ada3 Flashcards
Describe the characteristics of Metformin.
Metformin has high efficacy in lowering glucose levels, no cardiovascular effects, no renal effects, and a potential for weight loss. It is taken orally and has low cost. However, it is contraindicated in patients with an estimated glomerular filtration rate (eGFR) less than 30 mL/min.
What are the clinical considerations for Metformin?
When prescribing Metformin, clinicians should be aware of the potential for gastrointestinal side effects and consider slow dose titration, extended-release formulations, and administration with food to mitigate these effects. Regular monitoring for vitamin B12 deficiency is also recommended.
What are the characteristics of SGLT2 inhibitors?
SGLT2 inhibitors have intermediate efficacy in lowering glucose levels, no cardiovascular effects, no renal effects, and a potential for weight loss. They are taken orally and have high cost. However, they carry a risk of diabetic ketoacidosis (DKA) and genital mycotic infections. Renal dose considerations should be followed.
How do SGLT2 inhibitors affect glucose-lowering effect at lower eGFR?
The glucose-lowering effect of SGLT2 inhibitors is lower at lower eGFR. Therefore, caution should be exercised when using these medications in patients with reduced kidney function.
Describe the characteristics of GLP-1 RAs.
GLP-1 RAs have high to very high efficacy in lowering glucose levels, no cardiovascular effects, no renal effects, and a potential for weight loss. They can be administered subcutaneously or orally. However, there is a risk of thyroid C-cell tumors in rodents, and the human relevance is not determined. Renal dose considerations should be followed.
Describe the characteristics of GLP-1 RAs.
GLP-1 RAs have high to very high efficacy in lowering glucose levels, no cardiovascular effects, no renal effects, and a potential for weight loss. They can be administered subcutaneously or orally. However, there is a risk of thyroid C-cell tumors in rodents, and the human relevance is not determined. Renal dose considerations should be followed.
What are the clinical considerations for GLP-1 RAs?
When prescribing GLP-1 RAs, clinicians should monitor for thyroid C-cell tumors, counsel patients on potential gastrointestinal side effects, and provide guidance on dietary modifications to mitigate these effects. Renal function should be monitored when initiating or escalating doses in patients with renal impairment.
Describe the recommended glucose-lowering regimen for people with reduced estimated glomerular filtration rates (eGFR).
Table 10.3C and Section 10 recommend a glucose-lowering regimen independent of A1C, independent of metformin use, and considering person-specific factors.
What are the potential side effects associated with metformin use?
Metformin use is associated with vitamin B12 deficiency and worsening symptoms of neuropathy.
What are the potential side effects associated with metformin use?
Metformin use is associated with vitamin B12 deficiency and worsening symptoms of neuropathy.
What does the VERIFY trial suggest about initial combination therapy for type 2 diabetes?
The VERIFY trial suggests that initial combination therapy with metformin and the dipeptidyl peptidase 4 (DPP-4) inhibitor vildagliptin has a slower decline of glycemic control compared to metformin alone.
Define the term ‘glycemic targets’.
Glycemic targets refer to the desired levels of blood glucose control in individuals with diabetes.
How should medication choice be guided when selecting a glucose-lowering regimen?
Medication choice should be guided by efficacy in achieving individualized glycemic and weight management goals, avoidance of side effects, cost/access, and individual preferences.
How should medication choice be guided when selecting a glucose-lowering regimen?
Medication choice should be guided by efficacy in achieving individualized glycemic and weight management goals, avoidance of side effects, cost/access, and individual preferences.
Describe the principles in Figure 9.3 for pharmacologic approaches to glycemic treatment.
The principles in Figure 9.3 include reinforcement of behavioral interventions such as weight management and physical activity, as well as provision of DSMES (Diabetes Self-Management Education and Support) to meet individualized treatment goals.
What are the recommended injectable therapies to reduce A1C in most individuals prior to insulin?
GLP-1 RA (Glucagon-Like Peptide-1 Receptor Agonist) or GIP/GLP-1 RA (Glucose-Dependent Insulinotropic Polypeptide/Glucagon-Like Peptide-1 Receptor Agonist) are recommended prior to insulin in most individuals.
How should the basal insulin dose be initiated and titrated?
The basal insulin dose should be initiated at an appropriate starting dose for the selected agent and titrated to a maintenance dose. The specific starting and titration doses vary within the class of basal insulin.
When should prandial insulin be considered and how should it be dosed?
Prandial insulin should be considered if A1C remains above target and the individual is not already on a GLP-1 RA or dual GIP and GLP-1 RA. It can be dosed individually or mixed with NPH as appropriate, usually with the largest meal or the meal with the greatest postprandial glucose excursion.
Describe the pharmacologic approaches to glycemic treatment.
Pharmacologic approaches to glycemic treatment involve the use of medications such as insulin therapy, GLP-1 receptor agonists, and SGLT2 inhibitors to manage blood sugar levels in individuals with diabetes.
What are the benefits associated with GLP-1 receptor agonists?
GLP-1 receptor agonists have been shown to have greater efficacy and durability of glycemic treatment compared to NPH insulin. They also reduce the risk of symptomatic and nocturnal hypoglycemia.
How do longer-acting basal insulin analogs differ from U-100 glargine or detemir?
Longer-acting basal insulin analogs, such as U-300 glargine or degludec, have a lower hypoglycemia risk when used in combination with oral agents compared to U-100 glargine.
Define overbasalization in insulin therapy.
Overbasalization in insulin therapy refers to the excessive use of basal insulin, which can lead to high bedtime-morning or postprandial glucose differentials, hypoglycemia, and high variability in blood sugar levels.
Describe the impact of chronic kidney disease (CKD) on treatment choices for diabetes.
Chronic kidney disease (CKD) can impact treatment choices for diabetes. Some medications, such as SGLT2 inhibitors, have been shown to have beneficial effects on indices of CKD. Clinicians should consider CKD when selecting treatment options.
What is the median AWP of metformin 850 mg (IR)?
$106 ($5, $189)
