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Recommendations For Antihyperglycemic Therapy In Type 2 Diabetes

Oral Antihyperglycemic Therapy For Type 2 Diabetes Mellitus

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 >>

Pharmacologic Therapy For Type 2 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

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 >>

Individualizing Insulin Therapy In Themanagement Of Type 2 Diabetes

Individualizing Insulin Therapy In Themanagement Of Type 2 Diabetes

Volume 127, Issue 10, Supplement , October 2014, Pages S3-S10 Individualizing Insulin Therapy in theManagement of Type 2 Diabetes Author links open overlay panel EtieMoghissiMD, FACEa Get rights and content It is recognized that reducing hyperglycemia early on in disease progression has long-term benefits for patients with diabetes. Insulin therapy has greater potential to reduce hyperglycemia than other therapies; however, there is often a significant delay in insulin initiation and intensification. Insulin replacement therapy in type 2 diabetes should no longer be viewed as the treatment of last resort. With the development of modern insulin analogs, the field has evolved. Large clinical trials have improved our understanding of the potential benefits and risks associated with intensive glycemic control in different patient populations and highlighted the need for individualization of glycemic targets and treatment strategies. Current treatment guidelines recognize the important role of insulin therapy both early on and throughout the progression of type 2 diabetes. Continue reading >>

Is Combination Antihyperglycemic Therapy Superior To Monotherapy As An Initial Type 2 Diabetes Treatment?

Is Combination Antihyperglycemic Therapy Superior To Monotherapy As An Initial Type 2 Diabetes Treatment?

Is Combination Antihyperglycemic Therapy Superior to Monotherapy as an Initial Type 2 Diabetes Treatment? Karin Sterl, MD, and Kim A. Carmichael, MDSeries Editor Q.What is the rationale behind starting initial combination therapy in patients with type 2 diabetes? A.Since type 2 diabetes is associated with multiple physiologic abnormalities, combination therapy may help address many of these concerns concomitantly so as to minimize side effects and provide rapid metabolic balance. Understanding the mechanisms of action of the differing agents will help the clinician choose the optimal regimen for any given patient. Q.What are the most common oral hypoglycemic agents used in the initial therapy of type 2 diabetes? A.The American Diabetes Association (ADA) recommends biguanides (eg, metformin in the United States), if not contraindicated, as the initial agent for treatment of type 2 diabetes.1 Metformin works by decreasing glucose production by the liver and increasing glucose uptake into the muscles. It can decrease hemoglobin A1c (HbA1c) values by 1.5% to 2%. It is contraindicated in patients with renal insufficiency (creatinine levels >1.4 mg/dL in females and >1.5 mg/dL in males). Metformin does not cause hypoglycemia, but patients frequently experience nausea and diarrhea. Side effects can be minimized or avoided by starting the medication at a low dose and gradually increasing it, taking it with food, and/or using time-release formulations. Metformin is safe, inexpensive, and may reduce cardiovascular risks. Other oral hypoglycemic agents that can be considered as first-line therapy include: Sulfonylureas. These are the most widely used antihyperglycemic medications. Some examples include glyburide, glipizide, and glimiperide. They can lower HbA1c by 1.5% to 2%. Sid Continue reading >>

Highlights From The American Diabetes Association's 2017 Standards Of Medical Care In Diabetes For Osteopathic Physicians

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 >>

Type 2 Diabetes Mellitustreatment & Management

Type 2 Diabetes Mellitustreatment & Management

Type 2 Diabetes MellitusTreatment & Management Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more... The goals in caring for patients with diabetes mellitus are to eliminate symptoms and to prevent, or at least slow, the development of complications. Microvascular (ie, eye and kidney disease) risk reduction is accomplished through control of glycemia and blood pressure; macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction, through control of lipids and hypertension, smoking cessation, and aspirin therapy; and metabolic and neurologic risk reduction, through control of glycemia. New abridged recommendations for primary care providers The American Diabetes Association has released condensed recommendations for Standards of Medical Care in Diabetes: Abridged for Primary Care Providers , highlighting recommendations most relevant to primary care. The abridged version focusses particularly on the following aspects: Diagnosis and treatment of vascular complications Intensification of insulin therapy in type 2 diabetes The recommendations can be accessed at American Diabetes Association DiabetesPro Professional Resources Online, Clinical Practice Recommendations 2015 . [ 121 ] Type 2 diabetes care is best provided by a multidisciplinary team of health professionals with expertise in diabetes, working in collaboration with the patient and family. [ 2 ] Management includes the following: Appropriate self-monitoring of blood glucose (SMBG) Ideally, blood glucose should be maintained at near-normal levels (preprandial levels of 90-130 mg/dL and hemoglobin A1C [HbA1c] levels < 7%). However, focus on glucose alone does not provide adequate treatment for patients with diabetes mellitus. Treatment involves multiple goals (ie, Continue reading >>

