Innovative, Unusual Therapies for DM-2: Insulin U-500, Bromocriptine, Colesevelam, and SGLT2 inhibitors. April 3 rd, 2014

Size: px
Start display at page:

Download "Innovative, Unusual Therapies for DM-2: Insulin U-500, Bromocriptine, Colesevelam, and SGLT2 inhibitors. April 3 rd, 2014"

Transcription

1 Innovative, Unusual Therapies for DM-2: Insulin U-500, Bromocriptine, Colesevelam, and SGLT2 inhibitors April 3 rd, 2014 KM Pantalone Associate Staff Endocrinology Speaker Bureau: Disclosures Bristol-Myers Squibb, Eli Lilly Consultant: Novo Nordisk, Eli Lilly, Sanofi

2 Objectives Review the newer and unusual therapies for patients with DM-2 Review indications, mechanisms of action, and common side effects of insulin U-500, bromocriptine (Cycloset), colesevelam (Welchol) and canagliflozin (Invokana)/dapagliflozin(Farxiga) Learn to identify patients for whom these therapies are therapeutic options Review the medications indications and contraindications Discuss patient populations which are good candidates for these therapies Available Medications SGLT-2 inhibitors

3 Things to consider when deciding on a therapy Efficacy ( HbA1C) Hypoglycemia Weight Individualize Care! Side Effects Cost Inzucchi SE et al. Diabetes Care. 2012; 35(6): Inzucchi SE et al. Diabetologia. 2012; 55(6): Humulin R U-500 Concentrated Insulin 500 units/ml vs. 100 units/ml (U-100) Indicated as an adjunct to diet and exercise to improve glycemic control in adults and children with DM-1 and DM-2

4 Humulin R U-500 It is useful for the treatment of insulinresistant patients requiring more than 200 units of insulin per day Allows for a large dose of insulin to be administered sc in a reasonable volume Complete a thorough H&P If a patient is on large doses of insulin, ask them if they are really taking the prescribed doses? Check for lypohypertrophy at favored sites of insulin administration!

5 PK Profiles of U-500 and U-100 Pork Insulins 100 Serum Insulin ( µu/ml) ARI U-500 Insulin NRI U-100 Insulin NPH U-100 Insulin 0 Serum insulin responses of normal fasted subjects to SC administration of acid and neutral regular (ARI and NRI) and NPH pork insulin (0.25 units/kg) using the concentrations (μu/ml) indicated. Adapted from: Galloway JA, et al. Diabetes Care. 1981;4: Time in Hours U-500 de la Peña A et al. Diabetes Care Dec;34(12):

6 Dosage and Administration An injection of U-500 should always be followed by a meal within ~ 30 minutes of administration Should only be administered subcutaneously Do not administer IV or IM Do not mix U-500 with other insulins in the same syringe Hypoglycemia Extreme caution must be observed in the measurement of doses Need to educate patients (and spouses/caregivers) and be sure they understand the dose being prescribed, how to draw up and administer a dose correctly, and the importance of taking the injection with meals Severe, life threatening hypoglycemia may occur, as with any insulin therapy Hypoglycemia is the most common adverse reaction of all insulin therapies, including Humulin R U-500

7 U-500 Oral anti-diabetic therapies can be (and are often) used in combination with insulin Insulin sensitizers are often used in an attempt to reduce the doses of insulin which are required to obtain glycemic control Fluid retention and CHF may occur with concomitant use of TZDs U-500 Hepatic and Renal Impairment Need to take these into consideration Frequent BG monitoring and insulin dose reduction may be required

8 U-500 No randomized controlled trials are available to guide dosing Need to take the patient s weight, hepatic and renal function, current doses of insulin U-100, and current level of glycemic control into consideration when deciding on the initial dose of U-500 U-500 Dosing The prescribed dose of Humulin R U-500 should always be expressed in actual units of U-500 along with the corresponding markings on the syringe the patient is using In terms of U-100 insulin syringe markings Volumetric, i.e. tuberculin syringe All available insulin syringes are U-100 There are NO U-500 insulin syringes U-500 does not come in pens

9 Dosing BID Dosing Humulin R U-500 (500 units/ml) Dispense # 1 vial (20 ml) Sig: Administer 120 units (draw to 24 unit markings on a U-100 insulin syringe Or 0.24 ml on a volumetric syringe sc 30 minutes AC-breakfast and evening meal Preferred syringe: insulin syringe or volumetric TID Dosing Humulin R U-500 (500 units/ml) Dispense # 1 vial (20 ml) Sig: Administer 80 units (draw to 16 unit markings on a U-100 insulin syringe Or 0.16 ml on a volumetric syringe sc 30 minutes AC-breakfast, lunch, and evening meal Preferred syringe: insulin syringe or volumetric Dosing

10 U-500 I prefer TID dosing vs. BID dosing Allows for the administration of three smaller doses of U-500 at the three main meals I have found this to reduce the risk of hypoglycemia Initially, the doses at each meal may be the same, but eventually, many patients may require different doses at different times of day U-500 When a patient is using U-500, this serves as both the basal and bolus insulin No utility in continuing other insulin analogues Need to consider the patient s perceptions of U-500 insulin Use of this insulin is not necessarily a sign of failure on the part of the patient or practitioner

