INSIGHT INTO MANAGING AND TREATING TYPE 2 DIABETES ISRAEL HARTMAN MD FACE
|
|
- Mary Hampton
- 6 years ago
- Views:
Transcription
1 INSIGHT INTO MANAGING AND TREATING TYPE 2 DIABETES ISRAEL HARTMAN MD FACE Type 2 Diabetes Mellitus (T2DM) Is an Epidemic The Centers for Disease Control and Prevention statistics from 2007 estimated that 23.5 million adults in the US had diabetes 10.7% of the US population aged 20 years or older 1 T2DM accounts for 90%-95% of all diagnosed cases of diabetes 1 3 Age-Adjusted Percentage of Adults With Diagnosed Diabetes in Arizona, Back to U.S. map AL HI MA NM SD AK ID MI NY TN AZ IL MN NC TX AR IN MS ND UT CA IA MO OH VT CO KS MT OK VA CT KY NE OR WA DE LA NV PA WV DC ME NH RI WI FL MD NJ SC WY GA 2007 Age-adjusted percent of adults with diagnosed diabetes Trends years old. 1. Centers for Disease Control Web site Centers for Disease Control Web site.
2 Obesity Trends Among U.S. Adults BRFSS, 2005 (BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% By the time of diabetes onset, up to 80% of beta cell function may be lost 2,3 Type 2 Diabetes Is a Complex and Progressive Metabolic Disorder History and Progression of Type 2 Diabetes 1 3 Diagnosis Adapted from Kendall DM, Bergenstal RM. 1. Kendall DM, et al. International Diabetes Center Defronzo DA. Diabetes Fehse F, et al. J Clin Endocrinol Metab β Cell mass 100% Natural History Of Pre Type 1 Diabetes Putative trigger Cellular autoimmunity Circulating autoantibodies (ICA, GAD65) Genetic predisposition Insulitis β Cell injury Loss of first phase insulin response (IVGTT) Glucose intolerance (OGTT) Pre diabetes Diabetes Clinical onset only 10% of β cells remain Time Eisenbarth GS. N Engl J Med. 1986;314:
3 IFG and IGT Intermediate Between Normal and Diabetes Impaired Fasting Glucose (IFG) FPG 100 but <126 mg/dl Predicts increased risk of diabetes and microand macrovascular complications Impaired Glucose Tolerance (IGT) 2-h PG on OGTT 140 but <200 mg/dl Predicts increased risk of diabetes and cardiovascular disease 9 Hyperglycemia Damages Tissues Effects of hyperglycemia Glycation of proteins (eg, hemoglobin, collagen) Accumulation of sorbitol and fructose (eg, in nerves, lens) Activation of protein kinase C (eg, on vascular cells) Tissue changes Altered protein function and turnover, cytokine activation Osmotic and oxidative stress Reduced motor and sensory nerve conduction velocity Increased glomerular filtration rate and renal plasma flow 2 Making the Diagnosis of Diabetes Symptoms of diabetes plus random plasma glucose 200 mg/dl or FPG 126 mg/dl or 2-h PG during a 75-g OGTT 200 mg/dl Requires confirmation by repeat testing American Diabetes Association. Diabetes Care. 2004;27(suppl 1):S5-S10 20
4 Classification of Diabetes Mellitus by Etiology Type 1 Type 2 Gestational Other specific types β-cell destruction complete lack of insulin β-cell dysfunction and insulin resistance β-cell dysfunction and insulin resistance during pregnancy Genetic defects of β-cell function Exocrine pancreatic diseases Endocrinopathies Drug- or chemical-induced Other rare forms 11 Gestational Diabetes Hyperglycemia during pregnancy usually resolves after birth Complicates ~4% of all pregnancies in the United States High risk of perinatal morbidity and mortality High risk of later type 2 diabetes in both mother and baby Diagnosed by specific glucose tolerance test methods Requires intensive dietary and glycemic management American Diabetes Association. Diabetes Care. 2004;27(suppl 1):S88-S90 18 Two Defects Contributing to Type 2 Diabetes Insulin resistance Beta-cell dysfunction Liver Muscle tissue Adipose tissue Pancreas Beta cell Type 2 Diabetes Buchanan TA. Clin Ther. 2003;25(suppl 2):B32 B46. Kahn SE. J Clin Endocrinol Metab. 2001;86:
