GLUCAGON LIKE PEPTIDE (GLP) 1 AGONISTS FOR THE TREATMENT OF TYPE 2 DIABETES, WEIGHT CONTROL AND CARDIOVASCULAR PROTECTION.
|
|
- Katherine Robbins
- 5 years ago
- Views:
Transcription
1 GLUCAGON LIKE PEPTIDE (GLP) 1 AGONISTS FOR THE TREATMENT OF TYPE 2 DIABETES, WEIGHT CONTROL AND CARDIOVASCULAR PROTECTION. Patricia Garnica MS, ANP-BC, CDE, CDTC Inpatient Diabetes Nurse Practitioner North Shore University Hospital Department of Medicine Division of Endocrinology Manhasset, N.Y. DISCLOSURE TO PARTICIPANTS No Conflict of Interest (COI) and Financial Relationship to Disclose No Endorsement of Products No Off Label Use LEARNING OBJECTIVES Attendees will be able to recognize the physiological effect of Glucagon like Peptide (GLP) 1 in glycemic homeostasis and how this effect is altered on patients with type 2 diabetes. Attendees will be able to identify the available pharmacological preparations of GLP 1 agonists including their action, indications and how they can be prescribed to specific patients needs and preferences. Attendees will be able to identify the most common side effects, adverse events and contraindications of GLP 1 agonists. 1
2 Insulin Resistance: The Core Defect in Type 2 Diabetes, Presented by Barry J. Goldstein, MD, PhD.(Medscape, 2018) INSULIN 2
3 DUAL IMPAIRMENT IN T2 DIABETES 1.Impaired insulin action (insulin resistance) 2. Impaired β cell function (Functional effect in insulin secretion) Insulin Resistance: The Core Defect in Type 2 Diabetes, Presented by Barry J. Goldstein, MD, PhD.(Medscape, 2018) HYPERGLYCEMIA CAUSES Defronzo et al. Diabetes Care
4 OVERWEIGHT AND OBESITY Fat has very important effects on metabolism and cardiovascular health People collect fat in their visceral compartment as they age Visceral adipose tissue has a high rate of lipolysis Fat tissue releases fatty acids into the blood steam Fatty acids block the promotion of glucose uptake into muscle Fatty acids enhance gluconeogenesis in the liver HYPERGLYCEMIA CARDIOVASCULAR RISK FACTORS Higher triglyceride levels Higher systolic blood pressure Lower HDL levels WHAT IS GLUCAGON LIKE PEPTIDE (GLP) 1? It is an incretin which is a gut derived hormone that is released by the L cells in the distal parts of the intestines in response to nutrient ingestion stimulating insulin secretion in response to meals. The are two gut derivate incretin hormones: glucagon like peptide 1 (GLP 1) and glucose dependent insulinotropic polypeptide (GIP). The main meal components that act as potent stimulants of GLP 1 secretion are glucose and triacylglycerol but fructose and some proteins are also effective. GLP 1 decreases blood glucose levels by increasing insulin production after a meal. Slows the rate of absorption of nutrients into the blood stream by reducing gastric emptying and by this action reduce food intake Inhibits glucagon release from the alpha cells of the islets of Langerhans. 4
5 INCRETINE PHYSIOLOGICAL EFFECT OF GLUCAGON LIKE PEPTIDE (GLP) 1 IN GLYCEMIC HOMEOSTASIS In healthy individuals, oral ingestion of nutrients stimulates secretion of multiple gut hormones involved in regulating digestion, motility and metabolism, including insulin. The gut hormones GIP and GLP 1 are secreted from the intestinal K and L cells within minutes of food ingestion Together they account for up to 70% of insulin secretory responses after nutrient ingestion GLP 1 IN PEOPLE WITH TYPE 2 DIABETES The incretin hormone glucagon like peptide 1 (GLP 1) might be reduced in some people with T2Diabetes specially those with obesity, older age and those with higher levels of glucagon in the blood. More studies are needed to conclude that ALL patients with T2DM had reduced GLP 1 production. Some studies had shown that the use of Metformin increases the natural release of GLP 1 Pharmacological doses/concentrations of GLP 1 can compensate for the inability of diabetic β cells to respond to the main incretin hormone glucose dependent insulinotropic polypeptide. Nauck, et al. Diabetologia. 2011, 54(1);