11 Potential Benefits of U-500 Can often get better control by switching to U-500 insulin Less insulin products required Patient stops prandial insulin analogue and basal insulin analogue and just takes the U- 500 Sometimes less injections required TID or BID U-500 vs. 4 or 5 injections of prandial insulin and basal insulin per day U-500 Pregnancy Category B: There are no adequate and well-controlled clinical studies of the use of Humulin R U-500 in pregnant or nursing women or during labor and delivery Pediatric Use: There are no well-controlled studies of the use of Humulin R U-500 in children

12 Insulin Syringes Patient should be given a prescription for the smallest U-100 insulin syringe required 0.3 ml in most cases Many patients have larger syringes than required from their prior U-100 therapy Not safe to have a bunch of pre-drawn syringes in the refrigerator, especially in a household with multiple diabetics Education Education of spouse and/or caregivers is critical Patients need reminded that they can t skip or delay meals when using U-500 Re-education on the signs and symptoms of hypoglycemia is necessary Many of these patients being switched to U- 500 have been under poor control for years Many may not have had a hypoglycemic event in the recent past

13 Safety Errors with U-500 dosing/administration tend to occur at the transitions of care ED visits Admission to hospital, nursing homes, switch of providers, etc. This is why it is critical that the absolute dose of U-500 insulin is clearly written on the prescription, as well as the number of U-100 insulin syringe unit markings Differences in Box and Bottle medscape

14 Oral Anti-diabetic Agents Used to be two main categories: Insulin sensitizers Insulin secretagogues However, the new agents do not fit nicely into these two categories Many of the new oral anti-diabetic agents work by novel mechanisms Anti-diabetic Agents: Major Sites of Action CNS Dopamine endotext.org

15 Dopamine Agonist Bromocriptine (Cyloset ) FDA approved for treatment of DM-2 in adults The exact mechanism by which Cycloset improves glycemic control is unknown Morning administration of Cycloset improves glycemic control in patients with type-2 diabetes without increasing plasma insulin concentrations Centrally acting insulin sensitizer Dopamine Defronzo RA. Diabetes Care Apr;34(4):

16 Dopamine Agonist Cycloset should be administered once daily within two hours upon awakening in the morning to augment low hypothalamic dopamine It is a quick acting formulation of bromocriptine which results in an increase in circulating levels of bromocriptine for 4-5 hours after administration Defronzo RA. Diabetes Care Apr;34(4): Cycloset When ingested on an empty stomach, the peak plasma concentration is reached within 60 min Absorption is delayed by food and peak plasma levels are achieved at ~ 120 min in the fed state Defronzo RA. Diabetes Care Apr;34(4):

17 Cycloset Cycloset differs from traditional bromocriptine formulations, such as Parlodel, in its quick release that provides peak concentrations within 60 min (~120 minutes in the fed state) Off label generic bromocriptine should NOT be prescribed as therapy for DM-2 Defronzo RA. Diabetes Care Apr;34(4): Cycloset Should be taken with food to potentially reduce gastrointestinal side effects such as nausea Cycloset comes as 0.8 mg tablets The starting dose is 0.8 mg/day and can be titrated to a maximum of 4.8 mg/day (6 tablets) Cycloset is administered as a once daily dose within 2 hours of awaking Defronzo RA. Diabetes Care Apr;34(4):

18 Efficacy Defronzo RA. Diabetes Care Apr;34(4): Side Effects No hypoglycemia Weight neutral Common side effects: Nausea Hypotension Including orthostatic hypotension Somnolence

19 Cautions/Concerns Hypotension Use caution in patients taking anti-hypertensive medications Psychosis May exacerbate psychotic disorders Beware of possible interaction with dopamine receptor antagonists (antipsychotics) Beware of possible interaction with other dopamine agonist therapies Used in the treatment of Parkinson s disease, hyperprolactinemia, restless leg syndrome, etc. CV Risk Reduction?

20 To date. There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with any antidiabetic drug Observation with Cycloset is intriguing and requires further study Bile Acid Sequestrant The exact mechanism by which bile acid sequestrants improve glycemic control is unknown Colesevelam (Welchol ) Specifically indicated as an adjunct to diet and exercise to improve glycemic control in adults with type-2 diabetes mellitus

21 Colesevelam Common side effect : Constipation Contraindications/Concerns: GI disease: Use with caution in patients with GI motility disorders, or a history of major GI tract surgery Secondary to the constipating effects of colesevelam Hypertriglyceridemia: Use with caution in patients with serum triglyceride concentrations >300 mg/dl Discontinue if triglyceride concentrations exceed 500 mg/dl or if hypertriglyceridemia-induced pancreatitis occurs Sodium-glucose co-transporter 2 (SGLT2) inhibitor Block the normal glucose reabsorption function of the kidney, resulting in the excretion of excess glucose up to 10% of daily calorific intake in patients' urine Dokken B. Diabetes Spectr 2012;25:29 36.

