Antihyperglycemic Therapy In Type 2 Diabetes: Which Drugs And When To Use Them
Antihyperglycemic Therapy in Type 2 Diabetes: Which Drugs and When to Use Them Antihyperglycemic Therapy in Type 2 Diabetes: Which Drugs and When to Use Them This course identifies defects that culminate in type 2 diabetes and the benefits and risk of glucose-lowering medication. Participants will be able to design treatment programs for patients with type 2 diabetes. Family Physicians, General Internists, Hospitalists, Physician Assistants,Nurse Practitioners, Nurses and Pharmacists. Identify the pathophysiological defects that culminate in type 2 diabetes. List the benefits and risks of each major class of glucose-lowering medication. Design rational treatment programs for individual patients with type 2 diabetes. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, r R, Matthews DR.Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Position Statement of the American DiabetesAssociation (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 35(6):1364-79, 2012 Ismail-Beigi F, Moghissi E, Tiktin M, Hirsch IB, Inzucchi SE, h S. Individualizing glycemic targets in type 2 diabetesmellitus: Implications of recent clinical trials. Annals Intern Med 154(8):554-559, 2011. Wendy L. Bennett, MD, MPH; Nisa M. Maruthur, MD, MHS; Sonal Singh, MD, MPH; Jodi B. Segal, MD, MPH; Lisa M. Wilson, ScM; e Chatterjee, MD, MPH; Spyridon S. Marinopoulos, MD, MBA; Milo A. n, MD, PhD; i Ranasinghe, MD,MPH; Lauren Block, MD; Wanda K. Nicholson, MD, MPH; Susan Hutfless, MPH, PhD; Eric B. Bass, MD, MPH; andShari Bolen, MD, MPHComparative Effectiveness and Safety of Medications for Type 2 Diabetes: An Update IncludingNew Drugs and 2-Drug Combinations. Annals Intern Med 2011 154(9):602-613. Continue reading >>
Oral Antihyperglycemic Therapy For Type 2 Diabetesscientific Review
Oral Antihyperglycemic Therapy for Type 2 Diabetes Customize your JAMA Network experience by selecting one or more topics from the list below. Challenges in Clinical Electrocardiography Clinical Implications of Basic Neuroscience Health Care Economics, Insurance, Payment Scientific Discovery and the Future of Medicine United States Preventive Services Task Force Inzucchi SE. Oral Antihyperglycemic Therapy for Type 2 DiabetesScientific Review. JAMA. 2002;287(3):360372. doi:10.1001/jama.287.3.360 Scientific Review and Clinical Applications ContextCare of patients with type 2 diabetes has been revolutionized throughoutthe past several yearsfirst, by the realization of the importance oftight glycemic control in forestalling complications, and second, by the availabilityof several unique classes of oral antidiabetic agents. Deciphering which agentto use in certain clinical situations is a new dilemma facing the primarycare physician. ObjectiveTo systematically review available data from the literature regardingthe efficacy of oral antidiabetic agents, both as monotherapy and in combination. Data SourcesA MEDLINE search was performed to identify all English-language reportsof unique, randomized controlled clinical trials involving recently availableoral agents for type 2 diabetes. Bibliographies were also reviewed to findadditional reports not otherwise identified. Study Selection and Data ExtractionStudies (63) were included in the analysis if they had a study periodof at least 3 months; if each group contained at least 10 subjects at thestudy's conclusion; and if hemoglobin A1c was reported. When multipledosages of a drug were tested, the results of the highest approved dosagewere used. In placebo-controlled trials, hemoglobin A1c data arepresented as the difference betwee Continue reading >>
Ada Updates Standards Of Medical Care For Patients With Diabetes Mellitus
Key Points for Practice • All adults should be tested for diabetes beginning at 45 years of age. • Overweight or obese patients with one or more risk factors for diabetes should be screened at any age. • Persons who use continuous glucose monitoring and insulin pumps should have continued access after 65 years of age. • Aspirin therapy should be considered for women with diabetes who are 50 years and older. • The addition of ezetimibe to statin therapy should be considered for eligible patients who can tolerate only a moderate-dose statin Ongoing patient self-management education and support are critical to preventing acute complications of diabetes mellitus and reducing the risk of long-term complications. The American Diabetes Association (ADA) recently updated its standards of care to provide the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Key changes in the 2016 update include new screening recommendations, clarification of diagnostic testing, and recommendations on the use of new technology for diabetes prevention, the use of continuous glucose monitoring devices, cardiovascular risk management, and screening for hyperlipidemia in children with type 1 diabetes. General recommendations for treatment of type 2 diabetes are shown in Figure 1. Antihyperglycemic therapy in type 2 diabetes: general recommendations. The order in the chart was determined by historical availability and the route of administration, with injectables to the right; it is not meant to denote any specific preference. Potential sequences of antihyperglycemic therapy for patients with type 2 diabetes are displayed, with the usual transition moving vertically from top to bottom, although horizontal movement within therapy stages is also Continue reading >>
