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Glipizide A1c Reduction

Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus

Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. All topics are updated as new evidence becomes available and our peer review process is complete. INTRODUCTION — Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise, and weight reduction when appropriate. Monotherapy with metformin is indicated for most patients, and insulin may be indicated for initial treatment for some [1]. Although several studies have noted remissions of type 2 diabetes mellitus that may last several years, most patients require continuous treatment in order to maintain normal or near-normal glycemia. Bariatric surgical procedures in obese patients that result in major weight loss have been shown to lead to remission in a substantial fraction of patients. Regardless of the initial response to therapy, the natural history of most patients with type 2 diabetes is for blood glucose concentrations to rise gradually with time. Treatment for hyperglycemia that fails to respond to initial monotherapy and long-term pharmacologic therapy in type 2 diabetes is reviewed here. Options for initial therapy and other therapeutic issues in diabetes management, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately. (See "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Overview of medical care in adults with diabetes mellitus". Continue reading >>

How To Wean Off Of Diabetes Medication

How To Wean Off Of Diabetes Medication

One of my greatest pleasures in life is to help patients achieve remission of their type 2 diabetes. This means their blood sugar levels have become normal in the absence of any diabetes medication. Many clinicians and patients are interested in learning my views about how to go about decreasing and discontinuing diabetes medications. The main role for medications is to help reduce or delay the risk of nasty complications of diabetes, particularly the damage to the retina, kidney, nerves, and circulation. The higher the average blood sugar level, as indicated by the hemoglobin A1c level, the greater the complication risk (which increases exponentially with increasing A1c). We know from clinical trials that using medication to keep the A1c at or below 7% can help reduce the risk of these complications. There is broad agreement that clinicians should recommend starting or increasing diabetes medications to patients who cannot get their A1c level to 7% or less via lifestyle change. Many patients come to me because the A1c is already over 7% and their primary care provider proposes increasing their diabetes medication, unless the patient can get to 7% or less with improved eating and/or exercise habits. Some of these patients are already on many pills, and insulin shots are the frequently the next appropriate treatment. Many patients would rather make the lifestyle changes than take more medication, so when the doctor frames the issue in this way, then a patient might become inspired to renew or increase the lifestyle efforts. The clinician might say “lets recheck the A1c in 3 months, and start the new medication if it is still above 7.0%”. My goal with patients is to use the lifestyle strategies I’ve discussed previously in this blog to drive the A1c as low as possib Continue reading >>

The Effect Of Oral Antidiabetic Agents On A1c Levels

The Effect Of Oral Antidiabetic Agents On A1c Levels

Abstract OBJECTIVE Previous reviews of the effect of oral antidiabetic (OAD) agents on A1C levels summarized studies with varying designs and methodological approaches. Using predetermined methodological criteria, we evaluated the effect of OAD agents on A1C levels. RESEARCH DESIGN AND METHODS The Excerpta Medica (EMBASE), the Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Cochrane Central Register of Controlled Trials databases were searched from 1980 through May 2008. Reference lists from systematic reviews, meta-analyses, and clinical practice guidelines were also reviewed. Two evaluators independently selected and reviewed eligible studies. RESULTS A total of 61 trials reporting 103 comparisons met the selection criteria, which included 26,367 study participants, 15,760 randomized to an intervention drug(s), and 10,607 randomized to placebo. Most OAD agents lowered A1C levels by 0.5−1.25%, whereas thiazolidinediones and sulfonylureas lowered A1C levels by ∼1.0–1.25%. By meta-regression, a 1% higher baseline A1C level predicted a 0.5 (95% CI 0.1–0.9) greater reduction in A1C levels after 6 months of OAD agent therapy. No clear effect of diabetes duration on the change in A1C with therapy was noted. CONCLUSIONS The benefit of initiating an OAD agent is most apparent within the first 4 to 6 months, with A1C levels unlikely to fall more than 1.5% on average. Pretreated A1C levels have a modest effect on the fall of A1C levels in response to treatment. Type 2 diabetes is a chronic, progressive disease that requires ongoing attention to lifestyle and pharmacotherapy to achieve and maintain optimal glucose control (1). Declining β-cell function and increasing insulin resistance over time lead to deteriorating glycemic control and the ne Continue reading >>

