FBS Cholesterol Triglyceride HDL LDL Creatinine 75g.OGTT: BS= 110,220mg/dL 111 mg/dl 245 mg/dl 230 mg/dl 45 mg/dl 123 mg/dl 1.0 mg/dl HbA1C 7.2
11 DM? Glycemic goal? Aim of glycemic control? Diabetic complication? New Diabetic Patient
12
13
14
15 GUIDELINE
16 Glycemic Treatment Targets* American Diabetes IDF 2 AACE 3 Association 1 HbA 1c (%) <7.0 < FPG mmol/l (mg/dl) < (70-130) <6.0 (<110) <6.1 (<110) PPG mmol/l (mg/dl) <10 (<180) <8.0 (<145) 7.8 (<140) *Treatment targets for non-pregnant adults. AACE = American Association of Clinical Endocrinologists; FPG = fasting plasma glucose; IDF = International Diabetes Foundation; PPG = postprandial plasma glucose. 1. American Diabetes Association. Diabetes Care. 2012;35(Suppl 1):S11-S International Diabetes Federation (IDF). Available at: Accessed 9 March Handelsman Y, et al. Endocr Pract. 2011;17(Suppl 2):1-53.
17 Thai Guideline การควบค ม เบาหวาน เป าหมาย ควบค มเข มงวดมาก ควบค มเข มงวด ควบค มไม เข มงวด ระด บน าตาลในเล อด ขณะอดอาหาร ระด บน าตาลในเล อดหล ง อาหาร 2 ช วโมง ระด บน าตาลในเล อด ส งส ดหล งอาหาร มก./ดล. 90- <130 มก./ดล. ใกล เค ยง 150 มก./ดล. <140 มก./ดล. - <180 มก./ดล. <180 มก./ดล. HbA1C < 6.5% < 7.0% % แนวทางเวชปฏ บ ต สาหร บโรคเบาหวาน 2557
18 GENERAL THERAPY RECOMMENDATIONS
19
20 Thai guideline 2014 FBS < 180 & HbA1C < 8 Lifestyle modification 3 month FBS 180 or HbA1C > 8 1 st line : MF 2 nd line : SU, TZD, DPP-4 inh, α-gi, Repaglinide FBS >220 or HbA1C >9 2 OHG combination MF, SU, TZD, DPP-4 inh, α-gi, Repaglinide, basal insulin FBS > 300 or HbA1C > 11 with symptoms 3 OHG or add NPH hs Multi-injection insulin OHG = oral hypoglycemic agent
21 Anti-hyperglycemic drugs Thai guideline 2008
22 At the time of type 2 diabetes diagnosis, Initiate metformin therapy along with lifestyle interventions, unless metformin is contraindicated. If noninsulin monotherapy at maximal tolerated dose does not achieve or maintain the A1C target over 3 6 months, add a second oral agent, a GLP-1 receptor agonist, or insulin. ADA 2012
23 Metformin First-line type 2 diabetes drug Reducing hepatic glucose production Reduce insulin resistance Weight-neutral with chronic use Does not increase the risk of hypoglycemia Side effects: Initial gastrointestinal side effects Lactic acidosis Caution in advanced renal insufficiency, alcoholism Rare complication
24 Diabetes Care 32:
25 Physical activity People with diabetes should be advised Moderate-intensity aerobic physical activity 50 70% of maximum heart rate At least 150 min/week Spread over at least 3 days per week
26
27 Screening!! Diabetic retinopathy Diabetic nephropathy Diabetic neuropathy PAD
28 Case Somsak is a 64-year-old man was diagnosed with T2DM, HT, and dyslipidemia 9 years ago. No history of hypoglycemia and cardiovascular disease -Glipizide (5) 2 tab bid.ac -Losartan (100) 1 tab OD -Metformin (500) 2 tab bid.pc -Simvastatin (10) 1 tab hs
29 Laboratory Fasting plasma glucose 154 mg/dl HbA1C 8.9 % Cholesterol 145 mg/dl Triglyceride 130 mg/dl HDL 45 mg/dl LDL 88 mg/dl Creatinine 1.0 mg/dl What would you recommend to improve his glycemic control?