22 Glucose reabsorption by the proximal convoluted tubule Dokken B. Diabetes Spectr 2012;25: Copyright 2011 American Diabetes Association, Inc. SGLT-2 inhibitor Dapagliflozin (Farxiga (Forxiga )-approved ) approved by FDA in January Europe 2014 Rejected by U.S. FDA in 2012 citing a need for more clinical information on the drug's risk-benefit profile and, possibly, additional trials Concerns regarding breast and bladder cancers as well as increased frequency of genital and urinary tract infections Canagliflozin (Invokana ) Approved by FDA March 2013 FDA requested 5 post-marketing studies for the drug, including a cardiovascular outcomes trial

23 Canagliflozin A clinical study of patients at especially high risk of cardiovascular disease initially found that within the first 30 days, 13 patients taking canagliflozin suffered a major cardiovascular event vs. just 1 patient taking placebo After that, the imbalance was reversed? Elevated risk of stroke Need to await results of ongoing trials Most common adverse reactions 5% incidence: female genital mycotic infections, urinary tract infection, and increased urination Canagliflozin Slight increase in LDL cholesterol Hypotension Intravascular volume contraction Weight loss No hypoglycemia Requires renal adjustment Monitor potassium in patients with impaired renal function

24 Canagliflozin Canagliflozin

25 Canagliflozin Blood Pressure

26 Metformin + SFU + Add-on Therapy Sitagliptin 100 mg daily Canagliflozin 300 mg daily At 52 weeks, canagliflozin demonstrated noninferiority and, in a subsequent assessment, showed superiority to sitagliptin 100 mg in reducing A1C, -1.03% and -0.66%, respectively Schernthaner G et al. Diabetes Care Sep;36(9): Add-on Therapy Greater reductions in FPG, body weight, and systolic BP were observed with canagliflozin versus sitagliptin (P < 0.001). Schernthaner G et al. Diabetes Care Sep;36(9):

27 Add-on Therapy Overall AE rates were similar between groups Incidence of serious AEs and AE-related discontinuations was low for both groups Higher incidences of genital mycotic infections and osmotic diuresis-related AEs were observed with canagliflozin, which led to one discontinuation Hypoglycemia rates were similar in both groups Schernthaner G et al. Diabetes Care Sep;36(9): GFR The dose of canagliflozin is limited to 100 mg once daily in patients with moderate renal impairment GFR 45 to <60 ml/min/1.73 m2 Canagliflozin should not be initiated in patients with an GFR <45 should be discontinued when GFR is persistently <45

28 Dapagliflozin The recommended starting dose is 5 mg once daily, dose can be increased to 10 mg once daily who require additional glycemic control, if tolerated Not recommended if egfr is below 60 Dapagliflozin Nauck MA et al. Diabetes Care Sep;34(9):

29 Dapagliflozin Risk vs. Benefits Benefits Improved glycemic control Weight loss No hypoglycemia Risks Slight increase in LDL cholesterol Increased frequency/risk of UTI and genital mycotic infections Hypotension (volume contraction) Impaired renal function (monitor and d/c if GFR persistently < 60) Dapagliflozin Bladder Cancer Across 22 clinical studies, newly diagnosed cases of bladder cancer were reported in 0.17% of dapagliflozin treated patients and 0.03% of placebo or comparator-treated patients

30 Dapagliflozin Bladder Cancer After excluding patients in whom exposure to study drug was < 1 year at the time of diagnosis of bladder cancer, there were 4 cases with dapagliflozin and no cases with placebo/comparator Study arms were balanced at baseline with respect to bladder cancer risk factors and hematuria Bottom line, there were too few cases to determine whether the emergence of these events were related to dapagliflozin Individualized Goals Inzucchi SE et al. Diabetes Care. 2012; 35(6): Inzucchi SE et al. Diabetologia. 2012; 55(6):

31 2012 ADA/EASD Position Statement Inzucchi SE et al. Diabetes Care. 2012; 35(6): Inzucchi SE et al. Diabetologia. 2012; 55(6): References Galloway JA, et al. Diabetes Care. 1981;4: de la Peña A et al. Diabetes Care Dec;34(12): Defronzo RA. Diabetes Care Apr;34(4): Dokken B. Diabetes Spectr 2012;25:29 36 Schernthaner G et al. Diabetes Care Sep;36(9): Nauck MA et al. Diabetes Care Sep;34(9): Inzucchi SE et al. Diabetes Care. 2012; 35(6): Inzucchi SE et al. Diabetologia. 2012; 55(6): Package Inserts: Invokana, Farxiga, Humulin R U 500, Welchol, Cycloset

32 Thank You! Questions?????

DM-2 Therapy Update: GLP-1, SGLT-2 Inhibitors, and Inhaled Insulin, Oh My!

DM-2 Therapy Update: GLP-1, SGLT-2 Inhibitors, and Inhaled Insulin, Oh My! DM-2 Therapy Update: GLP-1, SGLT-2 Inhibitors, and Inhaled Insulin, Oh My! Kevin M. Pantalone, DO, ECNU, CCD Associate Staff Director of Clinical Research Department of Endocrinology Endocrinology and

More information

Study Design: Prospective, Multicenter randomized, parallel-group, double blind, placebo controlled study.