Stopping Diabetes Medicines

Stopping Diabetes Medicines

“I want to get off some of these drugs,” Ellen told me. “But my doctor says I need them. I’m on three for glucose, two for blood pressure, and one for depression. They’re costing me hundreds every month. What can I do?” Ellen is a health-coaching client of mine, age 62 with Type 2 diabetes. She works as an executive secretary in an insurance company. It’s stressful. She’s usually there from 8 AM until 6 PM or later and comes home “too tired to exercise.” She mentioned that just “putting herself together” for work every day requires an hour of prep time. “You have to look good for these executives,” she says. I asked about her drugs. She said she takes metformin (Glucophage and others), sitagliptin ( brand name Januvia), and pioglitazone (Actos) for diabetes, lisinopril (Privinil, Zestril) for blood pressure, simvastatin (Zocor) for cholesterol, and paroxetine (Paxil) for depression. Her A1C is now at 7.3%, down from a high of 9.9% a year ago, when she was on only two medicines. “I think the drugs are depressing me,” she said. “The cost, the side effects… I have nausea most days, I have cough from the lisinopril. That doesn’t help at work. I don’t know what’s worse, the drugs or diabetes.” What would you have said to Ellen? Although I strongly believe in reducing drug use, I told her what most experts say, that she can get off some, possibly all diabetes drugs, but it will take a lot of work. Asqual Getaneh, MD, a diabetes expert who writes for Everyday Health, says that doctors want to be “assured that an A1C will stay down” if a person goes off medicines. She says doctors usually won’t reduce medicines until A1C drops below 7.0%. In the ADA publication Diabetes Forecast, pharmacist Craig Williams, PharmD, writes, “Unf Continue reading >>

Comparable Reduction In A1c Levels At 1 Year

Comparable Reduction In A1c Levels At 1 Year

Important Safety Information For Farxiga Prior serious hypersensitivity reaction to FARXIGA Severe renal impairment (eGFR <30 mL/min/1.73 m2), end-stage renal disease, or patients on dialysis Warnings and Precautions Hypotension: FARXIGA causes intravascular volume contraction, and symptomatic hypotension can occur. Assess and correct volume status before initiating FARXIGA in patients with impaired renal function, elderly patients, or patients on loop diuretics. Monitor for hypotension Ketoacidosis has been reported in patients with type 1 and type 2 diabetes receiving FARXIGA. Some cases were fatal. Assess patients who present with signs and symptoms of metabolic acidosis for ketoacidosis, regardless of blood glucose level. If suspected, discontinue FARXIGA, evaluate and treat promptly. Before initiating FARXIGA, consider risk factors for ketoacidosis. Patients on FARXIGA may require monitoring and temporary discontinuation in situations known to predispose to ketoacidosis Acute Kidney Injury and Impairment in Renal Function: FARXIGA causes intravascular volume contraction and renal impairment, with reports of acute kidney injury requiring hospitalization and dialysis. Consider temporarily discontinuing in settings of reduced oral intake or fluid losses. If acute kidney injury occurs, discontinue and promptly treat. FARXIGA increases serum creatinine and decreases eGFR. Elderly patients and patients with impaired renal function may be more susceptible to these changes. Before initiating FARXIGA, evaluate renal function and monitor periodically. FARXIGA is not recommended in patients with an eGFR persistently between 30 and <60 mL/min/1.73 m2 Urosepsis and Pyelonephritis: SGLT2 inhibitors increase the risk for urinary tract infections [UTIs] and serious UTIs have been Continue reading >>

Metformin Reduced Cv Events Compared With Glipizide In Patients With Type 2 Diabetes And Cad

Metformin Reduced Cv Events Compared With Glipizide In Patients With Type 2 Diabetes And Cad