5 Plasma glucose (mg/dl) A1C Reflects Both Fasting and Postprandial Hyperglycemia Postprandial hyperglycemia Fasting hyperglycemia Normal Time of day Riddle MC. Diabetes Care. 1990;13: Appropriate A1C Management Should Consider Both FPG and PPG Levels 14 Approximate Contribution to A1C (%) PPG FPG A1C (%) 70% 30% <7.3 53% 47% % 55% FPG and PPG contributions to A1C differ as A1C levels change PPG is the major contributor to A1C in patients with A1C <7.3% FPG is the major contributor to A1C in patients with A1C 9.3% 40% 60% % 70% >10.2 FPG and PPG concentrations were measured in 290 patients with T2DM. Patients were divided into quintiles of A1C and these values were used to calculate the relative contribution that each made to the patient s overall diurnal hyperglycemia. The results were compared across quintiles. Significant difference was observed between FPG and PPG. Significantly different from all other quintiles. Significantly different from >10.2 quintile. All percentages are approximated. Monnier L et al. Diabetes Care. 2003;26: Nearly Half of All Adult Patients With T2DM Remain Uncontrolled on Their Current Therapy 1 15 Treated Patients with T2DM 42.9% of patients not at goal Recommended A1C A1C >7% A1C <7% 57.1% ADA 2 <7.0% AACE 3 6.5% Mean A1C=7.17% (N=491) NHANES=National Health and Nutrition Examination Survey. Data from NHANES, includes all men and non-pregnant women 20 years with valid data on diabetes history and body mass index measurement (N= 4430). Participants with diabetes diagnosed at age <30 years, who were treated with insulin alone, were excluded from the analysis of determinants of glycemic control as they were likely to have type 1 diabetes. 1. Ong KL, et al. Ann Epidemiol. 2008;18: Nathan DM, et al. Diabetes Care. 2009;32: Rodbard HW et al. Endocr Pract. 2009;15:
6 Type 2 Diabetes Associated with Serious Complications Diabetic Retinopathy Leading cause of blindness in adults Stroke CV disease & stroke account for ~65% of deaths in T2D patients Cardiovascular Disease Diabetic Nephropathy Major cause of kidney failure Diabetic Neuropathy Major cause of lower extremity amputations CV = cardiovascular. National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics fact sheet: general information and national estimates on diabetes in the United States, Bethesda, MD: U.S. Department of Health and Human Services, National Institute of Health, Patients ages 20 years. Centers for Disease Control. National Diabetes Fact Sheet. Accessed February 27, Relationship of A1C to Risk of Microvascular Complications Relative Risk 15 Retinopathy Nephropathy Neuropathy Microalbuminuria A1C (%) Adapted with permission from Skyler JS. Endocrinol Metab Clin North Am. 1996;25:243 Who Should Be Tested for Diabetes? Consider if One or More of the Following Apply Symptoms suggesting diabetes: weight loss, hunger, urinary frequency, blurred vision Age >45 (>30 if patient has other risk factors) Prior IGT or IFG or family history of diabetes Prior gestational diabetes or baby weighing >9 lb Women with polycystic ovarian syndrome (PCOS) Obesity (BMI 25 kg/m 2 ), especially adolescents African, Latino, Asian, or Native American ancestry History of vascular disease or hypertension American Diabetes Association. Diabetes Care. 2004;27(suppl 1):S11-S14; AACE/ACE medical guidelines. Endocr Pract. 2002;8(suppl 1):
7 Type 2 Diabetes Treatment Options Utilize Different Mechanisms of Action and Target Different Primary Tissues Liver Adipose Muscle Pancreas Metformin (MET) 1 Primarily decreases hepatic glucose production Thiazolidinediones (TZDs) 2 Improve insulin sensitivity Sulfonylureas (SU) 3 Increase insulin secretion in functioning pancreatic beta cells DPP-4 Inhibitors 4 Slow inactivation of incretin hormones resulting in: increased synthesis and release of insulin from functioning pancreatic beta cells and lower glucagon secretion from pancreatic alpha cells Not intended to imply a comparison of efficacy or safety of these treatment options. Also decreases intestinal absorption of glucose and increases peripheral glucose uptake and utilization. 1. Glucophage [prescribing information]. Bristol-Myers Squibb; 2. Prescribing information for AVANDIA; 3. Amaryl (glimepiride) [prescribing information]. Aventis Pharmaceuticals; 4. Januvia TM (sitagliptin phosphate) [prescribing information]. Merck & Co., Inc. Initial Diabetes Management Patient Education Exercise Diet Glucose Monitoring Complication avoidance Be sure that the patient understands the game plan for their diabetes Dietary Recommendations Determine current BMI and ideal weight BMI = Weight (lbs) x 703 / (height in inches)^2 Normal = Overweight Obese 30.0 or more Ideal weight Men: 106 for first 60 inches, then 6 # each additional inch. Women: 100 for first 60 inches, then 5# each additional inch
