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

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