6 GLUCOSE LOWERING ACTION OF GLP 1 RECEPTOR AGONISTS Use of native GLP 1 is limited by its very short half life and rapid degradation.glp 1 receptor agonists are resistant to degradation making them more therapeutic Mimic the effects of the incretin hormone GLP 1 which is excreted from the intestine when eating. Enhance glucose dependent insulin secretion release from the pancreatic islets. Inhibit inappropriate post meal glucagon release. Reduce food intake (increase satiety feeling, slow gastric emptying). Diabetes, Obesity and Metabolism. 2016; 18(3): GLP 1 AGONISTS BENEFITS Can reduce A1C (by %) Can reduce body weight (by 1 3 kg) Decrease free fatty acids concentrations Reduce blood pressure and lipid levels. Protect beta cells against cytokine induced apoptosis and in s0me studies improves β call mass Can be added to Metformin/TZD as a second agent on patients that want to avoid weight gain or hypoglycemia. In some cases they can be as effective on achieving glycemic control as insulin therapy Diabetes, Obesity and Metabolism. 2016; 18(3): Diabetes Spectrum 2017 Aug; 30(3): Prasad Reddy, L & Isaacs, D. Drugs in context. 2015; 4: GLP 1 AGONISTS THERAPEUTIC ACTION 6
7 GLUCAGON LIKE PEPTIDE 1 (GLP 1) AGONIST. SIDE EFFECTS Gastrointestinal: diarrhea, nausea, and vomiting. Adverse reactions Albiglutide Dulaglutide Liraglutide Exenatide QW Exenatide BID N Albiglutide N=923, % Placebo N=468, % Dulaglutid Dulaglutide e 0.75 mg 1.5 mg N=834, % N=836, % Placebo Liraglutide Exenatide N=568, N=497, % N=248, % % Exenatide N=963, % Placebo N=483, % Diarrhea Nausea Vomiting NA 13 4 Injection site reaction or nodules NA 10.5 NA NA GLUCAGON LIKE PEPTIDE 1 (GLP 1) AGONIST: CONTRAINDICATIONS Any one with the following history: Acute pancreatitis Pancreatic cancer Thyroid C cell hyperplasia, adenomas Medullary Thyroid carcinoma Multiple neoplasia syndrome type 2 (MEN2) Gastroparesis Caution on patients with liver or kidney disease Prasad Reddy, L & Isaacs, D. Drugs in context. 2015; 4: GLUCAGON LIKE PEPTIDE 1 (GLP 1) BASED THERAPIES (NON INSULIN INJECTABLES) exenatide (Byetta ) 2005 liraglutide (Victoza,Saxenda ) 2010 lixisenatide (Adlyxin, Lyxumia ) 2016 exenatide (Bydureon ) 2012 weekly albiglutide (Tanzeum ) 2014 Weekly dulaglutide (Trulicity )2014 weekly semaglutide (Ozempic ) 2017 Weekly 7
8 SHORT ACTING GLP1 RECEPTOR AGONIST EXENATIDE (BYETTA ) This 39 amino acid synthetic peptide is based on exendin 4 from the lizard Heloderma suspectum (Gila monster), sharing 53% homology with human GLP 1 It binds to the pancreatic GLP 1 receptor and has many of the glucoregulatory properties of human GLP 1 such as enhances glucose dependent insulin secretion, suppresses postprandial glucagon secretion, slows gastric emptying and reduces caloric intake. Some studies have shown that exenatide also increases pancreatic β cell mass and improves β cell function Give BID 60 minutes prior to breakfast and dinner. Half life is 2.4 hours Start dose is 5mcg sq bid for one month and then if tolerated increase to 10mcg bid Uccellatore et al. Diabetes ther. 2015; 6(3): Byetta for Heath Care Professionals 2016 SHORT ACTING GLP1 RECEPTOR AGONIST LIRAGLUTIDE (VICTOZA,SAXENDA ) It is a human GLP 1 analog in which lysine 34 is substituted with arginine, and lysine 26 has a C16 acyl chain attached. The above modifications improve the absorption and extend the half life compared to native GLP 1 Give once a day. Half life is 13 h Liraglutide should be initiated at a dose of 0.6 mg once daily for 1 week and then titrated to 1.2 mg daily. If the 1.2 mg dose does not achieve glycemic goals, it can be increased to 1.8 mg daily. Initial dose of 0.6 mg is ineffective for glycemic control, and is only initiated to maximize patient tolerance to the potential gastrointestinal effects of the medication Studies had shown improves fasting BG levels better than BID exenatide Uccellatore et al. Diabetes ther. 2015; 6(3): SHORT ACTING GLP1 RECEPTOR AGONIST LIXISENATIDE (ADLYXIN, LYXUMIA ) It is a synthetic peptide derived from the exendin 4 hormone. It is made up of 44 amino acids and includes six lysine residues at the C terminal end of the molecule to prevent degradation of the peptide increasing the peptide s time in circulation. Starting dose of 50 mcg/ml strength for 2 weeks for titration and 100 mcg/ml strength for maintenance dose. Lixisenatide has a half life of hours and given as a once daily injection It has a positive effect on both the first phase and second phase insulin response, providing reductions in both fasting and postprandial glucose concentrations. A study comparing it to Liraglutide showed better post prandial glycemic control but lesser effect on fasting blood glucose. Prasad Reddy, L & Isaacs, D. Drugs in context. 2015; 4: Lixisenatide: Division Director Review FDA