Management Of Hyperglycemia In Type 2 Diabetes: A Patient-centered Approach
Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) 1 Richard M. Bergenstal , MD,2 John B. Buse , MD, PHD,3 Michaela Diamant , MD, PHD,4 Ele Ferrannini , MD,5 Michael Nauck , MD,6 Anne L. Peters , MD,7 Apostolos Tsapas , MD, PHD,8 Richard Wender , MD,9 and David R. Matthews , MD, DPHIL10,11,12 From the 1Section of Endocrinology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut; the 10Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, U.K.; the 11National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, U.K.; and the 12Harris Manchester College, University of Oxford, Oxford, U.K From the 1Section of Endocrinology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut; the 2International Diabetes Center at Park Nicollet, Minneapolis, Minnesota; the 3Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; the 4Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands; the 5Department of Medicine, University of Pisa School of Medicine, Pisa, Italy; 6Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany; the 7Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California; the 8Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece; the 9Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; the 10Oxford Centre for Diabetes, Endoc Continue reading >>
Management Of Hyperglycemia In Type 2 Diabetes: A Patient-centered Approach Developed By The American Diabetes Association And The European Association For The Study Of Diabetes
Your browser does not support the NLM PubReader view. Go to this page to see a list of supporting browsers. Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach Developed by the American Diabetes Association and the European Association for the Study of Diabetes J Korean Diabetes. 2012 Dec;13(4):172-181. J Korean Diabetes. 2012 Dec;13(4):172-181. Korean. Published online December 27, 2012. Copyright 2012 Korean Diabetes Association Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach Developed by the American Diabetes Association and the European Association for the Study of Diabetes Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University School of Medicine, Gangneung, Korea. Corresponding author (Email: [email protected] ) In 2012, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published new guidelines for the management of type 2 diabetes, emphasizing the need to individualize treatment goals with preference, need and cost-effects compared with the 2008 ADA/EASD algorithm. These ADA/EASD recommendations provided characteristics of medications in view of improved pharmacodynamics, effects, side effect and cost. The ADA/EASD explained stratification of treatment based on HbA1c and no preferred sequential order for regimens involving dual and triple therapy, indicating the strong effects of insulin therapy in the case of triple therapy. In this section, we summarize "Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes" in Korean. Keywords: Algorithms; Disease management; Hyperglycemia; Pati Continue reading >>
Antihyperglycemic Therapy In Elderly Diabetics
Antihyperglycemic Therapy in Elderly Diabetics Adopting an individualized approach is the cornerstone of much of modern medicine, and nowhere is that more true than in the care of older patients with type 2 diabetes (T2DM).1 Older patients represent a highly variable population. Some may have no health problems other than T2DM, while others may suffer from multiple health issues that complicate treatment. Longstanding diabetes increases the risk for microvascular and macrovascular complications, yet those with well controlled disease may need a different treatment approach than those whose disease has been difficult to manage. Patients who are newly diagnosed later in life with T2DM may need yet another strategy. In recent years, guidelines have recognized the variability in this age group by emphasizing the importance of balancing the risks of hypoglycemia vs the benefits of adequate glucose control. Although guidelines differ, in general they recommend less intensive treatment and more relaxed HbA1c targets in certain circumstances, especially for frail patients and those with cardiovascular disease. These guidelines follow on the heels of research suggesting the existence of a U-shaped curve for mortality vs HbA1c. Results from the landmark ACCORD trial showed that participants (mean age 62 years) had increased risk of mortality at A1c values around 6.0% and 9.0%, and lower risk of mortality for A1c levels intermediate between 6.0% and 9.0%.2 A recent Kaiser Permanente of Northern California study confirmed this U-shaped curve in 71,000 people who were over age 60 and had T2DM. The retrospective cohort study also found that the risk of death and chronic complications rose significantly at A1C 8.0%.3 Despite less stringent A1c goals, experts stress the importance of Continue reading >>