ACP Diabetes Monthly | From ACP Journal Club | May 10, 2013 Metformin reduced CV events compared with glipizide in patients with type 2 diabetes and CAD A multicenter randomized controlled trial of Chinese patients with type 2 diabetes and coronary artery disease found that metformin reduced cardiovascular events more than glipizide at 5 years. A multicenter randomized controlled trial (RCT) of Chinese patients with type 2 diabetes and coronary artery disease (CAD) found that metformin reduced cardiovascular events more than glipizide at 5 years. The study was published by Diabetes Care on Dec. 10, 2012. The following commentary by Michael Tanner, MD, FACP, was published in the ACP Journal Club section of the April 16 Annals of Internal Medicine. In SPREAD-DIMCAD, Hong and colleagues randomized 304 high-risk Chinese patients with CAD and mild type 2 diabetes (mean hemoglobin A1c 7.6%) to metformin or glipizide plus placebo 3 times per day for 3 years, with insulin added as needed. The primary outcome was a composite of death, stroke, MI, or revascularization. Metformin and glipizide both reduced hemoglobin A1c (7.0% and 7.1%, respectively), yet the metformin group had fewer CV events (P=0.026). In simple hypertension, it matters more that blood pressure is reduced than how it is reduced. The SPREAD-DIMCAD findings show that the opposite is true in diabetes: How matters. There is more to stroke and MI prevention than just glucose control. The authors note that metformin may confer antiatherogenic benefit beyond its hypoglycemic action through reduction of coagulation, inflammation, and endothelial dysfunction. Metformin is weight-neutral, but the weight lost by the metformin group and gained by the glipizide group during the trial is unlikely to have played an important Continue reading >>

Press Release: Merck's Januvia Wins New Uses But Risks Outlined

Press Release: Merck's Januvia Wins New Uses But Risks Outlined

Merck's Januvia Wins New Uses but Risks Outlined WHITEHOUSE STATION, N.J. -- Merck & Co., Inc. today announced that the U.S. Food and Drug Administration (FDA) has approved expanded labeling for JANUVIA(TM) (sitagliptin), the only DPP-4 inhibitor available in the United States for the treatment of type 2 diabetes. JANUVIA is indicated, as an adjunct to diet and exercise, to improve glycemic control in adult patients with type 2 diabetes. JANUVIA should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. JANUVIA has not been studied in combination with insulin. The new regimens with JANUVIA described in the updated labeling include, as an adjunct to diet and exercise, initial therapy in combination with metformin; add-on therapy to a sulfonylurea (glimepiride) when the single agent alone does not provide adequate glycemic control; and, add-on therapy to the combination of a sulfonylurea (glimepiride) and metformin when dual therapy does not provide adequate glycemic control. New data contained in three studies support the efficacy and safety of JANUVIA. Initial therapy with the combination of JANUVIA and metformin provided substantial A1C reductions. JANUVIA demonstrated similar efficacy to a sulfonylurea (glipizide) in patients inadequately controlled on metformin. JANUVIA also provided significant placebo-adjusted A1C reductions in patients being treated with a sulfonylurea (glimepiride), with or without metformin. The expanded labeling for JANUVIA was also updated, within Warnings and Precautions, to include post-marketing reports of hypersensitivity reactions in patients treated with JANUVIA. These reactions include anaphylaxis, angioedema and exfoliative skin conditions including Stevens-Johnson syndrome. Because these reactio Continue reading >>

Treatment Of Type 2 Diabetes Mellitus In The Older Patient

Treatment Of Type 2 Diabetes Mellitus In The Older Patient

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. All topics are updated as new evidence becomes available and our peer review process is complete. INTRODUCTION — The prevalence of type 2 diabetes continues to increase steadily as more people live longer and grow heavier. Older adults with diabetes are at risk of developing a similar spectrum of macrovascular and microvascular complications as their younger counterparts with diabetes. In addition, they are at high risk for polypharmacy, functional disabilities, and common geriatric syndromes that include cognitive impairment, depression, urinary incontinence, falls, and persistent pain [1]. This topic will review diabetes management in older patients and how management priorities and treatment choices may differ between older and younger patients. The general management of type 2 diabetes is reviewed separately. (See "Overview of medical care in adults with diabetes mellitus" and "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Management of persistent hyperglycemia in type 2 diabetes mellitus".) TREATMENT GOALS — The overall goals of diabetes management in older adults are similar to those in younger adults and include management of both hyperglycemia and risk factors. Older adults with diabetes are a heterogeneous population that includes persons residing independently in communities, in assisted care facilities, or in nursing homes. They can be fit and healthy or frail with many como Continue reading >>