Study Design: Prospective, Multicenter randomized, parallel-group, double blind, placebo controlled study. Brand Name: Farxiga Generic Name: Dapagliflozin Manufacturer: Astra-Zenica Drug Class 1,2 : Antidiabetic agent, SGLT2 Inhibitor Uses: Labeled Uses 1,2,3,4 : Improving glycemic control in adults with type

More information

Invokana (canagliflozin) NEW INDICATION REVIEW

Invokana (canagliflozin) NEW INDICATION REVIEW Invokana (canagliflozin) NEW INDICATION REVIEW Introduction Brand name: Invokana Generic name: Canagliflozin Pharmacological class: Sodium-glucose cotransporter 2 (SGLT2) inhibitor Strength and Formulation:

More information

Update on Therapies for Type 2 Diabetes: Angela D. Mazza, DO July 31, 2015

Update on Therapies for Type 2 Diabetes: Angela D. Mazza, DO July 31, 2015 Update on Therapies for Type 2 Diabetes: 2015 Angela D. Mazza, DO July 31, 2015 Objectives To present the newer available therapies for the management of T2D To discuss the advantages and disadvantages

More information

Ertugliflozin (Steglatro ) 5 mg daily. May increase to 15 mg daily. Take in the morning +/- food. < 60: Do not initiate; discontinue therapy

Ertugliflozin (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 information

SESSION 4 12:30pm 1:45pm

SESSION 4 12:30pm 1:45pm SESSION 4 12:30pm 1:45pm Addressing Renal-Mediated Glucose Homeostasis: Diabetes and the Kidney SPEAKER Davida Kruger, MSN, BC-ADM, APRN Presenter Disclosure Information The following relationships exist

More information

Rebecca Newberry APRN MS CDE

Rebecca Newberry APRN MS CDE Current Diabetes Medications Nursing Implications and Applications Rebecca Newberry APRN MS CDE Methodist Center for Diabetes and Nutritional Health Disclosures Objectives Speakers Bureaus/Consulting Board

More information

Joshua Settle, PharmD Clinical Pharmacist Baptist Medical Center South ALSHP Fall Meeting September 30, 2016

Joshua Settle, PharmD Clinical Pharmacist Baptist Medical Center South ALSHP Fall Meeting September 30, 2016 Joshua Settle, PharmD Clinical Pharmacist Baptist Medical Center South jjsettle@baptistfirst.org ALSHP Fall Meeting September 30, 2016 Objectives Describe the current information concerning newly approved

More information

What s New in Diabetes Treatment. Disclosures

What 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 information

Diabetes 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 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 information

Oral and Injectable Non-insulin Antihyperglycemic Agents

Oral 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 information

Drug Class Monograph

Drug Class Monograph Drug Class Monograph Class: Sodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors Drugs: Farxiga (dapagliflozin), Invokamet (canagliflozin/metformin), Invokana (canagliflozin), Jardiance (empagliflozin),

More information

3/8/2011. Julie M. Sease, Pharm D, BCPS, CDE Associate Professor of Pharmacy Practice Presbyterian College School of Pharmacy

3/8/2011. 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

9/29/ Disclosure. Learning Objectives. Diabetes Update: Guidelines, Treatment Options & Trends

9/29/ Disclosure. Learning Objectives. Diabetes Update: Guidelines, Treatment Options & Trends + Diabetes Update: Guidelines, Treatment Options & Trends Melissa Max, PharmD, BC-ADM, CDE Assistant Professor of Pharmacy Practice Harding University College of Pharmacy + Disclosure Conflicts Of Interest

More information

Sodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors Drug Class Prior Authorization Protocol

Sodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors Drug Class Prior Authorization Protocol Sodium-Glucose Co-Transporter 2 (SGLT-2) 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

More information

Diabetes Update: Keeping patients safe. Victoria Ruszala MFRPSII North Bristol NHS Trust

Diabetes Update: Keeping patients safe. Victoria Ruszala MFRPSII North Bristol NHS Trust Diabetes Update: Keeping patients safe Victoria Ruszala MFRPSII North Bristol NHS Trust Declaration of Interests I have received funding from the following companies for providing education sessions, attending

More information

Professor Rudy Bilous James Cook University Hospital

Professor 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 information

A Practical Approach to the Use of Diabetes Medications

A 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 information

NEW DIABETES CARE MEDICATIONS

NEW 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 information

Xultophy 100/3.6. (insulin degludec, liraglutide) New Product Slideshow

Xultophy 100/3.6. (insulin degludec, liraglutide) New Product Slideshow Xultophy 100/3.6 (insulin degludec, liraglutide) New Product Slideshow Introduction Brand name: Xultophy Generic name: Insulin degludec, liraglutide Pharmacological class: Human insulin analog + glucagon-like

More information

FARXIGA (dapagliflozin) Jardiance (empagliflozin) tablets. Synjardy (empagliflozin and metformin hydrochloride) tablets. GLUCOPHAGE* (metformin)