9 LONG ACTING GLP1 RECEPTOR AGONIST EXENATIDE (BYDUREON ) The first once weekly diabetes treatment 2 mg subcutaneously once every 7 days (weekly). The dose can be administered at any time of day, with or without meals. The day of weekly administration can be changed if necessary as long as the last dose was administered 3 or more days before the new day of administration. Bydureon is made up of biodegradable microspheres that provide a controlled release of exenatide throughout the week. Uccellatore et al. Diabetes ther.2015; 6(3): Bydureon for health care professionals LONG ACTING GLP1 RECEPTOR AGONIST EXENATIDE (BYDUREON ) The initial presentation of BYDUREON in 2012 was of four single dose trays with vials requiring constitution to obtain a final concentration of 2 mg In 2014, the FDA approved a prefilled single use pen injector, eliminating the need for the patient to transfer the medication between a vial and syringe during the self injection process. In 2017, the FDA approved Bydureon Bcise single dose autoinjector device. In 2018, the FDA approved Bydureon (exenatide extended release) for injectable suspension as an add on therapy to basal insulin in adults with type 2 diabetes (T2D) with inadequate glycemic control. Uccellatore et al. Diabetes ther. 2015; 6(3): Prasad Reddy, L & Isaacs, D. Drugs in context. 2015; 4: LONG ACTING GLP1 RECEPTOR AGONIST EXENATIDE (BYDUREON ) bcise/how to use bydureon bcise.html 9
10 LONG ACTING GLP1 RECEPTOR AGONIST ALBIGLUTIDE (TANZEUM ) It is a dimer of two copies of 30 amino acid fused to human albumin, and a single amino acid substitution (glycine to alanine) in vivo, resulting in a half life of approximately 5 days Comparison data between albiglutide and lispro insulin in HARMONY 6 trial suggest that this long acting GLP 1 RA is a valid alternative to lispro insulin in add on basal insulin. In the HARMONY 7 clinical trial, it was demonstrated that liraglutide at a dose of 0.6 mg titrated to 1.8 mg was more effective than albiglutide (at a dose of 30 mg titrated to 50 mg), but with less frequent gastrointestinal adverse events albiglutide may be an alternative option in patients who cannot tolerate shorteracting GLP 1 receptor agents due to adverse effects Prasad Reddy, L & Isaacs, D. Drugs in context. 2015; 4: LONG ACTING GLP1 RECEPTOR AGONIST DULAGLUTIDE (TRULICITY ) It has modified amino acid sequences that resist DPP 4 degradation, as well as the large size of the molecule, reducing renal clearance Administered as a 0.75 mg injection which can be titrated to 1.5 mg once weekly to achieve glycemic targets. Therapeutic concentrations are achieved faster when compared to other weekly GLP 1 receptor agonists, within 1 3 days versus 2 4 weeks after administration Dulaglutide is available in two dosage forms, a prefilled pen syringe ready for injection and a solution for injection that requires reconstitution by the patient prior to administration In the AWARD 2 study, dulaglutide at doses of 0.75 mg once weekly and 1.5 mg weekly resulted in a larger reduction in hemoglobin A1C compared to insulin glargine titrated to a goal fasting blood glucose level of <100 mg/dl Prasad Reddy, L & Isaacs, D. Drugs in context. 2015; 4: LONG ACTING GLP1 RECEPTOR AGONIST SEMAGLUTIDE (OZEMPIC ) Has 94% sequence homology to native GLP 1 Start at 0.25 mg once weekly. After 4 weeks, increase the dose to 0.5 mg once weekly. If after at least 4 weeks additional glycemic control is needed, increase to 1 mg once weekly increased risk for diabetic retinopathy complications was noted on semaglutide trial while medication was improving glycemic control. Benefit risk needs to be evaluated and this agent should be avoided on people with baseline retinopathy. More studies need to be done since the DCCT study showed the same effect on patients with thigh glycemic control. OZEMPIC (semaglutide) injection, for subcutaneous use. Prescribing information. Ozempic (semaglutide) Injection FDA
11 BASAL AND GLP 1 AGONISTS MIX 2016 Basal insulin glargine plus lixisenatide (Soliqua 100/33 ) Basal insulin degludec plus liraglutide (Xultophy 100/3.6 ) GLP 1 AGONISTS DIFFERENCES Clinical application of GLP 1 Receptor Agonists. J Korean Diabetes Dec; 16(4): COMPARISON OF SHORT ACTING VERSUS LONG ACTING GLP 1 AGONISTS Clinical application of GLP 1 Receptor Agonists. J Korean Diabetes Dec; 16(4):