Highlights From The American Diabetes Association's 2017 Standards Of Medical Care In Diabetes For Osteopathic Physicians
The American Diabetes Association (ADA) updates its Standards of Medical Care (SOMC) in Diabetes annually. These ADA standards make up a comprehensive document that serves as an excellent resource for clinical care. The current article comes from the ADA's Primary Care Advisory Group. This article highlights key aspects of the SOMC that are relevant to the day-to-day practice of osteopathic primary care physicians. It is not intended to replace the full SOMC but will refer to the master document for further explanation and evidence-based support. Continue reading >>
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Ada/easd New Hyperglycemia Management Guidelines
ADA/EASD New Hyperglycemia Management Guidelines ADA/EASD New Hyperglycemia Management Guidelines Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Inzucchi SE, Bergenstal RM, Buse JB, et al. Glycemic targets and glucose-lowering therapies must be individualized. Diet, exercise, and education remain the foundation of any type 2 diabetes treatment program. Unless there are prevalent contraindications, metformin is the optimal first-line drug. After metformin, there are limited data to guide us. Combination therapy with an additional 12 oral or injectable agents is reasonable, aiming to minimize side effects where possible. Ultimately, many patients will require insulin therapy alone or in combination with other agents to maintain glucose control. All treatment decisions, where possible, should be made in conjunction with the patient, focusing on his/her preferences, needs, and values. Comprehensive cardiovascular risk reduction must be a major focus of therapy. Antihyperglycemic therapy in type 2 diabetes: general recommendations, based on patient and drug characteristics See right right column to download as PowerPoint The American Diabetes Association and the European Association for the Study of Diabetes have updated guidelines on the management of hyperglycemia in nonpregnant adults with type 2 diabetes. The update is based on new evidence of risks and benefits of glycemic control, evidence on safety and efficacy of new drug classes, the withdrawal and restriction of other drug classes and the increasing need for a more patient-centered approach to care. Individualized treatment is the cornerstone of success. The nov Continue reading >>
Oral Antihyperglycemic Therapy For Type 2 Diabetes Mellitus
Oral antihyperglycemic therapy for type 2 diabetes mellitus We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Oral antihyperglycemic therapy for type 2 diabetes mellitus DIABETES MELLITUS IS A CHRONIC DISEASE that is growing in prevalence worldwide. Pharmacologic therapy is often necessary to achieve optimal glycemic control in the management of diabetes. Orally administered antihyperglycemic agents (OHAs) can be used either alone or in combination with other OHAs or insulin. The number of available OHAs has increased significantly in the last decade, which translates into more therapeutic options and complex decision-making for physicians. This review article is designed to help with these decisions. We review the mechanism of action, efficacy and side effects of the different classes of OHAs (-glucosidase inhibitors, biguanides, insulin secretagogues, insulin sensitizers and intestinal lipase inhibitor) and discuss the current recommendations for their use. Diabetes mellitus is a chronic disease that is growing in prevalence worldwide. 1 Canadian data from the National Diabetes Surveillance Strategy demonstrate a prevalence of 4.8% among adults, with the vast majority having type 2 diabetes. 2 With the growing elderly Canadian population, the rising prevalence of obesity and the alarming increase in childhood and adolescent type 2 diabetes, the burden of this disease will continue to grow. Aggressive glycemic control has been de Continue reading >>
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Ada/easd Antihyperglycemic Therapy - General Recommendations1