FARXIGA (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 information

4/2/2018. Human U-500 insulin Learning Objectives. Dr. Ken Cathcart FACE

4/2/2018. Human U-500 insulin Learning Objectives. Dr. Ken Cathcart FACE Human U-500 insulin 2018 Dr. Ken Cathcart FACE Learning Objectives Participants will be able to identify when it is appropriate to use U500 insulin Participants will be able to state how to determine a

More information

Brand Name: Farxiga. Generic Name: dapagliflozin. Manufacturer 1 : Bristol-Myers Squibb

Brand Name: Farxiga. Generic Name: dapagliflozin. Manufacturer 1 : Bristol-Myers Squibb Brand Name: Farxiga Generic Name: dapagliflozin Manufacturer 1 : Bristol-Myers Squibb Drug Class 1,3,4 : Antidiabetic, sodium-glucose cotransporter 2 (SGLT2) inhibitor Uses Labeled Uses 1,2,3,4,5 : Adjunct

More information

Antihyperglycemic 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 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 information

Objectives. Recognize all available medical treatment options for diabetes. Individualize treatment and glycemic target based on patient factors

Objectives. 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 information

Soliqua 100/33. (insulin glargine, lixisenatide) New Product Slideshow

Soliqua 100/33. (insulin glargine, lixisenatide) New Product Slideshow Soliqua 100/33 (insulin glargine, lixisenatide) New Product Slideshow Introduction Brand name: Soliqua 100/33 Generic name: Insulin glargine (rdna origin), lixisenatide Pharmacological class: Human insulin

More information

Diabetes Mellitus: Overview and Guidelines

Diabetes 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 information

Diabetes and New Meds for Cardiovascular Risk Reduction. F. Dwight Chrisman, MD, FACC. Disclosures: BI Boehringer Ingelheim speaker

Diabetes and New Meds for Cardiovascular Risk Reduction. F. Dwight Chrisman, MD, FACC. Disclosures: BI Boehringer Ingelheim speaker Diabetes and New Meds for Cardiovascular Risk Reduction F. Dwight Chrisman, MD, FACC Disclosures: BI Boehringer Ingelheim speaker 1 Prevalence of DM DM state specific prevalence 2006 4%-6% 6-8% 8-10% 10-12%

More information

What s New in Type 2 Diabetes? 2018 Diabetes Updates

What s New in Type 2 Diabetes? 2018 Diabetes Updates What s New in Type 2 Diabetes? 2018 Diabetes Updates Gretchen Ray, PharmD, PhC, BCACP, CDE Associate Professor, UNM College of Pharmacy January 28, 2018 gray@salud.unm.edu OBJECTIVES Describe the most

More information

Pharmacology Updates. Quang T Nguyen, FACP, FACE, FTOS 11/18/17

Pharmacology 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 information

Dept of Diabetes Main Desk

Dept 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 information

Non-insulin treatment in Type 1 DM Sang Yong Kim

Non-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 information

INSULIN IN THE OBESE PATIENT JACQUELINE THOMPSON RN, MAS, CDE SYSTEM DIRECTOR, DIABETES SERVICE LINE SHARP HEALTHCARE

INSULIN IN THE OBESE PATIENT JACQUELINE THOMPSON RN, MAS, CDE SYSTEM DIRECTOR, DIABETES SERVICE LINE SHARP HEALTHCARE INSULIN IN THE OBESE PATIENT JACQUELINE THOMPSON RN, MAS, CDE SYSTEM DIRECTOR, DIABETES SERVICE LINE SHARP HEALTHCARE OBJECTIVES DESCRIBE INSULIN, INCLUDING WHERE IT COMES FROM AND WHAT IT DOES STATE THAT

More information

Comprehensive Diabetes Treatment

Comprehensive 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 information

6/1/2018. Lou Haenel, IV, DO, FACE, FACOI Endocrinology Roper St Francis Charleston, SC THE OMINOUS OCTET: HOW PATHOPHYSIOLOGY AND THERAPY MERGE

6/1/2018. 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 information

The ABCs (A1C, BP and Cholesterol) of Diabetes

The 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 information

Brand name: Steglatro. Generic name: Ertugliflozin (er too gli FLOE zin) Manufacturer: Merck

Brand name: Steglatro. Generic name: Ertugliflozin (er too gli FLOE zin) Manufacturer: Merck Brand name: Steglatro Generic name: Ertugliflozin (er too gli FLOE zin) Manufacturer: Merck Drug Class: Sodium-glucose co-transporter 2 (SGLT2) inhibitor Uses: Labeled: Indicated as adjunct to diet and

More information

Diabetes Mellitus in Older Adults. Presenter Disclosure Information

Diabetes 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 information

Adlyxin. (lixisenatide) New Product Slideshow

Adlyxin. (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 information

Let s not sugarcoat it! Update on Pharmacologic Management of Type II DM

Let s not sugarcoat it! Update on Pharmacologic Management of Type II DM Let s not sugarcoat it! Update on Pharmacologic Management of Type II DM Gregory Castelli, PharmD, BCPS, BC-ADM Clinical Pharmacist UPMC St. Margaret Objectives By the end of this presentation, participants

More information

New Therapies for Diabetes

New Therapies for Diabetes Type 2 diabetes is increasingly prevalent New Therapies for Diabetes Lynn Mack, M.D. Associate Professor Diabetes, Endocrinology, & Metabolism The Nebraska Medical Center lmack@unmc.edu No Conflicts of

More information

Non-Insulin Diabetes Medications Summary

Non-Insulin Diabetes Medications Summary Non-Insulin Diabetes Medications Summary Medications marked with an asterisk (*) can cause hypoglycemia INSULIN SECRETAGOGUES Sulfonylureas* GLYBURIDE* (Diabeta) (Micronase) production. Side effects: Potential

More information

This program applies to Commercial, GenPlus and Health Insurance Marketplace formularies.