12 WEIGHT LOSS OUTCOMES FOR GLP 1 AGONISTS CARDIOVASCULAR OUTCOMES OF GLP 1 AGONISTS. A systematic review and meta analysis of trials of GLP 1 receptor agonists versus placebo assessed a primary outcome including, but not limited to, cardiovascular mortality, non fatal myocardial infarction, and non fatal stroke. Four trials of cardiovascular outcomes of GLP 1 receptor agonists were identified: ELIXA (lixisenatide), LEADER (liraglutide), SUSTAIN 6 (semaglutide), and EXSCEL (extended release exenatide) Findings included 10% relative risk reduction (RRR) in the three point major adverse cardiovascular event primary outcome, a 13% RRR in cardiovascular mortality, and a 12% relative risk reduction in all cause No significant effect of GLP 1 receptor agonists was identified on fatal and non fatal myocardial infarction, fatal and non fatal stroke, hospital admission for unstable angina, or hospital admission for heart failure Bethel et al. The Lancet: Diabetes and endocrinology 2018, 6(2): MULTIPLE CAUSES OF HYPERGLYCEMIA 12
13 REFERENCES A clinical review of GLP 1 receptor agonists: efficacy and safety in diabetes and beyond. Drugs in context. 2015; 4: Byetta for Heath Care Professionals andadministration.html Bydureon for health care professionals. Cardiovascular outcomes with glucagon like peptide 1 receptor agonists in patients with type 2 diabetes: a meta analysis. The Lancet: Diabetes and endocrinology 2018, 6(2): (17) /fulltext Clinical application of GLP 1 Receptor Agonists. J Korean Diabetes Dec; 16(4): Comparison Review of Short Acting and Long Acting Glucagon like Peptide 1 Receptor Agonists. Diabetes therapeutics. 2015; 6(3): Glucagon Like Peptide 1 Receptor Agonists for Type 2 Diabetes. Diabetes Spectrum 2017 Aug; 30(3): REFERENCES Incretin therapies: highlighting common features and differences in the modes of action of glucagon like peptide 1 receptor agonists and dipeptidyl peptidase 4 inhibitors. Diabetes, Obesity and Metabolism. 2016; 18(3): Lixisenatide: Division Director Review FDA Ozempic (semaglutide) Injection FDA OZEMPIC (semaglutide) injection, for subcutaneous use Secretion of glucagon like peptide 1 (GLP 1) in type 2 diabetes: what is up, what is down? Diabetologia. 2011, 54(1); Q&A 13
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 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 informationIncredible Incretins Abby Frye, PharmD, BCACP
Incredible Incretins Abby Frye, PharmD, BCACP Objectives & Disclosures Review the pathophysiology of T2DM and the impact of the incretin system Describe the defining characteristics of the available glucagonlike
More informationGLP-1 RECEPTOR AGONIST SHOULD I TRY IT? VERONICA BRADY, PHD, BC-ADM, CDE PROJECT ECHO JUNE 21, 2018
GLP-1 RECEPTOR AGONIST SHOULD I TRY IT? VERONICA BRADY, PHD, BC-ADM, CDE PROJECT ECHO JUNE 21, 2018 SOMETHING TO CONSIDER IF YOU COULD PRESCRIBE A MEDICATION FOR YOUR PATIENT WITH DIABETES THAT: DECREASED
More informationGLP-1 agonists. 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 informationINJECTABLE THERAPY FOR THE TREATMENT OF DIABETES
INJECTABLE THERAPY FOR THE TREATMENT OF DIABETES ARSHNA SANGHRAJKA DIABETES SPECIALIST PRESCRIBING PHARMACIST OBJECTIVES EXPLORE THE TYPES OF INSULIN AND INJECTABLE DIABETES TREATMENTS AND DEVICES AVAILABLE
More 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 informationType 2 DM in Adolescents: Use of GLP-1 RA. Objectives. Scope of Problem: Obesity. Background. Pathophysiology of T2DM
Type 2 DM in Adolescents: Use of GLP-1 RA Objectives Identify patients in the pediatric population with T2DM that would potentially benefit from the use of GLP-1 RA Discuss changes in glycemic outcomes
More informationAchieving and maintaining good glycemic control is an
Glycemic Efficacy, Weight Effects, and Safety of Once-Weekly Glucagon-Like Peptide-1 Receptor Agonists Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE; Kathleen Wyne, MD, PhD, FACE, FNLA; Anthony Cannon,
More informationBeyond A1C. Non-glycemic Effects of GLP-1 Receptor Agonists. Olga Astapova MD, PhD Luis Chavez MD URMC Endocrinology Fellows
Beyond A1C Non-glycemic Effects of GLP-1 Receptor Agonists Olga Astapova MD, PhD Luis Chavez MD URMC Endocrinology Fellows Disclosures No conflicts of interest. Learning Objectives 1. Understand the physiological
More informationErtugliflozin (Steglatro ) 5 mg daily. May increase to 15 mg daily. Take in the morning +/- food. < 60: Do not initiate; discontinue therapy
Sodium-glucose Cotransporter-2 (SGLT2) s Inhibit SGLT in proximal renal tubules, reducing reabsorption of filtered glucose from tubular lumen Lowers renal threshold for glucose à increase urinary excretion