There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with TRADJENTA. Nasopharyngitis, hypoglycemia (when used in combination with sulfonylurea) The efficacy of TRADJENTA may be reduced when administered in combination with a strong P-gp or CYP3A4 inducer. Alternative treatments should be used. Use during pregnancy only if clearly needed. Exercise caution when administering to a nursing woman. Please see Prescribing Information and Medication Guide . INDICATION AND IMPORTANT LIMITATIONS OF USE TRADJENTA is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. TRADJENTA should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. TRADJENTA has not been studied in patients with a history of pancreatitis, and it is unknown if using TRADJENTA increases the risk of developing pancreatitis in these patients. TRADJENTA is contraindicated in patients with a history of hypersensitivity reaction to linagliptin, such as anaphylaxis, angioedema, exfoliative skin conditions, urticaria, or bronchial hyperreactivity. Acute pancreatitis, including fatal pancreatitis, has been reported in patients taking TRADJENTA. Take careful notice of potential signs and symptoms of pancreatitis and, if suspected, promptly discontinue and initiate appropriate management. It is unknown whether patients with a history of pancreatitis are at increased risk for the development of pancreatitis while using TRADJENTA. Heart failure has been observed with two other members of the dipeptidyl peptidase-4 (DPP-4) inhibitor class. Consider the risks and benefits of TRADJENTA in patients at risk for heart failure, such as those with a prior history of heart failure and Continue reading >>
Management Of Hyperglycemia In Type 2 Diabetes: A Patient-centered Approach
Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) 1 Richard M. Bergenstal , MD,2 John B. Buse , MD, PHD,3 Michaela Diamant , MD, PHD,4 Ele Ferrannini , MD,5 Michael Nauck , MD,6 Anne L. Peters , MD,7 Apostolos Tsapas , MD, PHD,8 Richard Wender , MD,9 and David R. Matthews , MD, DPHIL10,11,12 From the 1Section of Endocrinology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut; the 10Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, U.K.; the 11National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, U.K.; and the 12Harris Manchester College, University of Oxford, Oxford, U.K From the 1Section of Endocrinology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut; the 2International Diabetes Center at Park Nicollet, Minneapolis, Minnesota; the 3Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; the 4Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands; the 5Department of Medicine, University of Pisa School of Medicine, Pisa, Italy; 6Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany; the 7Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California; the 8Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece; the 9Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; the 10Oxford Centre for Diabetes, Endoc Continue reading >>
Pharmacologic Therapy For Type 2 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free
Abstract Description: The American Diabetes Association (ADA) annually updates the Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. Methods: For the 2017 Standards, the ADA Professional Practice Committee updated previous MEDLINE searches performed from 1 January 2016 to November 2016 to add, clarify, or revise recommendations based on new evidence. The committee rates the recommendations as A, B, or C, depending on the quality of evidence, or E for expert consensus or clinical experience. The Standards were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions. Recommendations: This synopsis focuses on recommendations from the 2017 Standards about pharmacologic approaches to glycemic treatment of type 2 diabetes. The American Diabetes Association (ADA) first released its Standards of Medical Care in Diabetes for health professionals in 1989. These practice guidelines provide an extensive set of evidence-based recommendations that are updated annually for the diagnosis and management of patients with diabetes. The 2017 Standards cover all aspects of patient care (1); this guideline synopsis focuses on pharmacologic approaches for patients with type 2 diabetes. Pharmacologic Therapy for Type 2 Diabetes: Recommendations Initial Treatment Approach: Metformin Assessing Response and Deciding to Intensify Therapy Recent Evidence From Cardiovascular Outcomes Trials Recent Warnings About Pharmacotherapies Insulin Therapy Continue reading >>
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8. Pharmacologic Approaches To Glycemic Treatment