30 Medical history Age and characteristics of onset of diabetes Eating patterns, physical activity habits, nutritional status, and weight history Diabetes education history Review of previous treatment regimens and response to therapy (A1C records) DIABETES CARE
31 Medical history Current treatment of diabetes, including Medications and medication adherence Meal plan Physical activity patterns Readiness for behavior change Results of glucose monitoring and patient s use of data DIABETES CARE
32 Medical history DKA frequency, severity, and cause Hypoglycemic episodes Hypoglycemia awareness Any severe hypoglycemia: frequency and cause History of diabetes-related complications Microvascular Macrovascular Other: psychosocial problems, dental disease DIABETES CARE
33 Physical examination Height, weight, BMI Blood pressure : orthostatic measurements Fundoscopic examination Thyroid palpation Skin Acanthosis nigricans Insulin injection sites Comprehensive foot examination DIABETES CARE
34 Laboratory evaluation A1C, every 2 3 months If not performed/available within past year: Fasting lipid profile: total, LDL, and HDL cholesterol and triglycerides Liver function tests Test for UAE with spot urine albumin-to-creatinine ratio Serum creatinine and calculated GFR Thyroid-stimulating hormone in Type 1 diabetes Dyslipidemia Women over age 50 years DIABETES CARE
35 GUIDELINE
36 Glycemic Treatment Targets* American Diabetes IDF 2 AACE 3 Association 1 HbA 1c (%) <7.0 < FPG mmol/l (mg/dl) < (70-130) <6.0 (<110) <6.1 (<110) PPG mmol/l (mg/dl) <10 (<180) <8.0 (<145) 7.8 (<140) *Treatment targets for non-pregnant adults. AACE = American Association of Clinical Endocrinologists; FPG = fasting plasma glucose; IDF = International Diabetes Foundation; PPG = postprandial plasma glucose. 1. American Diabetes Association. Diabetes Care. 2012;35(Suppl 1):S11-S International Diabetes Federation (IDF). Available at: Accessed 9 March Handelsman Y, et al. Endocr Pract. 2011;17(Suppl 2):1-53.
37 Thai Guideline การควบค ม เบาหวาน เป าหมาย ควบค มเข มงวดมาก ควบค มเข มงวด ควบค มไม เข มงวด ระด บน าตาลในเล อด ขณะอดอาหาร ระด บน าตาลในเล อดหล ง อาหาร 2 ช วโมง ระด บน าตาลในเล อด ส งส ดหล งอาหาร มก./ดล. 90- <130 มก./ดล. ใกล เค ยง 150 มก./ดล. <140 มก./ดล. - <180 มก./ดล. <180 มก./ดล. HbA1C < 6.5% < 7.0% % แนวทางเวชปฏ บ ต สาหร บโรคเบาหวาน 2557
38 N Engl J Med 2012;366:
39 Laboratory Fasting plasma glucose 154 mg/dl HbA1C 8.9 % Cholesterol 145 mg/dl Triglyceride 130 mg/dl HDL 45 mg/dl LDL 88 mg/dl Creatinine 1.0 mg/dl What would you recommend to improve his glycemic control?
40 Correlation of A1C with average glucose
41 Contribution (%) HbA 1c Is a Combination of FPG and PPG PPG FPG 0 < >10.2 HbA 1c Range (%) The relative contribution of PPG and FPG varies with HbA 1c The clinical significance of improvement in postprandial hyperglycemia has not been established As patients HbA 1c level approaches the healthy range, PPG takes on greater importance in determining HbA 1c. FPG = fasting plasma glucose. Monnier L, et al. Diabetes Care. 2003;26(3):
42
43 Glinides Short duration Three times/day dosing, expensive Diabetologia (2006) 49: Diabetes Care 2012;35: Antidiabetic interventions as monotherapy Interventions Expected decrease in HbA1c (%) Advantages Disadvantages Lifestyle interventions 1-2 Low cost, many benefits Fails for most in first year Metformin 1.5 Weight neutral, inexpensive GI side effects, rare lactic acidosis Insulin No dose limit, inexpensive, improved lipid profile Injections, monitoring, hypoglycaemia, weight gain Sulfonylureas 1.5 Inexpensive Weight gain, hypoglycaemia TZDs Improved lipid profile Fluid retention, weight gain, expensive DPP IV inhibitor No hypoglycemia, Well tolerated α-glucosidase inhibitors Urticaria/angioedema? Pancreatitis Weight neutral Frequent GI side effects, three times/day dosing, expensive Exenatide Weight loss Injections, frequent GI side effects, expensive, little experience
44 Sulfonylurea Insulin secretagogues Stimulate insulin release Glibenclamide, Glipizide, Gliclazide, Glimepiride Through the closure of ATP-sensitive potassium channels on β-cells Associated with modest weight gain and risk of hypoglycemia
45 Thiazolidinediones (TZDs) Peroxisome proliferator activated receptor γ activators Improve insulin sensitivity in skeletal muscle and reduce hepatic glucose production Not increase the risk of hypoglycemia May be more durable in their effectiveness than sulfonylureas and metformin Actos,Utmos
46 Pioglitazone Thiazolidinediones (TZDs) Modest benefit on CV events as a 2 outcome in one large trial involving patients with overt macrovascular disease Possible increased risk of bladder cancer Side effects Weight gain Fluid retention leading to edema ± Heart failure in predisposed individuals Increased risk of bone fractures Rosiglitazone No longer widely available >> Increased myocardial infarction risk
47 Dipeptidyl peptidase 4 (DPP-4) inhibitors Oral drug Regulation of insulin and glucagon secretion Weight neutral Not increase the risk of hypoglycemia Sitagliptin (Januvia), Vidagliptin (Galvus) Linagliptin (Tradjenta), Saxagliptin (Onglyza)
48 α-glucosidase inhibitors (AGIs) Decrease gut carbohydrate absorption But have gastrointestinal effects, mainly flatulence and constipation Acarbose (Glucobay), Vogibose (Basen)
49 Incretin system GLP-1 receptor agonists Injectable GLP-1 receptor agonists Stimulating pancreatic insulin secretion in a glucose-dependent Suppressing pancreatic glucagon output Slowing gastric emptying Decreasing appetite Weight loss in most patients
50 GLP-1 receptor agonists Side effect : Nausea and vomiting, particularly early in the course of treatment Increased risk of pancreatitis Exenatide(Byetta), Liraglutide (Victosa)
51 Canagliflozin, Dapagliflozin, Empagliflozin SGLT-2 SGLT2 inhibitors lower blood sugar by causing the kidneys to remove sugar from the body through the urine. SGLT2 inhibitors are a class of prescription medicines that are FDA-approved for use with diet and exercise to lower blood sugar in adults with type 2 diabetes. Side efffects : metabolic acidosis possible side effects : dehydration, kidney problems, increased cholesterol in the blood, and yeast infections.