More informationThis 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 informationWhat 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 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 informationSoliqua (insulin glargine and lixisenatide), Xultophy (insulin degludec and liraglutide)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.48 Subject: Insulin GLP-1 Combinations Page: 1 of 5 Last Review Date: September 15, 2017 Insulin GLP-1
More informationVICTOSA and Renal impairment DR.R.S.SAJAD
VICTOSA and Renal impairment DR.R.S.SAJAD February 2019 Main effect of GLP-1 is : Stimulating glucose dependent insulin release from the pancreatic islets. Slow gastric emptying Inhibit inappropriate
More 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 informationGlucagon-like peptide-1 (GLP-1) Agonists Drug Class Prior Authorization Protocol
Glucagon-like peptide-1 (GLP-1) Agonists Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed
More 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 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 informationAdlyxin. (lixisenatide) New Product Slideshow
Adlyxin (lixisenatide) New Product Slideshow Introduction Brand name: Adlyxin Generic name: Lixisenatide Pharmacological class: Glucagon-like peptide-1 (GLP-1) receptor agonist Strength and Formulation:
More informationClinical Policy: Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists
Clinical Policy: Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Reference Number: LA.PST.14 Effective Date: 03.18 Last Review Date: 3.18 Line of Business: Medicaid Revision Log 1Revision Log 1Revision
More informationSide 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 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 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 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 informationGLP-1 Receptor Agonists and SGLT-2 Inhibitors. Debbie Hicks
GLP-1 Receptor Agonists and SGLT-2 Inhibitors Debbie Hicks Prescribing and Adverse Event reporting information is available at this meeting from the AstraZeneca representative The views expressed by the
More informationApproaches to Addressing Incretin Deficiency. Non-Insulin Injectable Agents. Incretin Mimetics. Exendin-4 in the Gila Monster
Non-Insulin Injectable Agents Approaches to Addressing Incretin Deficiency Longer-acting analogs? (Incretin mimetics) GLP-1 Analogs Inhibition of inactivation? (Incretin enhancers) DPP-4 Inhibitors Drucker
More informationUpdate 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 informationDiabetes Update: Intensifying Insulin Therapy Nuts, Bolts and Other Items
Diabetes Update: Intensifying Insulin Therapy Nuts, Bolts and Other Items Hayley A. Miller, MD Physician, Internal Medicine, Diabetes and Metabolism, Sandy Clinic, Intermountain Healthcare Objectives:
More informationDiabesity. Metabolic dysfunction that ranges from mild blood glucose imbalance to full fledged Type 2 DM Signs
Diabesity Metabolic dysfunction that ranges from mild blood glucose imbalance to full fledged Type 2 DM Signs Abdominal obesity Low HDL, high LDL, and high triglycerides HTN High blood glucose (F>100l,
More informationCardiovascular Benefits of Two Classes of Antihyperglycemic Medications
Cardiovascular Benefits of Two Classes of Antihyperglycemic Medications Nathan Woolever, Pharm.D., Resident Pharmacist Pharmacy Grand Rounds November 6 th, 2018 Franciscan Healthcare La Crosse, WI 2017
More information6/1/2018. Lou Haenel, IV, DO, FACE, FACOI Endocrinology Roper St Francis Charleston, SC THE OMINOUS OCTET: HOW PATHOPHYSIOLOGY AND THERAPY MERGE
Lou Haenel, IV, DO, FACE, FACOI Endocrinology Roper St Francis Charleston, SC THE OMINOUS OCTET: HOW PATHOPHYSIOLOGY AND THERAPY MERGE 1 2 3 Sulfonylureas Glipizide Glyburide Glimeperide 4 Metformin Gold
More 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 informationSTEP 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 informationPharmacology Updates. Quang T Nguyen, FACP, FACE, FTOS 11/18/17
Pharmacology Updates Quang T Nguyen, FACP, FACE, FTOS 11/18/17 14 Classes of Drugs Available for the Treatment of Type 2 DM in the USA ### Class A1c Reduction Hypoglycemia Weight Change Dosing (times/day)
More informationAlbiglutide, a Once-Weekly GLP-1RA, for the Treatment of Type 2 Diabetes