PHARMACOLOGIC THERAPY FOR TYPE 1 DIABETES Most people with type 1 diabetes should be treated with multiple daily injections of prandial insulin and basal insulin or continuous subcutaneous insulin infusion. A Most individuals with type 1 diabetes should use rapid-acting insulin analogs to reduce hypoglycemia risk. A Consider educating individuals with type 1 diabetes on matching prandial insulin doses to carbohydrate intake, premeal blood glucose levels, and anticipated physical activity. E Individuals with type 1 diabetes who have been successfully using continuous subcutaneous insulin infusion should have continued access to this therapy after they turn 65 years of age. E Insulin Therapy Insulin is the mainstay of therapy for individuals with type 1 diabetes. Generally, the starting insulin dose is based on weight, with doses ranging from 0.4 to 1.0 units/kg/day of total insulin with higher amounts required during puberty. The American Diabetes Association/JDRF Type 1 Diabetes Sourcebook notes 0.5 units/kg/day as a typical starting dose in patients who are metabolically stable, with higher weight-based dosing required immediately following presentation with ketoacidosis (1), and provides detailed information on intensification of therapy to meet individualized needs. The American Diabetes Association (ADA) position statement “Type 1 Diabetes Management Through the Life Span” additionally provides a thorough overview of type 1 diabetes treatment and associated recommendations (2). Education regarding matching prandial insulin dosing to carbohydrate intake, premeal glucose levels, and anticipated activity should be considered, and selected individuals who have mastered carbohydrate counting should be educated on fat and protein gram estimation (3–5). Although most Continue reading >>
:: The Korean Journal Of Internal Medicine
The Korean Diabetes Association (KDA) recently updated the Clinical Practice Guidelines on antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus (T2DM). In combination therapy of oral hypoglycemic agents (OHAs), general recommendations were not changed from those of the 2015 KDA guidelines. The Committee on Clinical Practice Guidelines of the KDA has extensively reviewed and discussed the results of meta-analyses and systematic reviews of effectiveness and safety of OHAs and many clinical trials on Korean patients with T2DM for the update of guidelines. All OHAs were effective when added to metformin or metformin and sulfonylurea, although the effects of each agent on body weight and hypoglycemia were different. Therefore, selection of a second agent as a metformin add-on therapy or third agent as a metformin and sulfonylurea add-on therapy should be based on the patients clinical characteristics and the efficacy, side effects, mechanism of action, risk of hypoglycemia, effect on body weight, patient preference, and combined comorbidity. In this review, we address the results of meta-analyses and systematic reviews, comparing the effectiveness and safety among OHAs. It will help to choose the appropriate drug for an individual patient with T2DM. Principles of treatment with antihyperglycemic agents 1. Metformin is the preferred initial oral antihyperglycemic agent [A]. 2. If metformin is contraindicated or intolerable as the initial treatment, then another class of antihyperglycemic agent can be used, depending on the clinical situation [E]. 3. If monotherapy fails to achieve the glycemic goal, then combination therapy using a second agent with a different mechanism of action should be initiated [A]. 4. Dual combination therapy can be used as Continue reading >>
American Diabetes Association® Releases 2018 Standards Of Medical Care In Diabetes, With Notable New Recommendations For People With Cardiovascular Disease And Diabetes
ARLINGTON, Va., Dec. 8, 2017 /PRNewswire/ -- Notable new recommendations in the 2018 edition of the American Diabetes Association's (ADA's) Standards of Medical Care in Diabetes (Standards of Care) include advances in cardiovascular disease risk management including hypertension; an updated care algorithm that is patient-focused; the integration of new technology into diabetes management; and routine screening for type 2 diabetes in high-risk youth (BMI >85th percentile plus at least one additional risk factor). The Standards of Care provide the latest in comprehensive, evidence-based recommendations for the diagnosis and treatment of children and adults with type 1, type 2 or gestational diabetes, strategies to improve the prevention or delay of type 2 diabetes, and therapeutic approaches that reduce complications and positively affect health outcomes. The Standards of Care are published annually and will be available online at 4:00 p.m. ET, December 8, 2017, and as a supplement to the January 2018 print issue of Diabetes Care. Experience the interactive Multichannel News Release here: Beginning in 2018, the ADA will update and revise the online version of the Standards of Care throughout the year with necessary annotations if new evidence or regulatory changes merit immediate incorporation. This will ensure that the Standards of Care provide clinicians, patients, researchers, health plans and policymakers with the most up-to-date components of diabetes care, general treatment goals and tools to evaluate the quality of care. The Standards of Care will also be available as a user-friendly and interactive app for both web and mobile devices in the spring of 2018. The app will allow clinicians to access the most up-to-date information conveniently and will include interac Continue reading >>
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