David’s Guide To Getting Our A1c Under 6.0

David’s Guide To Getting Our A1c Under 6.0

The A1C test is our best scorecard to show how well we are controlling our diabetes. It measures how much glucose has been sticking to our red blood cells for the previous two or three months. Since our bodies replace each red blood cell with a new one every four months, this test tells us the average of how high our glucose levels have been during the life of the cells. The experts recommend that we should get our A1C level tested at least twice a year. People who take insulin need to get it about four times a year. If the test shows that our blood glucose level is high, it means that we have a greater risk of having diabetes problems. Think of the A1C as an early warning system for the insidious complications that we can get down the road when we don’t control our condition. But what do we mean by a “high” A1C level? Here the experts disagree. The American Diabetes Association says that we need to keep our A1C results below 7.0 percent. The American Association of Clinical Endocrinologists sets the target at 6.5 percent. The International Diabetes Federation, or IDF, also recommends that most people with diabetes keep their levels below 6.5 percent. The more our A1C level is higher than normal, the greater the likelihood that we will suffer from one or more of the complications of diabetes. And here too the experts disagree with how they define “normal.” People who don’t have diabetes have A1C levels below 6.0 percent. That’s the gist of what I wrote here recently in “The Normal A1C Level.” The IDF agrees. But more aggressive endocrinologists say that a truly normal A1C ranges from 4.2 percent to 4.6 percent. That’s what Dr. Richard K. Bernstein wrote in Dr. Bernstein’s Diabetes Solution. No matter what our level is, we can be sure that lower is Continue reading >>

A1c Lowering Of Diabetes Medications – A1c Lowering Medications

A1c Lowering Of Diabetes Medications – A1c Lowering Medications

Diabetes and prediabetes are one of the biggest health issues in the nation. A huge number of people are at risk for diabetes and it’s astounding, It is stated that over 86 million people in the US have prediabetes, which means their blood sugar levels are higher than normal but not so high that they will be declared as type 2 diabetes. So A1c Lowering Of Diabetes Medications is considered as one of the best options. Diabetes is a condition that leads to high levels of blood glucose (or sugar) in the body. This happens when your body can’t make or use insulin like it’s supposed to. Insulin is a substance that helps your body use the sugar from the food you eat Diabetes leads to high levels of blood glucose or sugar in the human body. This happens because your body cannot make or use insulin like it is supposed to do. Insulin helps your body to use the sugar which you get from the food you eat on a daily basis. If you are really concerned about your a1c levels then A1c Lowering Of Diabetes Medications is one of the ways you should focus on. There are two types of diabetes. Type 1 diabetes and Type 2 diabetes. Both the types need medications to lower their blood sugar levels and stay healthy. The types of drugs are chosen depending on which type of diabetes you have. Here we are going to let you know about A1c Lowering Of Diabetes Medications – Supplements To Lower A1C Levels. Medications for type 1 diabetes – A1c Lowering Of Diabetes Medications Insulin Insulin is the most mundane type of medication utilized in type 1 diabetes treatment. It’s additionally utilized in type 2 diabetes treatment. It’s given by injection and comes in variants. The type of insulin you require depends on how rigorous your insulin depletion is. Options include: Short-acting insuli Continue reading >>