52 Anti-hyperglycemic drugs Thai guideline 2008
53 Case Somsak is a 64-year-old man was diagnosed with T2DM, HT, and dyslipidemia 9 years ago. No history of hypoglycemia and cardiovascular disease -Glipizide (5) 2 tab bid.ac -Losartan (100) 1 tab OD -Metformin (500) 2 tab bid.pc -Simvastatin (10) 1 tab hs Add Pioglitazone (30) 1x1 oral OD
54 SMBG Self-monitor blood glucose
55
56 Case 3 month later Somsak is a 64-year-old man was diagnosed with T2DM, HT, and dyslipidemia 9 years ago. No history of hypoglycemia and cardiovascular disease -Glipizide (5) 2 tab bid.ac -Metformin (500) 2 tab bid.pc -Losartan (100) 1 tab OD -Simvastatin (10) 1 tab hs -Pioglitazone (30) 1x1 oral OD FBS 155 mg/dl, HbA1C 8.2
57 Day ac pc ac pc ac pc hs Pre/post-prandial hyperglycemia
58 Anti-hyperglycemic drugs Thai guideline 2008
59 The steps of insulin treatment Setting glucose control goal Initiating insulin therapy Titration of insulin dose Intensification of treatment regimen DIABETES CARE, VOLUME 36, SUPPLEMENT 2 AUGUST 2013
60 Summary of glycemic recommendations A1C <,7.0% Preprandial capillary plasma glucose mg/dl Peak postprandial capillary plasma glucose <180 mg/dl Goals should be individualized based on* Duration of diabetes Age/life expectancy Comorbid conditions Postprandial glucose measure 1 2 h after meal Known CVD or advanced microvascular complications Hypoglycemia unawareness Individual patient considerations More- or less-stringent glycemic goals may be appropriate for individual patients
61
62 ADA 2009 Start : NPH 10 unit SC hs Typically by 2 unit every 3 days If hypoglycemia, reduce 4 unit or 10%
63 Initiating insulin therapy Basal insulin is preferable when adding insulin therapy to antidiabetes drugs. 3 exceptions... Patients with relatively low fasting or preprandial glucose (<150 mg/dl) despite high HbA1C Patients with difficulty in compliance with the high demands of basal-bolus treatment Patients in whom self-titration might not be feasible DIABETES CARE, VOLUME 36, SUPPLEMENT 2, AUGUST 2013
64 Case Somsak is a 64-year-old man was diagnosed with T2DM, HT, and dyslipidemia 9 years ago. No history of hypoglycemia and cardiovascular disease -Glipizide (5) 2 tab bid.ac -Metformin (500) 2 tab bid.pc -Losartan (100) 1 tab OD -Simvastatin (10) 1 tab hs -Pioglitazone (30) 1x1 oral OD Add NPH 10 unit sc hs
65 NPH 10 unit sc hs Day ac pc ac pc ac pc hs month later
66 The steps of insulin treatment Setting glucose control goal Initiating insulin therapy Titration of insulin dose Intensification of treatment regimen DIABETES CARE, VOLUME 36, SUPPLEMENT 2, AUGUST 2013
67 Pharmacokinetic Profiles of Insulin Insulin type Onset Peak Duration Long-acting Detemir Glargine 2 hr 2 4 hr No peak No peak Intermediate-acting NPH 1-3 hr Short-acting Aspart/Glulisine/Lispro Regular 15 to 30 min. 30 to 60 min. 30 to 90 min. 2 to 4 hr 3 to 5 hr 5 to 8 hr Mixed NPH/lispro or aspart NPH/regular 15 to 30 min. 30 to 60 min. Dual Dual 14 to 24 hr 14 to 24 hr J Clin Endocrinol Metab, May 2012, 97(5): Am Fam Physician. 2011;84(2):
68 Insulin intensification When basal insulin fails to achieve the target in spite of titration, the physician should proceed to insulin intensification. 3 common regimens... Premix Basal plus Addition of rapid-acting insulin with one of the daily meals Basal bolus Addition of rapid insulin with 2-3 daily meals DIABETES CARE, VOLUME 36, SUPPLEMENT 2, AUGUST 2013
