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 >>
How Farxiga May Help
Being inspired to fight back against your type 2 diabetes is an important first step in your treatment plan. Sometimes, one of the next steps is taking a medication that may help control your blood sugar. FARXIGA (far-SEE-guh) is a once-daily pill taken in the morning with or without food. In studies, FARXIGA: Additionally, FARXIGA may help you: Do not take FARXIGA if you: have severe kidney problems or are on dialysis. Your healthcare provider should do blood tests to check how well your kidneys are working before and during your treatment with FARXIGA FARXIGA may cause serious side effects including: Dehydration (the loss of body water and salt), which may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up (orthostatic hypotension). You may be at a higher risk of dehydration if you have low blood pressure; take medicines to lower your blood pressure, including water pills (diuretics); are 65 years of age or older; are on a low salt diet, or have kidney problems FARXIGA has been tested in 24 clinical studies that looked at its benefits and safety. The studies had more than 11,000 adults with type 2 diabetes, including more than 6,000 patients treated with FARXIGA. FARXIGA, combined with diet and exercise, was studied alone as well as in combination with other diabetes medicines you may be taking. The other medicines included metformin, glimepiride, pioglitazone, insulin, and sitagliptin. Real patients. Real stories. Patients who are fighting back, sharing their challenges—and their successes—managing their type 2 diabetes. See Patient Stories FARXIGA works with the body to flush sugar away in urine. Learn more about how FARXIGA works › Continue reading >>
Oral Diabetes Medications Fact Sheet
Summa Health System developed this fact sheet for patients who need to take oral medicine to manage their diabetes. Care providers give it to patients during diabetes planned visits, and it is part of the Diabetes Planned Visit Notebook. Oral Diabetes Medications Family Medicine Center of Akron Copyright © 2006 American Diabetes Association Adapted from the ADA Patient Information The first treatment for type 2 diabetes is often meal planning for blood glucose (sugar) control, weight loss, and exercising. Sometimes these measures are not enough to bring blood glucose levels down near the normal range. The next step is taking a medicine that lowers blood glucose levels. How they work In people with diabetes, blood glucose levels are too high. These high levels occur because glucose remains in the blood rather than entering cells, where it belongs. But for glucose to pass into a cell, insulin must be present and the cell must be "hungry" for glucose. People with type 1 diabetes don't make insulin. For them, insulin shots are the only way to keep blood glucose levels down. People with type 2 diabetes tend to have two problems: they don't make quite enough insulin and the cells of their bodies don't seem to take in glucose as eagerly as they should. All diabetes pills sold today in the United States are members of five classes of drugs: sulfonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. These five classes of drugs work in different ways to lower blood glucose levels. Can diabetes pills help me? Only people with type 2 diabetes can use pills to manage their diabetes. These pills work best when used with meal planning and exercise. This way you have three therapies working together to lower your blood glucose levels. Diabetes pills Continue reading >>
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 >>
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- The Impact of Bariatric Surgery on Type 2 Diabetes Mellitus and the Management of Hypoglycemic Events
- Olive oil in the prevention and management of type 2 diabetes mellitus: a systematic review and meta-analysis of cohort studies and intervention trials
Management Of Blood Glucose With Noninsulin Therapies In Type 2 Diabetes
A comprehensive, collaborative approach is necessary for optimal treatment of patients with type 2 diabetes mellitus. Treatment guidelines focus on nutrition, exercise, and pharmacologic therapies to prevent and manage complications. Patients with prediabetes or new-onset diabetes should receive individualized medical nutrition therapy, preferably from a registered dietitian, as needed to achieve treatment goals. Patients should be treated initially with metformin because it is the only medication shown in randomized controlled trials to reduce mortality and complications. Additional medications such as sulfonylureas, dipeptidyl-peptidase-4 inhibitors, thiazolidinediones, and glucagon-like peptide-1 receptor agonists should be added as needed in a patient-centered fashion. However, there is no evidence that any of these medications reduce the risk of diabetes-related complications, cardiovascular mortality, or all-cause mortality. There is insufficient evidence on which combination of hypoglycemic agents best improves health outcomes before escalating to insulin therapy. The American Diabetes Association recommends an A1C goal of less than 7% for many nonpregnant adults, with the option of a less stringent goal of less than 8% for patients with short life expectancy, cardiovascular risk factors, or long-standing diabetes. Randomized trials in middle-aged patients with cardiovascular risk factors have shown no mortality benefit and in some cases increased mortality with more stringent A1C targets. Clinical recommendation Evidence rating References Metformin should be used as first-line therapy to reduce microvascular complications, assist in weight management, reduce the risk of cardiovascular events, and reduce the risk of mortality in patients with type 2 diabetes mell Continue reading >>