The Effect Of Oral Antidiabetic Agents On A1c Levels

The Effect Of Oral Antidiabetic Agents On A1c Levels

Go to: Previous reviews of the effect of oral antidiabetic (OAD) agents on A1C levels summarized studies with varying designs and methodological approaches. Using predetermined methodological criteria, we evaluated the effect of OAD agents on A1C levels. The Excerpta Medica (EMBASE), the Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Cochrane Central Register of Controlled Trials databases were searched from 1980 through May 2008. Reference lists from systematic reviews, meta-analyses, and clinical practice guidelines were also reviewed. Two evaluators independently selected and reviewed eligible studies. A total of 61 trials reporting 103 comparisons met the selection criteria, which included 26,367 study participants, 15,760 randomized to an intervention drug(s), and 10,607 randomized to placebo. Most OAD agents lowered A1C levels by 0.5−1.25%, whereas thiazolidinediones and sulfonylureas lowered A1C levels by ∼1.0–1.25%. By meta-regression, a 1% higher baseline A1C level predicted a 0.5 (95% CI 0.1–0.9) greater reduction in A1C levels after 6 months of OAD agent therapy. No clear effect of diabetes duration on the change in A1C with therapy was noted. The benefit of initiating an OAD agent is most apparent within the first 4 to 6 months, with A1C levels unlikely to fall more than 1.5% on average. Pretreated A1C levels have a modest effect on the fall of A1C levels in response to treatment. Treatment effects on A1C by OAD class, dose, and time. Error bars represent 95% CIs. ●, represent pooled, weighted mean differences. ○, represent individual comparison treatment effects. *Treatment effect 1.1 (95% CI 0.8–1.4). †Illustrates the generally accepted maximum daily dose. A, acarbose; AG-α, glucosidase inhibitors; Gm, glimepiri Continue reading >>

Management Of Blood Glucose In Type 2 Diabetes Mellitus

Management Of Blood Glucose In Type 2 Diabetes Mellitus

Evidence-based guidelines for the treatment of type 2 diabetes mellitus focus on three areas: intensive lifestyle intervention that includes at least 150 minutes per week of physical activity, weight loss with an initial goal of 7 percent of baseline weight, and a low-fat, reduced-calorie diet; aggressive management of cardiovascular risk factors (i.e., hypertension, dyslipidemia, and microalbuminuria) with the use of aspirin, statins, and angiotensin-converting enzyme inhibitors; and normalization of blood glucose levels (hemoglobin A1C level less than 7 percent). Insulin resistance, decreased insulin secretion, and increased hepatic glucose output are the hallmarks of type 2 diabetes, and each class of medication targets one or more of these defects. Metformin, which decreases hepatic glucose output and sensitizes peripheral tissues to insulin, has been shown to decrease mortality rates in patients with type 2 diabetes and is considered a first-line agent. Other medications include sulfonylureas and nonsulfonylurea secretagogues, alpha glucosidase inhibitors, and thiazolidinediones. Insulin can be used acutely in patients newly diagnosed with type 2 diabetes to normalize blood glucose, or it can be added to a regimen of oral medication to improve glycemic control. Except in patients taking multiple insulin injections, home monitoring of blood glucose levels has questionable utility, especially in relatively well-controlled patients. Its use should be tailored to the needs of the individual patient. Type 2 diabetes mellitus, the sixth leading cause of death in the United States, is directly responsible for more than 73,000 deaths annually and is a contributing factor in more than 220,000 deaths.1 It is the leading cause of kidney failure and new cases of blindness in a Continue reading >>

A Review Of Oral Antidiabetic Agents

A Review Of Oral Antidiabetic Agents

Jeff Ketz, Pharm.D., BCPS Return to Pharmacotherapy Update Index Introduction The benefits of meeting optimal blood glucose goals in diabetic patients are now well understood due to data from many clinical trials (See Table 1). Currently, a variety of oral medications such as sulfonylureas, biguanides, thiazolidinediones, meglitinides, and alpha-glucosidase inhibitors are available to treat type 2 diabetes. Medication regimens should be based on patient-specific factors to optimize blood glucose control and minimize morbidity and mortality. Several factors should be considered when choosing a medication regimen including desired glycemic control, patients' weight and lipid profile, contraindications, and cost.. Table 1: Glycemic Goals for Patients* with Diabetes Goal Action Recommended Pre-prandial glucose 80-120 mg/dl < 80 mg/dl or > 140 mg/dl Bedtime glucose 100-140 mg/dl < 100 mg/dl or > 160 mg/dl Hemoglobin A1c <7% >8% *Non-pregnant patients Adapted from Diabetes Care 1998;21(Suppl 1):S23-31. Sulfonylureas Sulfonylureas have long been the cornerstone in managing type 2 diabetes. Some examples of sulfonylureas include glyburide (Diabeta®), glipizide (Glucotrol®), and glimepiride (Amaryl®). Sulfonylureas primarily work by increasing endogenous insulin secretion; therefore, they must be used in patients with viable ß-cells. Sulfonylurea monotherapy can lower fasting plasma glucose (FPG) by 60 to 70 mg/dl and lower hemoglobin A1c by 1.5 to 2%. The most significant adverse effects of sulfonylureas are: 1) hypoglycemia which occurs in 2 to 4% of patients per year and 2) weight gain (approximately 4 to 6 kg). Additionally, less common side effects include dermatological and hematological reactions and gastrointestinal disturbances. Sulfonylureas have no effect on trigl Continue reading >>