8 Specify a diet Refer to a dietitian if at all possible They have more time than you do They can answer questions about specific food preferences better than you can They can schedule follow up They are usually less expensive than you A diet of 13 kcal / pound IBW will usually induce gradual weight loss Give the patient an exercise prescription Be specific Type of exercise walking, bicycling, swimming, Gazelle, weightlifting, etc How long: Ask them to do 30 minutes, you may get 20 minutes How often: 5 or more times a week Point out that exercise is effective, and less expensive than many of our medications ADA/EASD 2008 Consensus Statement Includes a GLP 1 Receptor Agonist STEP 1 At diagnosis: Lifestyle + MET If A1C 7% STEP 2 Tier 1: Well validated core therapies OR Tier 2: Less well validated therapies Lifestyle + MET + SFU CHF, chronic heart failure MET, metformin PIO, pioglitazone SFU, sulfonylurea Lifestyle + MET + basal insulin Lifestyle + MET + GLP-1 receptor agonist If hypoglycemia is particularly undesirable Lifestyle + MET and/or + promotion PIO + SFU of weight loss is a consideration Lifestyle + MET + PIO Lifestyle + MET + basal insulin STEP 3 Lifestyle + MET + intensive insulin Validation based on clinical trials and clinical judgment. Insufficient clinical use to be confident regarding safety. Adapted from Nathan DM, et al. Diabetes Care
9 Oral Diabetes Meds Sulfonylureas Glipizide, glyburide, glimipiride, Biguanides / Metformin Thiazoladinediones Avandia, Actos α Glucosidase Inhibitors Precose, Glyset Glinides Starlix, Prandin DPP IV inhibitors Januvia, Onglyza Sulfonylureas Introduced in 1955 Inexpensive ($4 at Target/Sams/WalMart) Stimulate insulin release from pancreatic beta cell Mean absolute A1c reduction: 1 2 % Sulfonylureas Cons: Weight gain Risk of hypoglycemia K channel inhibition may worsen arrhythmia risk in patients with coronary artery disease Do not delay progression of disease
10 Non SU Secretagogues Starlix (nateglinide) and Prandin (repaglinide) $125/month Increase mealtime beta cell release of insulin Shorter duration of action than SU A1c Starlix 0.4 ~ 1.1 % A1c Prandin 1.7~1.9% Non SU Secretagogues Pros Short half life Less hypoglycemia than SU Starlix can be used in renal failure patients Cons Weight gain, but not as much as SU Must be taken just before meal Less long term outcome data Metformin Introduced 1962 (France) 1995 (USA) Inexpensive ($4 at Target/Sams/WalMart) Decreases hepatic glucose production primarily gluconeogenesis, probably through effects on AMP kinase Mean absolute A1c reduction: 1 2 %
11 Metformin Pros: Modest amount of weight loss Modest lipid lowering effect Benefit on cardiovascular risk markers As monotherapy, had lowest CV risk in UKPDS May be useful in prevention of diabetes DPP Treatment option for PCOS Metformin Cons: Gastrointestinal side effects Contraindicated in renal, liver, cardiac dysfunction because of risk of lactic acidosis AGI s Acarbose (Precose) Miglitol (Glyset) Inhibit enzyme on enterocyte brush border that breaks down complex starches Approximately $95 per month Mean absolute A1c reduction: 0.5 1% Reduces postprandial BG more than fasting Reduced risk of MI in STOP NIDDM
12 Thiozoladinediones (TZDs) Activate nuclear transcription factors PPARγ rosiglitazone (Avandia) & pioglitazone (Actos) Cost (full dose) $180 $213 per month Improve insulin sensitivity & glucose uptake in adipocytes and muscle Thiozoladinediones (TZDs) Pros: Durable control demonstrated for rosiglitazone (ADOPT) May delay progression of disease Improved lipid parameters ( pio > rosi ) A1c reduction of 1 2 % Rosiglitazone demonstrated to reduce IGT progression to DM by 60% (DREAM) Thiozoladinediones (TZDs) Activate nuclear transcription factors PPARγ rosiglitazone (Avandia) & pioglitazone (Actos) Cost (full dose) $180 $213 per month Improve insulin sensitivity & glucose uptake in adipocytes and muscle