St. Onge et al. Medical Research Archives, vol. 5, issue 11, November 2017 issue Page 1 of 10 REVIEW ARTICLE Albiglutide, a Once-Weekly GLP-1RA, for the Treatment of Type 2 Diabetes Erin St. Onge 1*, Shannon
More informationXultophy 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 informationMetformin although effective has become obsolete
Metformin although effective has become obsolete Does not address core needs as well as other agents (ominous octet) Does not address metabolic parameters (blood pressure, Hgb A1C) as well as other agents
More informationGLP-1-based therapies in the management of type 2 diabetes
GLP-1-based therapies in the management of type 2 diabetes Makbul Aman Mansyur Division Endocrine & Metabolism Department of Internal Medicine Faculty of Medicine Hasanuddin University/ RSUP Dr. Wahidin
More 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 informationInsulin Initiation and Intensification. Disclosure. Objectives
Insulin Initiation and Intensification Neil Skolnik, M.D. Associate Director Family Medicine Residency Program Abington Memorial Hospital Professor of Family and Community Medicine Temple University School
More informationLet 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 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 information2/9/2016. The Evolving Armamentarium for Type 2 Diabetes: Incorporating New Classes in the Treatment of Our Patients. Objectives: Pharmacists
WAYNE STATE UNIVERSITY COLLEGE OF PHARMACY & HEALTH SCIENCES FEBRUARY 28, 2016 The Evolving Armamentarium for Type 2 Diabetes: Clinical Assistant Professor, Department of Pharmacy Practice Ambulatory Care
More informationIncretin-based Therapies for Type 2 Diabetes Comparisons Between Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors
Incretin-based Therapies for Type 2 Diabetes Comparisons Between Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors Timothy Bailey, MD, FACE, CPI Director, AMCR Institute,
More information8/21/2017 UNRAVELING THE CROWED INSULIN SCENE. A Practical Overview of Insulin Focusing on New Insulin Preparations
UNRAVELING THE CROWED INSULIN SCENE A Practical Overview of Insulin Focusing on New Insulin Preparations Patricia Garnica MS, ANP-BC, CDE, CDTC North Shore University Hospital, Manhasset, N.Y. October
More informationUpdate on GLP-1 Agonists in Type 2 Diabetes is supported by an educational grant from Novo Nordisk Inc. It has been accredited by the American
Update on GLP-1 Agonists in Type 2 Diabetes is supported by an educational grant from Novo Nordisk Inc. It has been accredited by the American Association of Diabetes Educators (AADE) for nurses, dietitians,
More informationHelp the Heart. An Update on GLP-1 Agonists and SGLT2 Inhibitors. Tara Hawley, PharmD PGY1 Pharmacy Resident Mayo Clinic Health System Eau Claire
Help the Heart An Update on GLP-1 Agonists and SGLT2 Inhibitors Tara Hawley, PharmD PGY1 Pharmacy Resident Mayo Clinic Health System Eau Claire Mayo Clinic Grand Rounds May 16, 2017 2017 MFMER slide-1
More informationThe 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 informationNEW DIABETES CARE MEDICATIONS
NEW DIABETES CARE MEDICATIONS James Bonucchi DO, ECNU, FACE Adult Medicine and Endocrinology Specialists Disclosures Speakers bureau Sanofi AZ BI Diabetes Diabetes cost ADA 2017 data Ever increasing disorder.
More informationThe first stop for professional medicines advice
London Medicines Evaluation Network Overview: Glucagon-Like Peptide-1 receptor analogues The first stop for professional medicines advice 1 London Medicines Evaluation Network Overview: Glucagon-Like Peptide-1
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 informationAdvances in Outpatient Diabetes Care: Algorithms for Care and the Role of Injectable Therapies. Module D
Advances in Outpatient Diabetes Care: Algorithms for Care and the Role of Injectable Therapies Module D 1 Learning Objectives Apply the principles of the comprehensive diabetes algorithms to patients with
More informationMOA: Long acting glucagon-like peptide 1 receptor agonist
Alexandria Rydz MOA: Long acting glucagon-like peptide 1 receptor agonist Increases glucose dependent insulin secretion Decreases inappropriate glucagon secretion Increases β- cell growth and replication
More information22 Emerging Therapies for
22 Emerging Therapies for Treatment of Type 2 Diabetes Siddharth N Shah Abstract: The prevalence of Diabetes is progressively increasing world-wide and the growth of the disease in our country is phenomenal.