69 Once-daily glargine, detemir, or NPH therapy Am Fam Physician. 2011;84(2):
70 Basal-bolus insulin Am Fam Physician. 2011;84(2):
71 Premix insulin Am Fam Physician. 2011;84(2):
72 Premix or Basal bolus?
73 Insulin Regimens Most patients who begin a basal plus regimen will eventually need a basal-bolus regimen; therefore, basal plus regimen should be initiated if the treating physician decides that the patient will be able to adhere to a basal-bolus regimen. Basal bolus most closely resembles physiological insulin secretion Premix insulin analogs can be a good option with less complicated and demanding glucose monitoring and injection schedule DIABETES CARE, VOLUME 36, SUPPLEMENT 2, AUGUST 2013
74 Diabetes Care 2012;35:
75 Which patient should be offered a premix vs basal-bolus/basal plus regimen? Premix insulin analogs Patient preference Older age Need assistance with injections Organaized lifestyle Two meals a day or evening main meal Basal plus/basal bolus Type 1 DM Younger age Highly motivated and compliance Active lifestyle High variability in eating habits DIABETES CARE, VOLUME 36, SUPPLEMENT 2, AUGUST 2013
76 Rationale for initiating basal versus premix insulin analogs DIABETES CARE, VOLUME 36, SUPPLEMENT 2, AUGUST 2013
77 Initiation and intensification of premix insulin analogs DIABETES CARE, VOLUME 36, SUPPLEMENT 2, AUGUST 2013
78 NPH 10 unit sc hs Day ac pc ac pc ac pc hs Divide basal insulin to 2/3 dose in morning and 1/3 evening -NPH unit sc 213hs Switch to -Mixtard (70/30) unit (NPH 7 / RI 3) sc ac before breakfast 6 unit (NPH 4 / RI 2) sc before dinner
79 Using Insulin with Oral Medications Insulin secretagogues (sulfonylureas and glitinides) can be combined with insulin, especially when only basal augmentation is being used. However, there is a possible increased risk of hypoglycemia that needs to be monitored closely. Usually by the time insulin is required for meals, insulin secretagogues are not effective or necessary. However, it is recommended to continue oral medications while starting insulin to prevent rebound hyperglycemia. After the diabetes is controlled, the patient may be weaned off of oral medications Am Fam Physician. 2011;84(2):
80 Using Insulin with Oral Medications Insulin sensitizers have been proven safe and effective when combined with insulin therapy Metformin,Thiazolidinediones, Alphaglucosidase inhibitors, DPP-IV inhibitor (Sitagliptin), etc. Am Fam Physician. 2011;84(2):
81 Case Somsak is a 64-year-old man was diagnosed with T2DM, HT, and dyslipidemia 9 years ago. No history of hypoglycemia and cardiovascular disease -Glipizide (5) 1 tab bid.ac -Metformin (500) 2 tab bid.pc -Losartan (100) 1 tab OD -Simvastatin (10) 1 tab hs -Pioglitazone (30) 1x1 oral OD -Mixtard (70/30) 10 unit sc ac with breakfast and 6 unit sc with dinner
82 Special considerations/patients Severely uncontrolled diabetes with catabolism : Fasting plasma glucose > 250 mg/dl Random glucose levels > 300 mg/dl HbA1C > 10% Presence of ketonuria Symptomatic diabetes with polyuria, polydipsia and weight loss Insulin therapy in combination with life-style intervention is the treatment of choice.
83 In newly type2 DM with markedly symptomatic ± elevated blood glucose levels or A1C, consider insulin, with or with additional agents High baseline HbA1c (e.g. 9.0%) Low probability of achieving a near-normal target with monotherapy. May combination of 2 noninsulin agents or with insulin itself in this circumstance
84 Summary of recommendations Glycemic, BP, and lipid control for diabetes A1C < 7.0% Blood pressure <140/80 mmhg LDL cholesterol <100 mg/dl แนวทางเวชปฏ บ ต สาหร บโรคเบาหวาน 2557
85 All treatment decisions, where possible, should be made in conjunction with the patient, focusing on his/her preferences, needs, and values
DM in OPD for Internist. Rungnapa Laortanakul, MD Maharat Nakhon Ratchasima hospital 28 Oct 2013
DM in OPD for Internist Rungnapa Laortanakul, MD Maharat Nakhon Ratchasima hospital 28 Oct 2013 Outlines DM management GDM Case Somjit is a 43-year-old woman Check-up No abnormal symptom Laboratory FBS
More informationINSULIN THERAPY. Rungnapa Laortanakul, MD Maharat Nakhon Ratchasima hospital
INSULIN THERAPY Rungnapa Laortanakul, MD Maharat Nakhon Ratchasima hospital 3 Sep. 2013 Case Somsak is a 64-year-old man was diagnosed with T2DM, HT, and dyslipidemia 9 years ago. No history of hypoglycemia
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 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 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 informationWayne Gravois, MD August 6, 2017
Wayne Gravois, MD August 6, 2017 Americans with Diabetes (Millions) 40 30 Source: National Diabetes Statistics Report, 2011, 2017 Millions 20 10 0 1980 2009 2015 2007 - $174 Billion 2015 - $245 Billion
More informationDiabetes Mellitus II CPG
1 Diabetes Mellitus II CPG Candidates for Screening Integrated Complex Care Patients: Check Yearly Prediabetes: Check Yearly No Diabetes Mellitus (DM) Risk Factors: Check at Age 45, Repeat Every 3 Years
More informationAgenda. Indications Different insulin preparations Insulin initiation Insulin intensification