13 Thiozoladinediones (TZDs) Cons Weight gain Edema Potential to exacerbate CHF contraindicated in Class III or IV Controversy over rosiglitazone and cardiovascular risk ADOPT: ADiabetes Outcome Progression Trial Reduced Rate of Monotherapy Failure with AVANDIA (FPG >180 mg/dl) 40 Primary Endpoint Cumulative incidence of monotherapy failure (%) Risk reduction with AVANDIA: 32% over MET 63% over SU SU MET AVANDIA Patients at risk AVANDIA MET SU Time (years) The characteristics of the participants who withdrew did not differ among treatment groups. The subgroup analyses demonstrated some benefit in all subgroups. The analyses suggest that the beneficial effect of AVANDIA vs MET was unlikely to be due to a withdrawal bias. Kahn SE et al. N Engl J Med. 2006;355: RECORD: Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of glycemia in Diabetes Study Results: Primary Endpoint Time to CV Death or First Event of CV Hospitalization Cumulative Incidence (%, SE) Rosiglitazone (321 events) Metformin/SU (323 events) HR: 0.99 (95% CI 0.85, 1.16) Time (years) People at risk Rosiglitazone Metformin/SU Home PD et al. Lancet Published June 5, Accessed June 6, 2009.
14 ROSIGLITAZONE ISSUES Neither increased or decreased risk of CV events is established. excluding trials from a meta analysis with zero events probably exaggerated risk estimates available evidence does not justify what the authors of the original meta analysis (as well as the media, the US Congress and worried patient groups decried as urgent need for comprehensive evaluations Ann Int Med 147;8: October 16, 2007 Five Long term Studies Showed No Increased Risk of Total Mortality with Rosiglitazone 1 7 Duration of Relevant Studies A Comparison of Relevant Studies ADOPT 1,2 DREAM 1,3 RECORD 1,4 ACCORD (Interim Studies) 5,6 VADT 7,8 4 6 years N=4360 patients N=5269 patients N=4447 patients N=10,251 patients 5 7 years N=1791 patients Duration, years Randomized, long term prospective trials with rosiglitazone Mean duration: 41 months. Not prospectively designed to assess the safety of Randomized, long term trials that included patients on rosiglitazone rosiglitazone. Independent, non GSK sponsored studies. 1. Prescribing Information for AVANDIA; 2. Kahn SE et al. N Engl J Med. 2006;355: ; 3. DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators, Gerstein HC et al. Lancet. 2006;368: ; 4. Home PD et al. Lancet Published June 5, Accessed June 6, The Action to Control Cardiovascular Risk in Diabetes Study Group. N Engl J Med. 2008;358: ; 6. NHLBI. feb2008/nhlbi-06.htm. Accessed February 12, 2009; 7. American Diabetes Association Web site. Accessed February 12, 2009; 8. Duckworth W et al. N Engl J Med. 2009;360: EXENATIDE LIRAGLUTIDE SITAGLIPTIN SAXAGLIPTIN Incretins
15 GLP 1 Is a Glucoregulatory Hormone With Multiple Physiological Actions Brain: Promotes satiety Food intake Pancreas α cells: Postprandial glucagon Pancreas β cells: Glucose dependent insulin secretion Liver: Hepatic glucose Stomach: Gastric emptying In animal models. Adapted from: 1. Flint A, et al. J Clin Invest Larsson H, et al. Acta Physiol Scand Nauck MA, et al. Diabetologia Drucker DJ. Diabetes GLP 1 Receptor Agonists Address GLP 1 Deficiencies and Leverage the GLP 1 Effect Active GLP 1 GLP 1 receptor agonist Binds to known GLP 1 receptor DPP 4 Activated GLP 1 receptor 1 3 Inactive GLP 1 Increases glucose dependent insulin secretion Restores first phase insulin response Suppresses glucagon release Delays gastric emptying Reduces food intake 1. Nielsen LL, et al. Regul Pept Kolterman OG, et al. J Clin Endocrinol Metab Fehse F, et al. J Clin Endocrinol Metab EXENATIDE Reduces A1C With Potential Weight Loss Three 30 Week, Double Blind, Phase 3 Studies EXENATIDE 10 mcg With Metformin and/or a Sulfonylurea Change in A1C (%) Change in Weight (lb) Δ A1C (%) % -0.8% Δ Weight (lb) lb -4.2 lb Time (wk) Time (wk) Placebo BID (n=483) EXENATIDE 10 mcg BID (n=483) Baseline A1C=8.5% Mean ±SE; compared to placebo. P<0.0001, P= Data on file. BYETTA is not indicated for the management of obesity, and weight change was a secondary end point in clinical trials. 45