Review Article Diabetes And Oral Therapies: A Review Of Oral Therapies For Diabetes Mellitus
For decades, antihyperglycaemic agents have been used for the treatment of type 2 diabetes mellitus given their effectiveness and convenience. Metformin (MET) and sulphonylureas (SU) are time-tested antihyperglycaemic agents that have been administered for more than 50 years. These agents were followed by the introduction of other antihyperglycaemic agents such as glinides (GLN), thiazolidinediones (TZD), alpha-glucosidase inhibitors (AGI), dipeptidyl peptidase-4 inhibitors (DPP-4I), and sodium–glucose cotransporter-2 inhibitors (SGLT2I). MET is recognized as the drug of choice for monotherapy unless contraindicated or unwanted side effects occur. SU-induced hypoglycaemia is losing ground to various new agents, but the generic formulae of SU together with MET are cheap and effective. The cardiovascular hazards of several agents are a major concern to physicians and legislating bodies. In choosing antihyperglycaemic agents for dual or triple therapy, the treating physician must keep in mind the health status of the patient, medication side effects, cost, and patient preference. This review addresses the advantages and disadvantages of a range of antihyperglycaemic agents and their applications in monotherapy or combination therapy. © 2016 The Author. Production and hosting by Elsevier Ltd on behalf of Taibah University. Continue reading >>
Wait Times: How Long Until Your Med Begins Working
Photography by Mike Watson Images/Thinkstock There are many type 2 medications, and each drug class works in the body in a different way. Here’s a quick guide to help you understand how long each drug will generally take to work: These short-acting oral medications, taken with meals, block the breakdown of complex sugars into simple sugars in the gastrointestinal (GI) tract. “Simple sugars are more easily absorbed and cause the blood sugar to ultimately go up,” Sam Ellis, PharmD, BCPS, CDE, associate professor in the Department of Clinical Pharmacy at the University of Colorado says. These drugs are minimally absorbed into the blood, so a certain blood level concentration is not necessary for them to work. You will see the effect immediately with the first dose. “You take it before a meal, and with that meal you see the effect,” says George Grunberger, MD, FACP, FACE, President of the American Association of Clinical Endocrinologists. While researchers aren’t exactly sure how these oral medications work, it’s likely that the meds block some absorption of glucose in the GI tract. “You’ll see most of the effect in the first week with these drugs,” says Ellis. alogliptin, linagliptin, saxagliptin, sitagliptin These drugs work to block the enzyme responsible for the breakdown of a specific gut hormone that helps the body produce more insulin when blood glucose is high and reduces the amount of glucose produced by the liver. Take a DPP-4 inhibitor (they come in pill form) and it’ll work pretty fast—you’ll see the full effect in about a week. “It’s blocking that enzyme after the first dose a little bit, but by the time you get out to dose five, you’re blocking the majority of that enzyme,” Ellis says. albiglutide, dulaglutide, exenatide, exe Continue reading >>
Steps To Take If Your Oral Diabetes Medication Stops Working
Oral medicines are effective at lowering blood sugar when diet and exercise aren’t enough to manage type 2 diabetes. Yet these drugs aren’t perfect — and they don’t always work in the long term. Even if you’ve been taking your medicine just as your doctor prescribed, you might not feel as well as you should. Diabetes drugs can and often do stop working. About 5 to 10 percent of people with type 2 diabetes stop responding to their medicine each year. If your oral diabetes drug is no longer working, you’ll need to figure out what’s preventing it from controlling your blood sugar. Then you’ll have to explore other options. Look at your daily habits When your oral diabetes medicine stops working, make an appointment with your doctor. They will want to know if anything in your routine has changed. Many factors can affect how well your medicine is working — for instance, weight gain, changes in your diet or activity level, or a recent illness. Making a few changes to your diet or exercising more each day might be enough to get your blood sugar under control again. It’s also possible that your diabetes has progressed. The beta cells in your pancreas that produce insulin can become less efficient over time. This can leave you with less insulin and poorer blood sugar control. Sometimes your doctor may not be able to figure out why your medicine stopped working. If the drug you’ve been taking is no longer effective, you’ll need to look at other medications. Add another drug Metformin (Glucophage) is often the first drug you’ll take to control type 2 diabetes. If it stops working, the next step is to add a second oral drug. You have a few oral diabetes medicines to choose from, and they work in different ways. Sulfonylureas such as glyburide (Glynase Pres Continue reading >>
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 >>
9 Types Of Medication That Help Control Type 2 Diabetes