Insulin Therapy F. Hosseinpanah Obesity Research Center Research Institute for Endocrine sciences Shahid Beheshti University of Medical Sciences November 11, 2017 Agenda Indications Different insulin preparations
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 informationCurrent Diabetes Care for Internists:2011
Current Diabetes Care for Internists:2011 Petch Rawdaree, DM, MSc, DLSHTM Faculty of Medicine Vajira Hospital University of Bangkok Metropolis 19 th January 2011 ก ก 1. ก ก ก ก 2. ก ก ก ก ก 3. ก ก ก ก
More informationClinical Practice Guidelines
Clinical Practice Guidelines Diabetes Objective The purpose is to guide the appropriate diagnosis and management of Diabetes. This guideline is designed to assist the clinician by providing a framework
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 informationObesity, Insulin Resistance, Metabolic Syndrome, and the Natural History of Type 2 Diabetes
Obesity, Insulin Resistance, Metabolic Syndrome, and the Natural History of Type 2 Diabetes Genetics, environment, and lifestyle (obesity, inactivity, poor diet) Impaired fasting glucose Decreased β-cell
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 informationVipul Lakhani, MD Oregon Medical Group Endocrinology
Vipul Lakhani, MD Oregon Medical Group Endocrinology Disclosures None Objectives Be able to diagnose diabetes and assess control Be able to identify appropriate classes of medications for diabetes treatment
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 informationOBJECTIVES 4/7/2014. Diabetes Update Overview of the Diabetes Epidemic in the United States. ISHP Annual Spring Meeting
Diabetes Update 2014 ISHP Annual Spring Meeting Hayley Miller MD April 13, 2014 OBJECTIVES Review diabetes guidelines. Understand diabetes management targets. Discuss current therapeutic strategies. Overview
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 informationProfessor Rudy Bilous James Cook University Hospital
Professor Rudy Bilous James Cook University Hospital Rate per 100 patient years Rate per 100 patient years 16 Risk of retinopathy progression 16 Risk of developing microalbuminuria 12 12 8 8 4 0 0 5 6
More informationAbbreviations DPP-IV dipeptidyl peptidase IV DREAM Diabetes REduction Assessment with ramipril and rosiglitazone
Index Abbreviations DPP-IV dipeptidyl peptidase IV DREAM Diabetes REduction Assessment with ramipril and rosiglitazone Medication GAD glutamic acid decarboxylase GLP-1 glucagon-like peptide 1 NPH neutral
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 informationAmerican Diabetes Association 2018 Guidelines Important Notable Points
American Diabetes Association 2018 Guidelines Important Notable Points The Standards of Medical Care in Diabetes-2018 by ADA include the most current evidencebased recommendations for diagnosing and treating
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 informationAntihyperglycemic Agents in Diabetes. Jamie Messenger, PharmD, CPP Department of Family Medicine East Carolina University August 18, 2014
Antihyperglycemic Agents in Diabetes Jamie Messenger, PharmD, CPP Department of Family Medicine East Carolina University August 18, 2014 Objectives Review 2014 ADA Standards of Medical Care in DM as they
More informationMr Rab Burtun. Dr David Kim. 8:30-10:30 WS #2: Diabetes Basic 11:00-13:00 WS #9: Diabetes Basic (Repeated)
Dr David Kim Endocrinologist and General Physician Waitemata DHB and Apollo Specialist Clinic Albany Auckland Mr Rab Burtun Diabetes Nurse Specialist Waitemata DHB Waitakere Hospital Auckland 8:30-10:30
More informationOral and Injectable Non-insulin Antihyperglycemic Agents
Appendix 5: Diabetes Education and Medical Management in Adults with Diabetes Oral and Injectable Non-insulin s This directive will be implemented by RPhs, RNs or RDs who have been deemed authorized implementers.
More informationDiabetes Oral Agents Pharmacology. University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D
Diabetes Oral Agents Pharmacology University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 1 Learning Objectives Understand the role of the utilization of free
More informationIMPROVED DIAGNOSIS OF TYPE 2 DIABETES AND TAILORING MEDICATIONS
IMPROVED DIAGNOSIS OF TYPE 2 DIABETES AND TAILORING MEDICATIONS Dr Bidhu Mohapatra, MBBS, MD, FRACP Consultant Physician Endocrinology and General Medicine Introduction 382 million people affected by diabetes
More informationDept of Diabetes Main Desk
Dept of Diabetes Main Desk 01202 448060 Glucose management in Type 2 Diabetes in Adults The natural history of type 2 diabetes is for HbA1c to deteriorate with time. A stepwise approach to treatment is
More informationManagement of Type 2 Diabetes. Why Do We Bother to Achieve Good Control in DM2. Insulin Secretion. The Importance of BP and Glucose Control
Insulin Secretion Management of Type 2 Diabetes DG van Zyl Why Do We Bother to Achieve Good Control in DM2 % reduction 0-5 -10-15 -20-25 -30-35 -40 The Importance of BP and Glucose Control Effects of tight
More informationInitiation and Titration of Insulin in Diabetes Mellitus Type 2
Initiation and Titration of Insulin in Diabetes Mellitus Type 2 Greg Doelle MD, MS April 6, 2016 Disclosure I have no actual or potential conflicts of interest in relation to the content of this lecture.
