Diabetes - Guidelines

Question 1

High Risk, Established ASCVD

Answer 1

• Age: 55 or older with 2 or more below:
• HTN, dyslipidemia, family hx of premature coronary disease (ASCVD)
• Chronic kidney disease (CKD), presence of albuminuria
• Smoking, inactive lifestyle, obesity

ASCVD High Risk > 20

Question 2

HF and CKD Risks

Answer 2

HF (current or prior sx)

CKD (CKD < 60, Alb > 30 >300)

Question 3

Drugs for + ASCVD/High Risk

Answer 3

-GLP1RA or SGLT2I with proven CV benefit
-After max dose, add other class (if no CI)
-Maybe TZD (only PIO, NO HF present)

Question 4

Best GLP1RAs for CV

Answer 4

-Liraglutide
-Dulaglutide
-Semaglutide (oral and injection)

Question 5

Best SGLT2I for CV/HF/KD

Answer 5

-Canagliflozin
-Dapagliflozin (main)
-Empagliflozin (main)

Question 6

Heart Failure Present

Answer 6

SGLT2I!

Question 7

CKD Present

Answer 7

GFR <60 or +Albuminuria

PREFER: SGLT2I

If not tolerated or CI: use GLP1RA with cvd benefit

Max dose reached: add other class

Question 8

Glycemic Management

Answer 8

-Metformin or combo
-Avoid hypo

Very High: Dula, Sema, Tirze, Insulin, combo orał/inj (GLP1RA/insulin)

High: GLP1RA, Metformin, SGLT2I, Sulf, TZD

Int: DPP4I

every 3 mo, add/titrate

Question 9

Weight Loss/Management

Answer 9

-MNT, PA

Highest wt loss
-Semaglutide or Tirze (Monjorno)

High
-Dulaglutide or Liraglutide

Int: other GLP1RA or SGLT2I

Neutral: metformin, DPP4I

ST DL GS MD
(saint is on the dl with gs cus she’s an md)

Question 10

Injectable Therapy Guidelines Options

Answer 10

-GLP1RA or GIP/GLP1RA FIRST

-Then: Titrate

-Then: add basal insulin:
*10 units or 0.1-0.2 u/kg
*Titrate up by 2u every 3 days

-Then: add rapid acting insulin (4u) before largest meal. Increase by 1-2 u. Then other largest meal, etc.

-If on NPH/prandial, BID pre mixed insulin (2/3 bfast 1/3 din)

Question 11

SMBG Goals

Answer 11

Preprandial 80-130 mg/dL

Postprandial < 180 mg/dL

Question 12

Metformin AVOID

Answer 12

-Poor renal function
-Lactic acidosis
-Severe CHF

Question 13

SU AVOID

Answer 13

Obese, hypoglycemia, older

Question 14

TZD AVOID

Answer 14

CHF, osteoporosis, macular edema, bladder CA (pio), cardiac (rosi)

Question 15

DPP4I AVOID

Answer 15

Saxa - CHF

with GLP1RA

Joint pain

Question 16

SGLT2I AVOID

Answer 16

-genital yeast infections or GU injections

-BP variations, ketosis

-(cana: osteoporosis)

-DKA risk

Question 17

GLP1 RA or GIP/GLP1 RA AVOID

Answer 17

Gastroporesis; thyroid CA?, with DPP4I, retinopathy?

Question 18

Insulin AVOID

Answer 18

Obese, hypoglycemia risk