16 EXENATIDE Monotherapy Provided Consistent Improvement in A1C and Weight Loss 24 Week, Double Blind, Placebo Controlled Study EXENITIDE 10 mcg Monotherapy Mean A1C Reduction From Baseline Mean Weight Loss From Baseline Mean A1C (%) EXENATIDE 10 mcg BID -0.2 P<0.01 Placebo Weight (lb) lb EXENATIDE 10 mcg BID -3.3 lb Placebo Least squares means are adjusted for screening A1C strata and baseline value of the dependent variable. BYETTA is not indicated for the management of obesity, and weight change was a secondary end point in clinical trials. 46 In addition to diet and exercise SAXAGLIPTIN 5 mg Provided Complementary A1C Reductions 47 Difference From Comparator (%) Significant A1C Reduction Across Clinical Trials at 6 Months When Partnered With MET, GLY, a TZD, or as Monotherapy Add-On to MET Baseline A1C: 8.1% 0.8% P< (n=186) Initial Combo With MET Baseline A1C: 9.4% 0.5% P< (n=306) Add-On to the SU Glyburide Baseline A1C: 8.5% 0.7% P< (n=250) Add-On to a TZD Baseline A1C: 8.4% P< (n=183) Monotherapy Baseline A1C: 8.0% 0.6% 0.6% P< (n=103) SAXAGLIPTIN Was Weight and Lipid Neutral GLY=glyburide. Please see full US Prescribing Information available at this presentation Treat to which target? AAFP Inappropriate to set a uniform target ADA in general is less than 7% Am Geriatrics Society Good functional status 7% Frail a less stringent target, such as 8% Canadian Diabetes Assn 7% or lower If it can be safely achieved <6.0% should be considered
17 Treat to which target? Institute for Clinical Systems < 7%, should be individualized Natl Institute for Health and Clinical Excellence Between % on the basis of vascular risk Scottish Intercollegiate Guidelines Network around 7.0 Veterans Health Administration target should be 7.0% Treat to which target? AACE Current targets for glycemic control are: A1C <6.5% Fasting/Preprandial <110 mg/dl 2 hr Postprandial <140 mg/dl Quest Diagnostics Data Can we do it? State % change Texas USA
18
Oral 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 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 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 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 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 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 informationModulating the Incretin System: A New Therapeutic Strategy for Type 2 Diabetes. Overview. Prevalence of Overweight in the U.S.
Modulating the Incretin System: A New Therapeutic Strategy for Type 2 Diabetes Geneva Clark Briggs, PharmD, BCPS Overview Underlying defects with Type 2 diabetes Importance of managing postprandial glucose
More informationDM Fundamentals Class 4 Meds for Type 2
DM Fundamentals Class 4 Meds for Type 2 Beverly Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Copyright 1999 2015, Diabetes Education Services, All Rights Reserved. Diabetes Meds
More 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 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 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 informationUpdate on Diabetes Mellitus
Update on Diabetes Mellitus Treatment: Targeting the Incretin System Overview Underlying defects with Type 2 diabetes Importance of managing postprandial glucose control Amylin Incretin Hormones New therapies
More informationA New Therapeutic Strategey for Type II Diabetes: Update 2008
Live, One Hour Webinar A New Therapeutic Strategey for Type II Diabetes: Update 2008 Geneva Clark Briggs, PharmD, BCPS Adjunct Professor at University of Appalachia College of Pharmacy in Grundy, Virginia.
More informationDiabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable?
Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable? Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of
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 informationDM Fundamentals Class 4 Meds for Type 2
DM Fundamentals Class 4 Meds for Type 2 Beverly Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Copyright 1999 2015, Diabetes Education Services, All Rights Reserved. Diabetes Meds
More 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 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 informationPre-diabetes. Pharmacological Approaches to Delay Progression to Diabetes
Pre-diabetes Pharmacological Approaches to Delay Progression to Diabetes Overview Definition of Pre-diabetes Risk Factors for Pre-diabetes Clinical practice guidelines for diabetes Management, including
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 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 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 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 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 informationAddressing Addressing Challenges in Type 2 Challenges in Type 2 Diabetes Diabetes Speaker:
Addressing Challenges in Type 2 Diabetes Geneva Briggs, PharmD,, BCPS Addressing Challenges in Type 2 Diabetes Speaker: Dr. Geneva Clark Briggs, a board-certified Pharmacotherapy Specialist, received her
More informationType II Diabetes Improving Blood Sugar Control. Geneva Clark Briggs, Pharm.D., BCPS
Type II Diabetes Improving Blood Sugar Control Geneva Clark Briggs, Pharm.D., BCPS Overview Importance of glucose control State of control Review available therapies Helping patients achieve control The
More informationDisclosure. Learning Objectives. Case. Diabetes Update: Incretin Agents in Diabetes-When to Use Them? I have no disclosures to declare
Disclosure Diabetes Update: Incretin Agents in Diabetes-When to Use Them? I have no disclosures to declare Spring Therapeutics Update 2011 CSHP BC Branch Anar Dossa BScPharm Pharm D CDE April 20, 2011
More informationChanging Diabetes: The time is now!
Midwest Cardiovascular Research Foundation Welcomes DANITA HARRISON, ARNP Ms. Harrison discloses speaking relationships with Lilly, Novo Nordisk and Pfizer. Changing Diabetes: The time is now! Danita Harrison
More 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 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 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 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 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 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 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 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 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 informationIDF Regions and global projections of the number of people with diabetes (20-79 years), 2013 and Diabetes Atlas -sixth Edition: IDF 2013
IDF Regions and global projections of the number of people with diabetes (20-79 years), 2013 and 2035 Diabetes Atlas -sixth Edition: IDF 2013 Diabetes Atlas -sixth Edition: IDF 2013 Chronic complications
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 informationCE on SUNDAY Newark, NJ October 18, 2009
CE on SUNDAY Newark, NJ October 18, 2009 Date: Sunday, October 18, 2009 Time: 2:45 PM 3:45 PM Location: Sheraton Newark Airport Hotel Title: Speaker(s): Addressing Challenges in Type 2 Diabetes ACPE #
More informationDiabetes Day for Primary Care Clinicians Advances in Diabetes Care
Diabetes Day for Primary Care Clinicians Advances in Diabetes Care Elliot Sternthal, MD, FACP, FACE Chair New England AACE Diabetes Day Planning Committee Welcome and Introduction This presentation will:
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 informationHanyang University Guri Hospital Chang Beom Lee
Hanyang University Guri Hospital Chang Beom Lee Meal prayer, Van Brekelenkam 17 th C Introduction 2012 ADA/EASD Position Statement Proper Patients for Pioglitazone β-cell Preservation by Pioglitazone Benefit
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 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 informationFARXIGA (dapagliflozin) Jardiance (empagliflozin) tablets. Synjardy (empagliflozin and metformin hydrochloride) tablets. GLUCOPHAGE* (metformin)
Type 2 Medications Drug Class How It Works Brand and Generic Names Manufacturers Usual Starting Dose The kidneys filter sugar and either absorb it back into your body for energy or remove it through your
More 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 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 informationGLP 1 agonists Winning the Losing Battle. Dr Bernard SAMIA. KCS Congress: Impact through collaboration
GLP 1 agonists Winning the Losing Battle Dr Bernard SAMIA KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email: kcardiacs@gmail.com Web: www.kenyacardiacs.org Disclosures I have
More 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 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 informationDIABETES. Mary Bruskewitz APNP, MS, BC-ADM Clinical Nurse Specialist Diabetes. November 2013
DIABETES Mary Bruskewitz APNP, MS, BC-ADM Clinical Nurse Specialist Diabetes November 2013 mbruskewitz@outlook.com Objectives Part 1 Overview of Endocrine Physiology Pathophysiology of Diabetes Diabetes
More informationRPCC Pharmacy Forum. The Type 2 Diabetes Issue. Type 2 Diabetes: The Basics
Nov/Dec 2015 Issue 11 RPCC Pharmacy Forum Special Interest Articles: Diabetes Medication Chart Insulin Chart Afreeza Did you know? Exanatide, marketed as Byetta, is the synthetic form of exendin-4, which
More informationChoosing a Diabetes Strategy Where to Start and Where to Go
Choosing a Diabetes Strategy Where to Start and Where to Go Erin Keely, MD, FRCPC; and Sharon Brez, RN, BScN, MA(Ed), CDE As presented at the University of Ottawa's 52nd Annual Refresher Course for Family
More information3/8/2011. Julie M. Sease, Pharm D, BCPS, CDE Associate Professor of Pharmacy Practice Presbyterian College School of Pharmacy
Summarize revisions to the 2011 American Diabetes Association clinical practice guidelines. Evaluate bromocriptine as a therapeutic option in the management of type 2 diabetes. Compare and contrast the
More informationDiabetes: Definition Pathophysiology Treatment Goals. By Scott Magee, MD, FACE
Diabetes: Definition Pathophysiology Treatment Goals By Scott Magee, MD, FACE Disclosures No disclosures to report Definition of Diabetes Mellitus Diabetes Mellitus comprises a group of disorders characterized
More informationEndo 2 SLO Practice (online) Page 1 of 7
Endo 2 SLO Practice (online) Page 1 of 7 1. A long- acting insulin, like Lantus is for? A. When the next meal is within 30-60 minutes of the injection B. Over night use or for ½ of the day often combined
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 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 informationFUNDING: MICIS mandated by Maine Legislature, funded by fees collected from pharmaceutical companies as a cost of doing business in the state.