This program applies to Commercial, GenPlus and Health Insurance Marketplace formularies. OBJECTIVE The intent of the GLP-1 (glucagon-like peptide-1) Agonists [Adlyxin (lixisenatide), Byetta (exenatide), Bydureon (exenatide extended-release), Tanzeum (albiglutide), Trulicity (dulaglutide),

More information

Side Effects of: GLP-1 agonists DPP-4 inhibitors SGLT-2 inhibitors. Bryce Fukunaga PharmD April 25, 2018

Side Effects of: GLP-1 agonists DPP-4 inhibitors SGLT-2 inhibitors. Bryce Fukunaga PharmD April 25, 2018 Side Effects of: GLP-1 agonists DPP-4 inhibitors SGLT-2 inhibitors Bryce Fukunaga PharmD April 25, 2018 Objectives For each drug class: Identify the overall place in therapy Explain the mechanism of action

More information

Bristol-Myers Squibb / AstraZeneca ADVICE dapagliflozin (Forxiga ) Indication under review: SMC restriction: Chairman, Scottish Medicines Consortium

Bristol-Myers Squibb / AstraZeneca ADVICE dapagliflozin (Forxiga ) Indication under review: SMC restriction: Chairman, Scottish Medicines Consortium Re-Submission dapagliflozin 5mg and 10mg film-coated tablets (Forxiga ) SMC No. (799/12) Bristol-Myers Squibb / AstraZeneca 07 February 2014 The Scottish Medicines Consortium (SMC) has completed its assessment

More information

1. Pharmacokinetics. When is steady state achieved? Steady-state was reached after 4 to 5 days of once-daily dosing with Sulisent 100 mg to 300mg.

1. Pharmacokinetics. When is steady state achieved? Steady-state was reached after 4 to 5 days of once-daily dosing with Sulisent 100 mg to 300mg. 1. Pharmacokinetics How is Sulisent metabolized? Sulisent has a novel mechanism of action that targets the kidneys and allows for excess glucose excretion resulting in urinary calorie loss. Sulisent is

More information

Drug Class Monograph

Drug 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 information

There have been important changes in diabetes care which may not be covered in undergraduate textbooks.

There have been important changes in diabetes care which may not be covered in undergraduate textbooks. Diabetes Clinical update There have been important changes in diabetes care which may not be covered in undergraduate textbooks. Changes in the diagnosis of diabetes a) HbA1C Since 2011, World Health Organisation

More information

Achieving and maintaining good glycemic control is an

Achieving 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 information

GLP-1 (glucagon-like peptide-1) Agonists (Byetta, Bydureon, Tanzeum, Trulicity, Victoza ) Step Therapy and Quantity Limit Criteria Program Summary

GLP-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 information

Exploring Non-Insulin Therapies in Type 1 Diabetes

Exploring Non-Insulin Therapies in Type 1 Diabetes Exploring Non-Insulin Therapies in Type 1 Diabetes Susan Cornell, BS, PharmD, CDE, FAPhA, FAADE Associate Professor Midwestern University - Chicago College of Pharmacy Disclosures Dr. Cornell: Advanced

More information

Insulin Initiation and Intensification. Disclosure. Objectives

Insulin 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 information

New and Emerging Therapies for Type 2 DM

New 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 information

Type 2 Diabetes: Where Do We Start with Treatment? DIABETES EDUCATION. Diabetes Mellitus: Complications and Co-Morbid Conditions

Type 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 information

What s New in Type 2 Diabetes? 2018 Diabetes Updates

What s New in Type 2 Diabetes? 2018 Diabetes Updates What s New in Type 2 Diabetes? 2018 Diabetes Updates Jessica Conklin, PharmD, PhC, BCACP, CDE, AAHIP Associate Professor, UNM College of Phar macy jeconklin@salud.unm.edu Luis Gonzales, PharmD, PhC UNM

More information

Exploring Non-Insulin Therapies in Type 1 Diabetes. Objectives. Pre-Assessment Question #1. Disclosures

Exploring Non-Insulin Therapies in Type 1 Diabetes. Objectives. Pre-Assessment Question #1. Disclosures Exploring Non-Insulin Therapies in Type 1 Diabetes Disclosures Dr. Cornell: Advanced Practitioner Advisory Board and Speakers Bureau: Novo Nordisk Susan Cornell, BS, PharmD, CDE, FAPhA, FAADE Associate