More informationWhat s New in Diabetes Treatment. Disclosures
What s New in Diabetes Treatment Shiri Levy M.D. Henry Ford Hospital Senior Staff Physician Service Chief, West Bloomfield Hospital Endocrinology, Metabolism, Bone and Mineral Disorders Disclosures None
More informationRole of incretins in the treatment of type 2 diabetes
Role of incretins in the treatment of type 2 diabetes Jens Juul Holst Department of Medical Physiology Panum Institute University of Copenhagen Denmark Diabetes & Obesity Spanish Society of Internal Medicine
More informationEXENATIDE (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 informationTargeting Incretins in Type 2 Diabetes: Role of GLP-1 Receptor Agonists and DPP-4 Inhibitors. Richard E. Pratley and Matthew Gilbert
REVIEW Targeting Incretins in Type 2 Diabetes: Role of GLP-1 Receptor Agonists and DPP-4 Inhibitors Richard E. Pratley and Matthew Gilbert Diabetes and Metabolism Translational Medicine Unit, University
More informationSelecting GLP-1 RA Treatment
Selecting GLP-1 RA Treatment Dr Felicity Kaplan March 2017 Objectives Review the progressive nature of type 2 diabetes Understand the need for timely treatment intensification Examine the place of GLP-1
More informationExploring 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 informationSoliqua 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 informationUpdate on Insulin-based Agents for T2D
Update on Insulin-based Agents for T2D Injectable Therapies for Type 2 Diabetes Mellitus (T2DM) and Obesity This presentation will: Describe established and newly available insulin therapies for treatment
More informationMechanisms and Clinical Efficacy of Lixisenatide for the Management of Type 2 Diabetes
Adv Ther (2013) 30(2):81 101. DOI 10.1007/s12325-013-0009-4 REVIEW Mechanisms and Clinical Efficacy of Lixisenatide for the Management of Type 2 Diabetes Michael Horowitz Christopher K. Rayner Karen L.
More informationThe Alphabet Soup of Diabetes. Egils Bogdanovics M.D. Hungerford Diabetes Center
The Alphabet Soup of Diabetes Egils Bogdanovics M.D. Hungerford Diabetes Center Insulin: January 11, 1922 12 year old Leonard Thompson, on a starvation diet for 2 years received his first insulin injection
More informationEffect of macronutrients and mixed meals on incretin hormone secretion and islet cell function
Effect of macronutrients and mixed meals on incretin hormone secretion and islet cell function Background. Following meal ingestion, several hormones are released from the gastrointestinal tract. Some
More 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 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 informationINSULIN 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 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 informationDrug Use Criteria: Glucagon-Like Peptide 1 Receptor Agonists
Texas Vendor Drug Program Drug Use Criteria: Glucagon-Like Peptide 1 Receptor Agonists Publication History Developed February 2006. Revised September 2018; September 2016; June 2015; October 2013; December
More informationClinical Policy: Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Reference Number: HIM.PA.53 Effective Date: Last Review Date: 02.