GOAL: To improve clinical outcomes by delivering upto-date, evidence-based prescribing information, using data and guidelines developed by noncommercial sources FUNDING: MICIS mandated by Maine Legislature,
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 informationNew and Emerging Therapies for Type 2 DM
Dale Clayton MHSc, MD, FRCPC Dalhousie University/Capital Health April 28, 2011 New and Emerging Therapies for Type 2 DM The science of today, is the technology of tomorrow. Edward Teller American Physicist
More informationShould Psychiatrists be diagnosing (and treating) metabolic syndrome
Should Psychiatrists be diagnosing (and treating) metabolic syndrome David Hopkins Clinical Director, Diabetes King s College Hospital, London Diabetes prevalence (thousands) Diabetes in the UK: 1995-2010
More informationClinical Overview of Combination Therapy with Sitagliptin and Metformin
Clinical Overview of Combination Therapy with Sitagliptin and Metformin 1 Contents Pathophysiology of type 2 diabetes and mechanism of action of sitagliptin Clinical data overview of sitagliptin: Monotherapy
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 informationHot Topics: The Future of Diabetes Management Cutting Edge Medication and Technology-Based Care
Hot Topics: The Future of Diabetes Management Cutting Edge Medication and Technology-Based Care Mary Jean Christian, MA, MBA, RD, CDE Diabetes Program Coordinator UC Irvine Health Hot Topics: 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 informationDiabetes Risk Assessment and Treatment
Diabetes Risk Assessment and Treatment Todd T. Brown, MD, PhD Professor of Medicine and Epidemiology Division of Endocrinology, Diabetes, & Metabolism Johns Hopkins University Baltimore, Maryland, USA
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 informationTreatment of Type 2 Diabetes: What Have We Learned? AACE Diabetes Algorithm. ADOPT Trial 6/13/2012
Treatment of Type 2 Diabetes: What Have We Learned? Outline the clinical considerations in the selection of pharmacotherapy for type 2 diabetes, including degree of A1C lowering needed, patientspecific
More informationYOU HAVE DIABETES. Angie O Connor Community Diabetes Nurse Specialist 25th September 2013
YOU HAVE DIABETES Angie O Connor Community Diabetes Nurse Specialist 25th September 2013 Predicated 2015 figures are already met 1 in 20 have diabetes:1in8 over 60years old Definite Diagnosis is key Early
More informationGLP-1 agonists. Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK
GLP-1 agonists Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK What do GLP-1 agonists do? Physiology of postprandial glucose regulation Meal ❶ ❷ Insulin Rising plasma
More 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 informationJeffery Davies, DO, MPH, FACOEP ACOEP Chicago, IL October Your DM patient is ready for discharge, now what?
Jeffery Davies, DO, MPH, FACOEP ACOEP Chicago, IL October 2018 Your DM patient is ready for discharge, now what? Financial Disclosures None Objectives 1. Understand follow up patterns/capability of patients
More informationDiabetes: What is the scope of the problem?
Diabetes: What is the scope of the problem? Elizabeth R. Seaquist MD Division of Endocrinology and Diabetes Department of Medicine Director, General Clinical Research Center Pennock Family Chair in Diabetes
More informationCURRENT ISSUES IN DIABETES MANAGEMENT
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 Diabetes Mellitus: U.S. Impact DIABETES
More informationCURRENT STATEGIES IN DIABETES MELLITUS DIABETES. Recommendations for Adults CURRENT STRATEGIES IN DIABETES MELLITUS. Diabetes Mellitus: U.S.