More information

What s New in Diabetes Medications. Jena Torpin, PharmD

What 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

SGLT2 Inhibitors

SGLT2 Inhibitors Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: SGLT2 Inhibitors Page: 1 of 7 Last Review Date: June 22, 2018 SGLT2 Inhibitors Description Invokana

More information

Cardiovascular Benefits of Two Classes of Antihyperglycemic Medications

Cardiovascular 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 information

What s New on the Horizon: Diabetes Medication Update

What 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 information

Peter Stein, MD Janssen Research and Development

Peter Stein, MD Janssen Research and Development New Agents and Technologies in the Pipeline for the Treatment of Patients with Diabetes Peter Stein, MD Janssen Research and Development Agents in Phase 3 Development for T2DM Long-acting GLP-1 analogues

More information

Obesity, 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 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 information

SGLT2 Inhibitors

SGLT2 Inhibitors Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: SGLT2 Inhibitors Page: 1 of 7 Last Review Date: November 30, 2018 SGLT2 Inhibitors Description

More information

Oral Medication for the Management of Diabetes Mechanism of. Duration of Daily Dosing Action

Oral 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 information

PRODUCT MONOGRAPH FORXIGA

PRODUCT MONOGRAPH FORXIGA PRODUCT MONOGRAPH dapagliflozin tablets (as dapagliflozin propanediol monohydrate) 5 mg and 10 mg ATC Code: A10BK01 Sodium-glucose co-transporter 2 (SGLT2) inhibitors AstraZeneca Canada Inc. 1004 Middlegate

More information

Diabetes Meds Update Disclaimer and Important Info. Objectives. Page 1. Copyright , Diabetes Education Services

Diabetes Meds Update Disclaimer and Important Info. Objectives. Page 1. Copyright , Diabetes Education Services Diabetes Meds Update 2016 Beverly Dyck Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Disclaimer and Important Info This content is for educational purposes only. Please see Package

More information

9/16/2013. No Conflict of Interest to Disclose

9/16/2013. No Conflict of Interest to Disclose Catie Prinzing MSN, APRN, Clinical Nurse Specialist September 27, 2013 No Conflict of Interest to Disclose List key concepts to determining patient insulin doses during transitions in care Identify 5 points

More information

CASE A2 Managing Between-meal Hypoglycemia

CASE A2 Managing Between-meal Hypoglycemia Managing Between-meal Hypoglycemia 1 I would like to discuss this case of a patient who, overall, was doing well on her therapy until she made an important lifestyle change to lose weight. This is a common

More information

What 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 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 information

EXENATIDE (BYETTA ) PROTOCOL, 5mcg and 10mcg SC injection pre-filled pens

EXENATIDE (BYETTA ) PROTOCOL, 5mcg and 10mcg SC injection pre-filled pens EXENATIDE (BYETTA ) PROTOCOL, 5mcg and 10mcg SC injection pre-filled pens This document should be read in conjunction with the current Summary of Product Characteristics http://www.medicines.org.uk 1.

More information

The Many Faces of T2DM in Long-term Care Facilities

The 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 information

PRESCRIBING INFORMATION (PI)

PRESCRIBING INFORMATION (PI) PRESCRIBING INFORMATION (PI) BYDUREON (exenatide) 2MG POWDER AND SOLVENT FOR PROLONGED-RELEASE SUSPENSION FOR INJECTION BYETTA (exenatide) 5 MICROGRAMS AND 10 MICROGRAMS SOLUTION FOR INJECTION, PREFILLED

More information

Type 2 Diabetes Mellitus: Update on Pharmacotherapy 04/04/18

Type 2 Diabetes Mellitus: Update on Pharmacotherapy 04/04/18 Type 2 Diabetes Mellitus: Update on Pharmacotherapy 04/04/18 No conflicts of interest Objectives for this talk Update on non-insulin drug therapy fro type 2 DM Appropriate use of insulin in type 2 DM ADA

More information

A MONTHLY DOSE OF EDUCATION

A MONTHLY DOSE OF EDUCATION A MONTHLY DOSE OF EDUCATION Brian Pelletier, PharmD, BCGP, FASCP CEO, A Dose of Education, LLC December 2017 FDA Approval Ozempic (semaglutide) approved 12/5/17 A glucagon-like peptide 1 (GLP-1) receptor

More information

Very Practical Tips for Managing Type 2 Diabetes

Very Practical Tips for Managing Type 2 Diabetes Very Practical Tips for Managing Type 2 Diabetes Jean-François Yale, MD, FRCPC McGill University Health Centre, Montreal, Canada Jean-francois.yale@mcgill.ca www.dryale.ca OBJECTIVES DISCLOSURES The participant

More information

Drug Class Monograph

Drug 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 information

Multiple Factors Should Be Considered When Setting a Glycemic Goal

Multiple 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 information

Initiation and Titration of Insulin in Diabetes Mellitus Type 2

Initiation 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 information

Diabesity. 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 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 information

Pharmacology Update for the Adult Patient - Newer Oral Medications for Diabetes

Pharmacology 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 information

SGLT2 Inhibitors

SGLT2 Inhibitors Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.19 Subject: SGLT2 Inhibitors Page: 1 of 6 Last Review Date: September 15, 2016 SGLT2 Inhibitors Description