How Glipizide Might Help With Your Type 2 Diabetes Management

How Glipizide Might Help With Your Type 2 Diabetes Management

Glipizide is an oral medication that is used to treat Type 2 diabetes. The drug is available in immediate-release tablets and extended-release tablets. Patients who currently take the medication as part of their diabetes treatment state that Glipizide has helped with lowering their blood sugar levels, and it seems that the extended-release tablets are favored over the immediate-release tablets. One of the main benefits from the drug is that it helps to lower your A1C levels by 1-2%. We will discuss the benefits and the downsides of Glipizide in more detail below. What is Glipizide? Glipizide is an oral medication used in the treatment of Type 2 diabetes. It is available in brand-name form as well as generic form, with the brand-names being Glucotrol and Glucotrol XL. Glipizide works by helping your pancreas produce more of your body’s natural insulin, which in turn regulates your blood sugar levels. Glipizide is used in conjunction with diet and exercise as part of a diabetes management plan. Glipizide is part of a class of diabetes drugs known as Sulfonylureas, which are designed to help your body’s pancreas to produce more of the body’s natural insulin. Diabetes medication aren’t designed to cure your Type 2 diabetes, but instead they are designed to treat the symptoms of diabetes, including blurry vision, excessive hunger, excessive thirst, frequent urination and sores that won’t heal. Further reading: Usually, the first diabetes medication that your doctor may prescribe is Metformin. However, many times, Glipizide is a popular choice for doctors to prescribe because many patients find that their bodies tolerate Glipizide better than Metformin. What are the Benefits of Glipizide? Glipizide can help lower your A1C levels by an average of 1-2%. Since Glipizid Continue reading >>

Comparable Reduction In A1c Levels Vs Combination Glipizide + Metformin

Comparable Reduction In A1c Levels Vs Combination Glipizide + Metformin

Primary end point: Mean reduction in A1C levels were noninferior to combination therapy with glipizide + metformin at 52 weeks1,2,a Values are last observation carried forward and represent adjusted mean change from baseline. aPatients on metformin ≥1500 mg per day were randomized following a 2-week placebo lead-in period to glipizide 5 mg or dapagliflozin 2.5 mg and were up-titrated over 18 weeks to optimal glycemic effect (FPG <110 mg/dL) or to the highest dose level (up to glipizide 20 mg and dapagliflozin 10 mg) as tolerated by patients. At the end of the titration period, 87% of patients treated with dapagliflozin had been titrated to the maximum study dose (10 mg) vs 73% treated with glipizide (20 mg). Dapagliflozin 2.5 mg is not an FDA-approved dose. BL=mean baseline. Values are last observation carried forward and represent adjusted mean change from baseline. bThe discrepancy between the weight change between treatments and the total weight change results from rounding. cP<0.0001. Hypotension: Dapagliflozin causes intravascular volume contraction, and symptomatic hypotension can occur. Assess and correct volume status before initiating XIGDUO XR in patients with impaired renal function, elderly patients, or patients on loop diuretics. Monitor for hypotension. 7 patients taking dapagliflozin + metformin experienced minore hypoglycemia vs 147 patients taking glipizide + metformin over 52 weeks1,2 No patients taking dapagliflozin + metformin experienced majorf hypoglycemia over 52 weeks vs 3 patients taking glipizide + metformin1,2 eMinor episodes of hypoglycemia were defined as either a symptomatic episode with a capillary or plasma glucose measurement <63 mg/dL, regardless of need for external assistance or an asymptomatic capillary or plasma glucose measuremen Continue reading >>

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