13. pharm rx t2 dm

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13. pharm rx t2 dm

  1. 1. Patient/Population Intervention Comparison Outcomes Inclusion <ul><li>People with T2DM: </li></ul><ul><li>Hyperglycemia severity: A1C > or < 8.5-9.0% </li></ul><ul><li>Duration: newly diagnosed, recently diagnosed, drug naïve </li></ul><ul><li>Weight: lean, obese, non-obese, overweight </li></ul>Lifestyle management (diet and exercise) Standard care <ul><li>Glycemic targets: A1C, blood glucose </li></ul><ul><li>Weight </li></ul>Exclusion Pregnancy Children Adolescent
  2. 2. Patient/Population Intervention Comparisons Outcomes Inclusion <ul><li>People with T2DM: </li></ul><ul><li>Hyperglycemia severity: A1C > or < 8.5-9.0% </li></ul><ul><li>Duration: newly diagnosed, recently diagnosed, drug naïve </li></ul><ul><li>Weight: lean, obese, non-obese, overweight </li></ul>Pharmacological therapy (see slide) <ul><li>Standard care </li></ul><ul><li>Other active therapies (head to head randomized comparisons) </li></ul><ul><li>Glycemic targets: A1C, blood glucose, postprandial glucose? </li></ul><ul><li>Microvascular complications </li></ul><ul><li>Macrovascular complications </li></ul><ul><li>Hypoglycemia </li></ul><ul><li>Weight </li></ul>Exclusion Pregnancy Children Adolescent
  3. 3. Pharmacotherapy <ul><ul><li>Metformin </li></ul></ul><ul><ul><li>Sulfonylureas (glyburide, gliclazide, glimepiride, glipizide,) </li></ul></ul><ul><ul><li>Thiazolidinediones (pioglitazone, rosiglitazone) </li></ul></ul><ul><ul><li>Dipeptidyl peptidase (DPP)-IV inhibitors (sitagliptin, saxagliptin, vildagliptin, alogliptin, dutogliptin, linagliptin) </li></ul></ul><ul><ul><li>Glucagon like peptide (GLP)-1 agonists (exenatide, liraglutide) </li></ul></ul><ul><ul><li>Sodium glucose transporter (SGLT)-2 inhibitors (dapagliflozin, sergliflozin, remogliflozin) </li></ul></ul><ul><ul><li>Amylin analogue (pramlinitide) </li></ul></ul><ul><ul><li>Alpha-glucosidase inhibitor (acarbose, miglitol) </li></ul></ul><ul><ul><li>Meglitinides (repaglinide, nateglinide) </li></ul></ul><ul><ul><li>Insulin </li></ul></ul><ul><ul><li>Rapid-acting insulin analogues (aspart, glulisine, lispro) </li></ul></ul><ul><ul><li>Basal insulin analogues (glargine, levemir) </li></ul></ul><ul><ul><li>Premix (human, analogue) </li></ul></ul><ul><ul><li>Inhaled insulin </li></ul></ul><ul><ul><li>Orlistat </li></ul></ul><ul><ul><li>Sibutramine REMOVE </li></ul></ul><ul><ul><li>Dopamine agonist – bromocriptine </li></ul></ul><ul><ul><li>Bile acid sequestrants - colesevelam </li></ul></ul>
  4. 4. Patient/Population Intervention Comparison Outcomes Inclusion <ul><li>People with T2DM: </li></ul><ul><li>Hyperglycemia severity: A1C > or < 8.5-9.0% </li></ul><ul><li>Duration: newly diagnosed, recently diagnosed, drug naïve </li></ul><ul><li>Weight: lean, obese, non-obese, overweight </li></ul>Pharmacological therapy (see slide) <ul><li>Standard </li></ul><ul><li>Other active therapies (head to head randomized comparisons) </li></ul><ul><li>Adverse Events (see slide) </li></ul>Exclusion Pregnancy Children Adolescent
  5. 5. Pharmacology: Adverse Events <ul><ul><li>Myocardial infarction </li></ul></ul><ul><ul><li>Congestive heart failure </li></ul></ul><ul><ul><li>Osteoporosis, fractures </li></ul></ul><ul><ul><li>Pancreatitis </li></ul></ul><ul><ul><li>Medullary thyroid carcinoma, C-cell hyperplasia </li></ul></ul><ul><ul><li>Lymphopenia, immunosuppression </li></ul></ul><ul><ul><li>Dehydration, urinary tract infection </li></ul></ul><ul><ul><li>Cancer </li></ul></ul><ul><ul><li>Other? </li></ul></ul>
  6. 6. Patient/Population Intervention Comparison Outcomes Inclusion People with newly diagnosed T2DM Short duration intensive insulin therapy Standard Care <ul><li>Glycemic targets: A1C, blood glucose </li></ul><ul><li>Duration off pharmacotherapy </li></ul>Exclusion Pregnancy Children Adolescent
  7. 7. Patient/Population Intervention Comparison Outcomes Inclusion <ul><li>People with T2DM: </li></ul><ul><li>Hyperglycemia severity: A1C > or < 8.5-9.0% </li></ul><ul><li>Duration: newly diagnosed, recently diagnosed, drug naïve </li></ul><ul><li>Weight: lean, obese, non-obese, overweight </li></ul>Continuous subcutaneous insulin infusion (CSII) pump Standard Other active therapies <ul><li>Glycemic targets: A1C, blood glucose, postprandial glucose? </li></ul><ul><li>Microvascular complications </li></ul><ul><li>Macrovascular complications </li></ul><ul><li>Hypoglycemia </li></ul><ul><li>Weight </li></ul>Exclusion Pregnancy Children Adolescent
  8. 8. Chapter Outline <ul><li>No major changes to Preamble structure (Intro, Treatment Regimens, Hypoglycemia) </li></ul><ul><li>Table </li></ul><ul><li>Algorithm: too early to discuss design, agent order, etc. (wait for literature review and appraisal) </li></ul><ul><li>Treatment Regimens: </li></ul><ul><ul><ul><li>Insulin regimens optimal and new: MDI, Premix bid/tid, etc. </li></ul></ul></ul><ul><li>Table: </li></ul><ul><ul><ul><li>AIC: arrows down versus percentage range of lowering </li></ul></ul></ul>

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