More information

Beyond 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 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 information

The Death of Sulfonylureas? A Review of New Diabetes Medications

The Death of Sulfonylureas? A Review of New Diabetes Medications The Death of Sulfonylureas? A Review of New Diabetes Medications Kelly Hoenig, Pharm.D., BCPS Cedar Rapids Family Medicine Residency 2/4/17 Objectives Review GLP-1 Agonists, DPP-IV Inhibitors and SGLT-2

More information

INSULIN INITIATION AND INTENSIFICATION WITH A FOCUS ON HYPOGLYCEMIA REDUCTION

INSULIN INITIATION AND INTENSIFICATION WITH A FOCUS ON HYPOGLYCEMIA REDUCTION INSULIN INITIATION AND INTENSIFICATION WITH A FOCUS ON HYPOGLYCEMIA REDUCTION Jaiwant Rangi, MD, FACE Nov 10 th 2018 DISCLOSURES Speaker Novo Nordisk Sanofi-Aventis Boheringer Ingleheim Merck Abbvie Abbott

More information

Multiple 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 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 information

Newer Drugs in the Management of Type 2 Diabetes Mellitus

Newer 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 information

DIABETES DEBATE - IS NEW BETTER?

DIABETES 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 information

GLP-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 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 information

Northern California Chapter ACP Update In Medicine I

Northern California Chapter ACP Update In Medicine I Northern California Chapter ACP Update In Medicine I Kurt M. Hafer MD, FACP Clinical Assistant Professor Stanford University School of Medicine Division of Primary Care and Population Health November 3,

More information

Sodium-Glucose Linked Transporter 2 (SGLT2) Inhibitors in the Management Of Type-2 Diabetes: A Drug Class Overview

Sodium-Glucose Linked Transporter 2 (SGLT2) Inhibitors in the Management Of Type-2 Diabetes: A Drug Class Overview Sodium-Glucose Linked Transporter 2 (SGLT2) Inhibitors in the Management Of Type-2 Diabetes: A Drug Class Overview Juan F. Mosley II, PharmD, CPh, AAHIVP; Lillian Smith, PharmD, CPh, MBA; Emily Everton,

More information

BRIAN MOSES, MD, FRCPC (INTERNAL MEDICINE) CHIEF OF MEDICINE, SOUTH WEST HEALTH

BRIAN MOSES, MD, FRCPC (INTERNAL MEDICINE) CHIEF OF MEDICINE, SOUTH WEST HEALTH Insulin Initiation BRIAN MOSES, MD, FRCPC (INTERNAL MEDICINE) CHIEF OF MEDICINE, SOUTH WEST HEALTH Disclosures In the past 12 months, I have received speakers honoraria from AstraZeneca, Boehringer Ingelheim,

More information

A Clinical Context Report

A Clinical Context Report Type 2 Diabetes in Practice An Expert Commentary with Silvio E. Inzucchi, MD A Clinical Context Report Clinical Context: Type 2 Diabetes in Practice Expert Commentary Jointly Sponsored by: and Clinical

More information

STEP THERAPY CRITERIA

STEP THERAPY CRITERIA CATEGORY DRUG CLASS BRAND NAME (generic) STEP THERAPY CRITERIA AMYLIN ANALOG: SYMLIN/SYMLINPEN (pramlintide acetate) ANTIDIABETIC AGENTS GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST (GLP-1): ADLYXIN (lixisenatide)

More information

VICTOSA and Renal impairment DR.R.S.SAJAD

VICTOSA 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 information

UK launch of once-daily tablet from Janssen provides new option to improve blood glucose control for thousands of people with Type 2 diabetes 1

UK launch of once-daily tablet from Janssen provides new option to improve blood glucose control for thousands of people with Type 2 diabetes 1 PRESS RELEASE 24 th February, 2014 UK launch of once-daily tablet from Janssen provides new option to improve blood glucose control for thousands of people with Type 2 diabetes 1 London, 24 February 2014

More information

INJECTABLE THERAPY FOR THE TREATMENT OF DIABETES

INJECTABLE 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 information

TREATMENTS FOR TYPE 2 DIABETES. Susan Henry Diabetes Specialist Nurse

TREATMENTS 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 information

Quick Reference Guide

Quick Reference Guide 2013 Clinical Practice Guidelines Quick Reference Guide (Updated November 2016) 416569-16 guidelines.diabetes.ca diabetes.ca 1-800-BANTING (226-8464) Copyright 2016 Canadian Diabetes Association SCREENING

More information

SGLT2 Inhibitors

SGLT2 Inhibitors Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.07.19 Subject: SGLT2 Inhibitors Page: 1 of 5 Last Review Date: December 3, 2015 SGLT2 Inhibitors Description

More information

The Role of Renal Glucose Excretion in Adults with Type 2 Diabetes

The Role of Renal Glucose Excretion in Adults with Type 2 Diabetes You are cordially invited to attend the following promotional program: The Role of Renal Glucose Excretion in Adults with Type 2 Diabetes Program Information: 1126785 Thursday, March 13, 2014 at 6:30 PM

More information