CURRENT STATEGIES IN DIABETES MELLITUS Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Diabetes Mellitus: U.S. Impact ~1 Million Type 1 DIABETES 16.7 Million IFG (8.3%) 12.3
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 informationAdult Diabetes Clinician Guide NOVEMBER 2017
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Adult Diabetes Clinician Guide Introduction NOVEMBER 2017 This evidence-based guideline summary is based on the 2017 KP National Diabetes Guideline.
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 informationUpdate in Type 2 Diabetes
Update in Type Diabetes Martin J Stevens MD, FRCP, Endocrinologist and Professor of Medicine, University of Birmingham Every Day in the United States Approximately people people lose lose their eyesight
More informationWhat s the Goal? Individualizing Glycemic Targets. Matthew Freeby M.D. December 3 rd, 2016
What s the Goal? Individualizing Glycemic Targets Matthew Freeby M.D. December 3 rd, 2016 Diabetes Mellitus: Complications and Co-Morbid Conditions Retinopathy Between 2005-2008, 28.5% of patients with
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 informationObjectives. Type 2 Diabetes: Treating an Epidemic. Angela R. Newsome, Pharm.D Mission Hospitals/MAHEC Asheville, NC April 20, 2006
Type 2 Diabetes: Treating an Epidemic Angela R. Newsome, Pharm.D Mission Hospitals/MAHEC Asheville, NC April 20, 2006 Objectives Discuss the health and economic burden of diabetes Discuss necessary lifestyle
More informationOld oral antidiabetic agents in the armamentarium of diabetes mellitus treatment: Safety and efficacy
Old oral antidiabetic agents in the armamentarium of diabetes mellitus treatment: Safety and efficacy Melpomeni Peppa Assistant Professor of Endocrinology 2 nd Dept of Internal Medicine-Propaedeutic, Athens
More informationGlycemic control a matter of life and death
Glycemic control a matter of life and death Linda Garcia Mellbin MD PhD Specialist in Cardiology & Internal medicine Dep of Cardiology Karolinska University Hospital /Karolinska Institutet Mortality (%)
More informationCURRENT ISSUES IN DIABETES MANAGEMENT
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 2011 BMI
More informationPathogenesis of Type 2 Diabetes
9/23/215 Multiple, Complex Pathophysiological Abnmalities in T2DM incretin effect gut carbohydrate delivery & absption pancreatic insulin secretion pancreatic glucagon secretion HYPERGLYCEMIA? Pathogenesis
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 informationLearning Objectives. Impact of Diabetes II UPDATES IN TYPE 2 DIABETES. David Doriguzzi, PA-C
UPDATES IN TYPE 2 DIABETES David Doriguzzi, PA-C Learning Objectives Upon completion of this educational activity, the participant should be able to: Overcome barriers and attitudes that limit Clinician/Patient
More informationNational Horizon Scanning Centre. Saxagliptin (BMS ) for type 2 diabetes. April 2008
Saxagliptin (BMS 477118) for type 2 diabetes This technology summary is based on information available at the time of research and a limited literature search. It is not intended to be a definitive statement
More informationDiabetes and the Heart
Diabetes and the Heart Jeffrey Boord, MD, MPH Advances in Cardiovascular Medicine Kingston, Jamaica December 6, 2012 Outline Screening for diabetes in patients with CAD Screening for CAD in patients with
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 informationPancreatic b-cell Dysfunction in Type 2 Diabetes ZIAD KAHWASH, M.D. Insulin resistance: Defects in Insulin Signaling
Plasma insulin (mu/ml) ZIAD KAHWASH, M.D. resistance: Defects in Signaling Increased glucose production Glucose Insufficient glucose disposal X Liver glucagon insulin Pancreas Peripheral tissues (skeletal
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 informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Proposed Health Technology Appraisal
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Proposed Health Technology Appraisal Dapagliflozin in combination therapy for the Final scope Remit/appraisal objective To appraise the clinical and
More 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 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 informationRhonda Eustice, PharmD, CDE. Will Power lasts about two weeks and is soluble in alcohol. Mark Twain
Rhonda Eustice, PharmD, CDE Will Power lasts about two weeks and is soluble in alcohol. Mark Twain Diabetes Management: The Three Legged Stool Diet Medication Exercise Objectives Know the treatment goals
More information