American Diabetes Association® Releases 2018 Standards Of Medical Care In Diabetes, With Notable New Recommendations For People With Cardiovascular Disease And Diabetes

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 >>

Ada/easd Antihyperglycemic Therapy - General Recommendations1

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 >>

Treatment Of T2dm | Outpatient.aace.com

Treatment Of T2dm | Outpatient.aace.com

Every patient with documented type 2 diabetes (T2D) should have a comprehensive care plan (CCP), which takes into account the patients unique medical history, behaviors and risk factors, ethnocultural background, and environment. The ultimate goal of the CCP is to reduce the risk of diabetes complications without jeopardizing patient safety. To achieve this goal, the CCP should include the following components:1 The multidisciplinary team typically oversees the medical management of T2D, including the prescription of antihyperglycemic therapy and the delivery of diabetes self-management education (DSME) . DSME is used to educate the patient on the components of therapeutic lifestyle changes, namely medical nutritional therapy (MNT) and physical activity. Each patients understanding of and participation in the CCP is essential to its success.1 The components of therapeutic lifestyle change include:1 Nutritional medicine for diabetes involves counseling about general healthful eating, MNT, as well as nutritional support when appropriate (eg, in patients receiving enteral or parenteral nutrition in which medications provided for glycemic control must be synchronized with carbohydrate delivery; see AACE Inpatient Glycemic Control Resource Center for more information).1 Either the physician or a registered dietitian (RD) should discuss healthful eating recommendations in plain language at diagnosis of T2D and then periodically during follow-up office visits (Table 1). These recommendations are suitable for the general population, including people without diabetes, and focus on foods that can promote health vs foods that may promote disease or complications. Discussions should cover specific foods, dishes, meal planning, grocery shopping, and dining-out strategies.1 Table 1. 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

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 >>

Tailoring Treatment To Reduce Disparities:

Tailoring Treatment To Reduce Disparities:

The American Diabetes Association (ADA) publishes the Standards of Medical Care in Diabetes annually, based on the latest medical research. The following narrative provides a summary of the 2017 updated recommendations that have been developed for clinical practice. The ADA guidelines are not intended to aid or preclude clinical judgment. The full guidelines can be accessed at ADA’s Diabetes Pro website. Tailoring Treatment to Reduce Disparities: Updated guidelines focus on improving outcomes and reducing disparities in populations with diabetes such as: Ethnic/Cultural/Sex/Socioeconomic Differences and Disparities: Provide structured interventions that are tailored to ethnic populations and integrate culture, language, religion, and literacy skills. Food Insecurity: Evaluate hyperglycemia and hypoglycemia in the context of food insecurity (FI), which is defined as the unreliable availability of nutritious food. Recognize that homelessness and poor literacy and numeracy often occur with FI. Propose solutions and resources accordingly. Comprehensive Medical Evaluation and Assessment of Comorbidities: The clinical evaluation should include conversation about lifestyle modifications and healthy living. PAs should address barriers including patient factors (e.g., remembering to obtain or take medications, fears, depression, and health beliefs), medication factors (e.g., complex directions, cost) and system factors (e.g., inadequate follow up). Simplifying treatment regimens may improve adherence. This section highlights the elements of a patient-centered comprehensive medical exam, including the importance of assessing comorbidities such as: Cognitive Dysfunction: Tailor glycemic therapy to avoid significant hypoglycemia. Cardiovascular benefits of statin therapy outweigh Continue reading >>

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 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 >>

Antihyperglycemic Therapy In Elderly Diabetics

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 >>

Antihyperglycemic Agent Therapy For Adult Patients With Type 2 Diabetes Mellitus 2017: A Position Statement Of The Korean Diabetes Association

Antihyperglycemic Agent Therapy For Adult Patients With Type 2 Diabetes Mellitus 2017: A Position Statement Of The Korean Diabetes Association

Antihyperglycemic Agent Therapy for Adult Patients with Type 2 Diabetes Mellitus 2017: A Position Statement of the Korean Diabetes Association 4 Jin Hwa Kim ,9 and Committee of Clinical Practice Guideline of Korean Diabetes Association 1Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 5Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. 8Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea. 1Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea. 4Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. 5Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. 6Department of Internal Medicine, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea. 7Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. 8Division of Endocrinology and Metabolism, Department of Internal Medicine, Ch Continue reading >>

Ada/easd New Hyperglycemia Management Guidelines

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 >>

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