More informationComprehensive Diabetes Treatment
Comprehensive Diabetes Treatment Joshua L. Cohen, M.D., F.A.C.P. Professor of Medicine Interim Director, Division of Endocrinology & Metabolism The George Washington University School of Medicine Diabetes
More informationHow can we improve outcomes in Type 2 diabetes?
How can we improve outcomes in Type 2 diabetes? Earlier diagnosis Better patient education Stress central role of lifestyle management Identify and treat all risk factors Use rational pharmacological therapy
More informationDiabetes mellitus. Treatment
Diabetes mellitus Treatment Recommended glycemic targets for the clinical management of diabetes(ada) Fasting glycemia: 80-110 mg/dl Postprandial : 100-145 mg/dl HbA1c: < 6,5 % Total cholesterol: < 200
More informationCURRENT ISSUES IN DIABETES MANAGEMENT. Screening for Diabetes Advantages of HbA1c as a Diagnostic Test. Diagnosis of Diabetes 2013
CURRENT ISSUES IN DIABETES MANAGEMENT Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Screening for Diabetes 2013 BMI
More informationJoslin Diabetes Center Joslin Diabetes Forum 2013: The Impact of Comorbidities on Glucose Control Scenario 2: Reduced Renal Function
Scenario 2: Reduced Renal Function 62 y.o. white man with type 2 diabetes for 18 years Hypertension and hypercholesterolemia Known proliferative retinopathy Current medications: Metformin 1000 mg bid Glyburide
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 information第十五章. Diabetes Mellitus
Diabetes-1/9 第十五章 Diabetes Mellitus 陳曉蓮醫師 2/9 - Diabetes 羅東博愛醫院 Management of Diabetes mellitus A. DEFINITION OF DIABETES MELLITUS Diabetes Mellitus is characterized by chronic hyperglycemia with disturbances
More informationObjectives. Recognize all available medical treatment options for diabetes. Individualize treatment and glycemic target based on patient factors
No disclosure Objectives Recognize all available medical treatment options for diabetes Individualize treatment and glycemic target based on patient factors Should be able to switch to more affordable
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 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 informationPharmacology Updates. Quang T Nguyen, FACP, FACE, FTOS 11/18/17
Pharmacology Updates Quang T Nguyen, FACP, FACE, FTOS 11/18/17 14 Classes of Drugs Available for the Treatment of Type 2 DM in the USA ### Class A1c Reduction Hypoglycemia Weight Change Dosing (times/day)
More informationDrugs used in Diabetes. Dr Andrew Smith
Drugs used in Diabetes Dr Andrew Smith Plan Introduction Insulin Sensitising Drugs: Metformin Glitazones Insulin Secretagogues: Sulphonylureas Meglitinides Others: Acarbose Incretins Amylin Analogues Damaglifozin
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 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 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 informationBeyond Basal Insulin: Intensification of Therapy Jennifer D Souza, PharmD, CDE, BC-ADM
Beyond Basal Insulin: Intensification of Therapy Jennifer D Souza, PharmD, CDE, BC-ADM Disclosures Jennifer D Souza has no conflicts of interest to disclose. 2 When Basal Insulin Is Not Enough Learning
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 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 informationManagement of Diabetes Mellitus: A Primary Care Perspective. Screening for Diabetes Advantages of HbA1c as a Diagnostic Test
Management of Diabetes Mellitus: 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 Screening
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 informationChief 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 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 informationI. General Considerations
1 2 3 I. General Considerations A. Type I ( Juvenile Onset or IDDM) IDDM results from autoimmune destruction of beta cells inability to secrete insulin --> ketone formation --> DKA 4 Diabetic Ketoacidosis
More informationManagement of Diabetes Mellitus: A Primary Care Perspective
Management of Diabetes Mellitus: 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 Screening
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 informationJanice Lazear, DNP, FNP-C, CDE DIAGNOSIS AND CLASSIFICATION OF DIABETES
Janice Lazear, DNP, FNP-C, CDE DIAGNOSIS AND CLASSIFICATION OF DIABETES Objectives u At conclusion of the lecture the participant will be able to: 1. Differentiate between the classifications of diabetes
More informationManagement of Diabetes
Management of Diabetes Mellitus: Which Drugs for Which Patients? Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine baron@medicine.ucsf.edu Disclosure No relevant financial relationships
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 informationNavigating the New Options for the Management of Type 2 Diabetes
Navigating the New Options for the Management of Type 2 Diabetes Clinical Associate Professor Mark Kennedy Department of General Practice, University of Melbourne Chair, Primary Care Diabetes Society of
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 informationReviewing Diabetes Guidelines. Newsletter compiled by Danny Jaek, Pharm.D. Candidate
Reviewing Diabetes Guidelines Newsletter compiled by Danny Jaek, Pharm.D. Candidate AL AS KA N AT IV E DI AB ET ES TE A M Volume 6, Issue 1 Spring 2011 Dia bet es Dis pat ch There are nearly 24 million
More informationPharmacology Update for the Adult Patient - Newer Oral Medications for Diabetes
Pharmacology Update for the Adult Patient - Newer Oral Medications for Diabetes Brooke Hudspeth, PharmD, CDE, MLDE Director of Diabetes Prevention, Kroger Pharmacy Adjunct Assistant Professor, University
More informationDIABETES DEBATE - IS NEW BETTER?
