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Transcript of Treatment Advances in Type 2 Diabetes Panhandle Nurse Practitioner Symposium April 11, 2015 Dr....
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Treatment Advances inType 2 Diabetes
Panhandle Nurse Practitioner Symposium
April 11, 2015
Dr. Caleb Kim
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Diagnosis of Diabetes Climbing Dramatically
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Type 1 verses Type 2Type 1 verses Type 2
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Diagnostic CriteriaDiagnostic Criteria
HbA1c >6.5 Fasting BG > 126 oral glucose tolerance
test
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Concerns of DM Medications Causing Concerns of DM Medications Causing HypoglycemiaHypoglycemia
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Treatment ParadigmTreatment Paradigm Step 1
◦ metformin Step 2
◦ DPP-4 vs GLP-1 Step 3
◦ SGLT-2, Actos ◦ (sulfonylureas if needed)
Step 4◦ insulin
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3 New Diabetes Medication Classes 3 New Diabetes Medication Classes Within the Past 10 YearsWithin the Past 10 Years
DPP-4 Inhibitors
SGLT-2 Inhibitors
GLP-1 Agonists
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DPP-4 MedicationsDPP-4 Medications
Tradjenta◦ Jentadueto (combo Tragjenta and metformin)
Onglyza◦ Kombiglyze (combo Onglyza and metformin)
Nesina◦ Kazano (combo Nesina and metformin)◦ Oseni (combo Nesina and pioglitazone)
Januvia◦ Janumet (combo Januvia and metformin)
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DPP-4 Mechanism of Action
inhibits dipeptidyl peptidase-4
slows incretin metabolism
increases insulin synthesis/release
decreases glucagon levels
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SGLT-2 MedicationsSGLT-2 Medications
Farxiga◦ Xigduo (combination farxiga and metformin)
Invokana◦ Invokamet (combination Inovokana and
metformin) Jardiance
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GLP-1GLP-1 Bydureon Byetta Tanzeum Victoza Trulicity
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2020
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44 year old female presents to establish PCP. ◦ PMH: DM II, BMI 32◦ Medication:
Lantus 97 units Q AM Novolog 50 units before meals Pt. taken off metformin 3 months prior due to
renal insufficiency◦ HbA1c: 13