Clinical Policy: Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Reference Number: HIM.PA.53 Effective Date: 03.01.18 Last Review Date: 02.19 Line of Business: HIM Revision Log See Important Reminder
More informationNormal Fuel Metabolism Five phases of fuel homeostasis have been described A. Phase I is the fed state (0 to 3.9 hours after meal/food consumption),
Normal Fuel Metabolism Five phases of fuel homeostasis have been described A. Phase I is the fed state (0 to 3.9 hours after meal/food consumption), in which blood glucose predominantly originates from
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 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 informationDM-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 informationSitagliptin: first DPP-4 inhibitor to treat type 2 diabetes Steve Chaplin MSc, MRPharmS and Andrew Krentz MD, FRCP
Sitagliptin: first DPP-4 inhibitor to treat type 2 diabetes Steve Chaplin MSc, MRPharmS and Andrew Krentz MD, FRCP KEY POINTS sitagliptin (Januvia) is a DPP-4 inhibitor that blocks the breakdown of the
More informationOptimizing Outcomes In Type 2 Diabetes: Integrating Longer Acting GLP-1 Receptor Agonists
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationWhat s New in Diabetes Medications. Jena Torpin, PharmD
What s New in Diabetes Medications Jena Torpin, PharmD 1 Objectives Discuss new medications in the management of diabetes Understand the mechanism of the medications discussed Understand the side effects
More informationFor Personal Use Only. Any commercial use is strictly prohibited. Role of glucagon-like peptide 1 receptor agonists in management of obesity
Role of glucagon-like peptide 1 receptor agonists in management of obesity Diana Isaacs, Pharm.D., BCPS, BC-ADM, CDE, Chicago State University, Chicago, IL, and Oak Lawn VA Clinic of Edward Hines Jr. VA
More informationNewer Therapies for Type 2 Diabetes
Newer Therapies for Type 2 Diabetes Sandra Indacochea Sobel, MD Clinical Assistant Professor of Medicine Clinical Chief of Endocrinology, UPMC Mercy Division of Endocrinology, Diabetes, and Metabolism
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 informationDulaglutide (LY ) for the treatment of type 2 diabetes
Expert Review of Clinical Pharmacology ISSN: 1751-2433 (Print) 1751-2441 (Online) Journal homepage: http://www.tandfonline.com/loi/ierj20 (LY-2189265) for the treatment of type 2 diabetes André J. Scheen
More informationB.C. Drug and Poison Information Centre 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Phone: (604) ; Fax: (604) Volume 31 (2) 2011
Volume 31 (2) 2011 Editor and author: Barbara Cadario, BSc(Hon), BScPhm., MSc Chairman, Medical Review Laird Birmingham, MD, MHSc, FRCP(C) SYNONYM: NN2211 TRADE NAME: Victoza CLASSIFICATION GLP-1 receptor
More informationNew Treatment Options for Type 2 Diabetes: Incretin-Based Therapy
New Treatment Options for Type 2 Diabetes: Incretin-Based Therapy New Treatment Options for Type 2 Diabetes: Incretin-Based Therapy is supported by an educational grant from Novo Nordisk Inc. This program
More informationGLP 1RAs in type 2 diabetes: mechanisms that underlie cardiovascular effects and overview of cardiovascular outcome data
https://doi.org/10.1186/s12933-018-0800-2 Cardiovascular Diabetology REVIEW Open Access GLP 1RAs in type 2 diabetes: mechanisms that underlie cardiovascular effects and overview of cardiovascular outcome
More informationInjectable GLP 1 therapy: weight loss effects seen in obesity with and without diabetes
Injectable GLP 1 therapy: weight loss effects seen in obesity with and without diabetes Dr Masud Haq Consultant Lead in Diabetes & Endocrinology Maidstone & Tunbridge Wells NHS Trust & The London Preventative
More informationAbstract. Effect of sitagliptin on glycemic control in patients with type 2 diabetes. Introduction. Abbas Mahdi Rahmah
Effect of sitagliptin on glycemic control in patients with type 2 diabetes Abbas Mahdi Rahmah Correspondence: Dr. Abbas Mahdi Rahmah Consultant Endocrinologist, FRCP (Edin) Director of Iraqi National Diabetes
More informationExploring 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 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 informationNew Drug Evaluation: Dulaglutide
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More information9/29/ 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 informationThere 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 informationIt is estimated that approximately 20.8 million Americans
FORMULARY MANAGEMENT Managed Care Perspective on Three New Agents for Type 2 Diabetes Shawna VanDeKoppel, PharmD; Hae Mi Choe, PharmD, CDE; and Burgunda V. Sweet, PharmD, FASHP ABSTRACT BACKGROUND: Despite
More 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 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 informationDR. SUBHASH K. WANGNOO
Photograph DR. SUBHASH K. WANGNOO M.D, D.M, FRCP (London) Senior Consultant, Endocrinologist & Diabetologist Apollo Centre for Obesity, Diabetes and Endocrinology Indraprastha Apollo Hospital, Sarita Vihar,
More informationLiraglutide: First Once-Daily Human GLP-1 Analogue
DRUG PROFILE KERALA MEDICAL JOURNAL Liraglutide: First Once-Daily Human GLP-1 Analogue Sreejith N Kumar Research Cell, IMA Kerala State, K-5, Kochar Road, Sasthamangalam Thiruvananthapuram* ABSTRACT Published
More informationData from an epidemiologic analysis of
CLINICAL TRIAL RESULTS OF GLP-1 RELATED AGENTS: THE EARLY EVIDENCE Lawrence Blonde, MD, FACP, FACE ABSTRACT Although it is well known that lowering A 1c (also known as glycated hemoglobin) is associated
More information