DIABETES DEBATE - IS NEW BETTER? WHAT MEDICATION CLASS AFTER METFORMIN TO CONTROL BLOOD SUGAR Dr. Lydia Hatcher, MD, CCFP, FCFP, CHE, D-CAPM Associate Clinical Professor of Family Medicine, McMaster Chief
More informationTimely!Insulinization In!Type!2! Diabetes,!When!and!How
Timely!Insulinization In!Type!2! Diabetes,!When!and!How, FACP, FACE, CDE Professor of Internal Medicine UT Southwestern Medical Center Dallas, Texas Current Control and Targets 1 Treatment Guidelines for
More informationThe Diabetes Guidelines Trek: The Next Generation. Inpatient Diabetes Guidelines. Learning Objectives. Current Inpatient Guidelines
The Diabetes Guidelines Trek: The Next Generation J. Christopher Lynch, PharmD, BCACP Southern Illinois University Edwardsville School of Pharmacy Susan Cornell BS, PharmD, CDE, FAPhA, FAADE Midwestern
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 informationOral Medication for the Management of Diabetes Mechanism of. Duration of Daily Dosing Action
Glyburide (Micronase, Diabeta, Glynase) Glipizide (Glucotrol) Glipizide XL (Glucotrol XL) Glimepiride (Amaryl) Prandin (Repaglinide) Starlix (Nateglinide) 1.25, 2.5, 5mg tabs, Dosing: 2.5-20 mg 12- (Glynase:
More informationDiabetes Mellitus. Intended Learning Objectives:
Intended Learning Objectives: Diabetes Mellitus 1. Compare and contrast the differences between the drug therapy recommendations of several of the latest and leading diabetes guidelines. 2. Assess the
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 informationIndividualizing Care for Patients with Type 2 Diabetes
Individualizing Care for Patients with Type 2 Diabetes Disclosures Speaker: AstraZeneca, Novo Nordisk, BI/Lilly, Valeritas, Takeda Advisor: Tandem Diabetes, Sanofi Objectives Develop individualized approaches
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 informationDiabetes Mellitus in Older Adults. Presenter Disclosure Information
Diabetes Mellitus in Older Adults Medha Munshi, M.D. Joslin Diabetes Center Beth Israel Deaconess Medical Center Harvard Medical School Presenter Disclosure Information Medha Munshi Research grant from
More informationQuick Reference Guide
2018 Clinical Practice Guidelines Quick Reference Guide 416569-18 guidelines.diabetes.ca diabetes.ca 1-800-BANTING (226-8464) Screening and Diagnosis Assess risk ANNUALLY if: Family history (First-degree
More informationGuidelines to assist General Practitioners in the Management of Type 2 Diabetes. April 2010
Guidelines to assist General Practitioners in the Management of Type 2 Diabetes April 2010 Foreword The guidelines were devised by the Diabetes Day Centre in Beaumont Hospital in consultation with a number
More informationInsulin Initiation and Intensification. Disclosure. Objectives
Insulin Initiation and Intensification Neil Skolnik, M.D. Associate Director Family Medicine Residency Program Abington Memorial Hospital Professor of Family and Community Medicine Temple University School
More informationDiabetes Mellitus: Overview and Guidelines
Diabetes Mellitus: Overview and Guidelines Rezvan Salehidoost, M.D., Endocrinologist Abidi Diabetes Master Class IMPORTANCE? Why is it interesting to do research in diabetes J. Olefsky, JAMA 2001:285:628-632
More informationLecture title. Name Family name Country
Lecture title Name Family name Country Patricia B. Gatbonton, MD, FPCP, FPSEM Endocrinology, Diabetes & Metabolism When insulin is NOT an option Learning Objectives Define factors leading to uncontrolled
More informationThe ABCs (A1C, BP and Cholesterol) of Diabetes
The ABCs (A1C, BP and Cholesterol) of Diabetes Gregg Simonson, PhD Director, Professional Training and Consulting International Diabetes Center; Adjunct Assistant Professor, University of Minnesota Department
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 informationDiabetes Mellitus: Implications of New Clinical Trials and New Medications
Diabetes Mellitus: Implications of New Clinical Trials and New Medications Estimates of Diagnosed Diabetes in Adults, 2005 Alka M. Kanaya, MD Asst. Professor of Medicine UCSF, Primary Care CME October
More informationApplication of the Diabetes Algorithm to a Patient
Application of the Diabetes Algorithm to a Patient Apply knowledge gained from this activity to improve disease management and outcomes for patients with T2DM and obesity Note: The cases in this deck represent
More informationCardiovascular Benefits of Two Classes of Antihyperglycemic Medications
Cardiovascular Benefits of Two Classes of Antihyperglycemic Medications Nathan Woolever, Pharm.D., Resident Pharmacist Pharmacy Grand Rounds November 6 th, 2018 Franciscan Healthcare La Crosse, WI 2017
More informationMultiple Small Feedings of the Mind: Diabetes. Sonja K Fredrickson, MD, BC-ADM March 7, 2014