Sometimes people with type 2 diabetes are able to bring their blood glucose levels under control through a combination of weight loss, diet, and exercise, but many people with diabetes take medication to manage their condition. For some, a single diabetes medication is effective, while in other cases a combination of drugs works better. “If diabetes control is suboptimal on the maximum dose of one medication, it’s prudent to add on a second agent,” says Deepashree Gupta, MD, assistant professor of endocrinology at Saint Louis University in Missouri. There are many drugs available to treat type 2 diabetes. Your diabetes care team can help you understand the differences among the types of medication on this long list, and will explain how you take them, what they do, and what side effects they may cause. Your doctor will discuss your specific situation and your options for adding one or more types of medication to your treatment. Types of Medication for Type 2 Diabetes In type 2 diabetes, even though insulin resistance is what leads to the condition, injections of insulin are not the first resort. Instead, other drugs are used to help boost insulin production and the body’s regulation of it. Insulin resistance occurs when the body’s cells don’t respond properly to insulin, which is a hormone made in the pancreas that’s responsible for ferrying glucose to cells for energy. When cells are resistant to insulin, they don’t use the insulin effectively to bring the glucose from the bloodstream into the cell. The pancreas needs to produce more insulin to overcome this resistance in an effort to normalize blood sugar levels. When the pancreas can’t keep up with the insulin demands in a person with insulin resistance, that person develops diabetes. Below is an ov Continue reading >>
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 >>
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- Olive oil in the prevention and management of type 2 diabetes mellitus: a systematic review and meta-analysis of cohort studies and intervention trials
Experts Offer Advice On Oral Drugs, Insulin For Diabetes
Progression of type 2 diabetes is almost inevitable, and with it usually comes a need for different medications. To help internists sort out which therapy to use and when, two speakers at Internal Medicine 2011 offered algorithms for oral medications, advice on using insulin, and pearls for managing patients when guidelines aren't always clear-cut. Animal insulin has been available since the 1920s, and sulfonylurea agents since the 1940s. When Anne Peters, FACP, CDE, did her endocrinology fellowship in the 1980s, she worked on clinical trials that brought metformin into the U.S. Since then, a dozen new drugs have been introduced, “and trust me, that's going to double in the next 10 years,” she said. Dr. Peters, director of the clinical diabetes programs at the University of Southern California, pointed out that almost all diabetic patients end up on multidrug therapy if they've had diabetes for 10 years or more. “And these [drugs] are no longer based on algorithms that are simple. It's always hard to figure out new guidelines.” Her best advice is to treat diabetes early and aggressively. “The earlier we start treating our patients with type 2 diabetes, the better we normalize their blood sugars, the less likely it is to progress,” Dr. Peters said. Metformin is the preferred first-line treatment for type 2 diabetes. It's well known, inexpensive, and has the best profile whether the goal is lowering A1c (by 1% to 2%) or avoiding weight gain or hypoglycemia, Dr. Peters said. Its maximal clinical effect is achieved at dosages of 1,500 to 2,000 mg/d. Metformin does have gastroenterological side effects in about 10% of patients but is not advised in cases of renal insufficiency, she noted. The second line of defense includes the addition of sulfonylureas, thiazoli Continue reading >>
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Using Type 2 Oral Meds To Reduce A1c?
I am a Type 1 diabetic of nearly 28 years (diagnosed at 2 years old) and wear an Omnipod insulin pump. I had struggled with an average A1C of around 8.5% for many years and was failing to bring the number down. I was monitoring my sugars very closely and liberally delivering insulin throughout the day. For some reason, my sugars were not budging. I felt as if the insulin (Humalog) was not working as effectively as it should and that such a small amount of food would send my blood sugars skyrocketing. After a long conversation with my endo, she came up with a bit of an unorthodox idea. She suggested I try taking an oral, Type 2, medication called Jardiance. Obviously, this would not be in place of my insulin pump, but in addition. I have been on the medication for over a year now and have seen really great results! My last A1C was 7.2% and the one before that was 7.1%. I am wondering if anyone else has had a similar experience or has tried using an oral diabetes medication to supplement their insulin? Anyone happen to be taking Jardiance? As a skeptic, I have a hard time believing that this medication will be the long-term answer. Meaning, the medication could lose its potency within my body or I could become resistant. Looking to hear other people's thoughts and opinions! I would start by getting the books "Pumping Insulin" by Walsh and "Think Like a Pancreas" by Scheiner. They have both helped me so much to figure out my insulin needs. You don't say if you are insulin resistant. If you are, metformin works well for lots of T1Ds. I probably would not use a T2 med if I was not insulin resistant, but we all need to make our own healthcare choices. Any discussion of why the first attempt would be Jardiance - what is the underlying condition that Jardiance will help? All m Continue reading >>
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 >>
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 >>