Multiple Small Feedings of the Mind: Diabetes Sonja K Fredrickson, MD, BC-ADM March 7, 2014 Question 1: Setting A1c Goals Describe the evidence based approach to determining the target HgbA1c in different
More informationDIABETES UPDATE 2018
DIABETES UPDATE 2018 Jerome V. Tolbert, M.D., Ph.D. Assistant Professor of Medicine Icahn School of Medicine at Mt. Sinai Division of Endocrinology and Bone Diseases 317 East 17 th Street New York, New
More informationManaging Perioperative Diabetes What s new? Kathryn A. Myers MD FRCPC Chair Chief Division of GIM Professor of Medicine Western University
Managing Perioperative Diabetes What s new? Kathryn A. Myers MD FRCPC Chair Chief Division of GIM Professor of Medicine Western University Objectives: By the end of this session, you will be able to: Identify
More informationMae Sheikh-Ali, M.D. Assistant Professor of Medicine Division of Endocrinology University of Florida College of Medicine- Jacksonville
Mae Sheikh-Ali, M.D. Assistant Professor of Medicine Division of Endocrinology University of Florida College of Medicine- Jacksonville Pathogenesis of Diabetes Mellitus (DM) Criteria for the diagnosis
More informationCurrent Clinical Practice Guideline for Diabetes Management
Current Clinical Practice Guideline for Diabetes Management Chaicharn Deerochanawong M.D. Professor of Medicine, i Rangsit Medical University it Diabetes and Endocrinology Unit Department of Medicine Rajavithi
More informationIntensification of Diabetic Therapy. Case studies
Intensification of Diabetic Therapy Case studies Patient #1 1 st visit: 64 year old male, H/O prediabetes, lost weight 280 lbs. to 240 lbs. ER for dental abscess, glucose >300 A1C 11.4%, no diabetic medication,
More informationPractical Strategies for the Clinical Use of Incretin Mimetics CME/CE. CME/CE Released: 09/15/2009; Valid for credit through 09/15/2010
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
More informationDiabetes Treatment Update
Diabetes Treatment Update Timothy C. Evans, MD PhD FACP University of Washington Department of Medicine Disclosure: Dr. Evans has no significant financial interest in any of the products or manufacturers
More informationJulie White, MS Administrative Director Boston University School of Medicine Continuing Medical Education
MENTOR QI Diabetes Performance Improvement Initiative, Getting Patients to Goal in Glycemic Control: Current Data Julie White, MS Administrative Director Boston University School of Medicine Continuing
More informationGlyceamic control is indicated by 1. Fasting blood sugar less than 126 mg/dl 2. Random blood sugar 3. HbA1c less than 6.5 % Good glycaemic control
Glyceamic control is indicated by 1. Fasting blood sugar less than 126 mg/dl 2. Random blood sugar 3. HbA1c less than 6.5 % Good glycaemic control can prevent many of early type 1 DM(in DCCT trail ). UK
More informationInsulin and Post Prandial
Insulin and Post Prandial Pr Luc Martinez PCDE Meeting Barcelona 2016 Conflicts of interest disclosure Advis consultant f Amgen Inc.; AstraZeneca Pharmaceuticals LP; GlaxoSmithKline; Ipsen; Lilly; Mayoly
More informationAdvanced Practice Education Associates. Endocrine
Advanced Practice Education Associates Endocrine Overview Diabetes Thyroid Disease 162 Copyright 2016 Advanced Practice Education Associates DIABETES MELLITUS What is the BMI cut point for screening adults
More information7/8/2016. Sol Jacobs MD, FACE Division of Endocrinology Emory University School of Medicine
Sol Jacobs MD, FACE Division of Endocrinology Emory University School of Medicine Participation in investigator initiated clinical research supported by: Merck Boehringer Ingelheim Novo Nordisk Astra Zeneca
More informationClinical Cases in Diabetes Management. Joseph Cook D.O.
Clinical Cases in Diabetes Management Joseph Cook D.O. Objectives State the prevalence of Diabetes Mellitus in Ohio State the percentage of diabetic patients in the U.S. treated by Primary Care Physicians
More informationWhat the Pill Looks Like. How it Works. Slows carbohydrate absorption. Reduces amount of sugar made by the liver. Increases release of insulin
Diabetes s Oral s - Pills These are some of the pills that are currently available in Canada to treat diabetes. Each medication has benefits and side effects you should be aware of. Your diabetes team
More informationInitiating Injectable Therapy in Type 2 Diabetes
Initiating Injectable Therapy in Type 2 Diabetes David Doriguzzi, PA C Learning Objectives To understand current Diabetes treatment guidelines To understand how injectable medications fit into current
More informationDr Tahseen A. Chowdhury Royal London Hospital. New Guidelines in Diabetes: NICE or Nasty?
Dr Tahseen A. Chowdhury Royal London Hospital New Guidelines in Diabetes: NICE or Nasty? I have no conflicts of interest I do not undertake talks / advisory bodies / research for any pharma company Consultant
More information