This slide is about diabetes care I presented on April 9th, 2015. My audience is a group of elder people who has interest in this topic, some of them are patients, some are family members. Most of the slides are Chinese because my audience use Chinese most. My targets are to let people understand what are their sugar-control medicine do their jobs and what they should be aware while using them.
Etiopathogenesis and pharmacotherapy of hyperlipidemias
a. the pathophysiology of selected disease states and the rationale for drug therapy;
b. the therapeutic approach to management of these diseases;
c. the controversies in drug therapy;
d. the importance of preparation of individualised therapeutic plans based on diagnosis;
e. needs to identify the patient-specific parameters relevant in initiating drug therapy,
and monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects);
f. describe the pathophysiology of selected disease states and explain the rationale for
drug therapy;
g. summarise the therapeutic approach to management of these diseases including
reference to the latest available evidence;
h. discuss the controversies in drug therapy;
i. discuss the preparation of individualised therapeutic plans based on diagnosis; and
j. identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory indices of therapeutic response and adverse effects).
Anti hypertensives and diuretics drugs - pharmacology Areej Abu Hanieh
Hypertension is defined as blood pressure greater than 140/90 mmHg. It can be caused by increased vascular resistance or reduced venous capacitance. While often asymptomatic, long term effects include strokes, heart failure, kidney damage, etc. Treatment involves lifestyle modifications and medications like diuretics, beta blockers, ACE inhibitors, and calcium channel blockers to lower blood pressure and reduce risks. Careful management is needed as uncontrolled hypertension can lead to serious health issues.
This document discusses SGLT2 inhibitors and DPP-4 inhibitors for the treatment of type 2 diabetes. SGLT2 inhibitors work by increasing glucose excretion in the urine, independently of insulin. They modestly lower blood pressure and weight. DPP-4 inhibitors work by inhibiting the DPP-4 enzyme and increasing GLP-1 and GIP levels. Both classes have few hypoglycemia risks but SGLT2 inhibitors should be used with caution in those with kidney impairment. Empagliflozin and canagliflozin are recommended for patients with cardiovascular disease.
This document discusses bisoprolol, a beta-1 selective adrenoceptor blocking agent used to treat hypertension and angina. It provides details on bisoprolol's history, pharmacological properties, therapeutic indications, contraindications, adverse reactions, and toxicological studies. Bisoprolol is a highly selective beta-1 blocker that is well-absorbed orally and has a half-life of 10-12 hours. It is used to treat hypertension, angina, and heart failure by reducing heart rate and contractility. Adverse effects include fatigue, dizziness, and bronchospasm. Toxicology studies found it to be non-cytotoxic, non-mutagenic, and
Telmisartan is a new angiotensin receptor blocker (ARB) that has several potential advantages over other ARBs. It has the strongest binding affinity to the AT1 receptor compared to other ARBs. This may provide stronger and longer-lasting blood pressure lowering effects. Telmisartan also has partial agonist effects on peroxisome proliferator-activated receptor gamma, which can improve insulin resistance and exert anti-inflammatory and anti-proliferative effects in the vasculature. Studies in animals and cells suggest Telmisartan may have insulin sensitizing effects and protect against diabetic complications by blocking upregulation of VEGF and AGE-RAGE protein expression in the retina. While more randomized clinical trials
Vildagliptin is a DPP-IV inhibitor used to treat type 2 diabetes. It works by inhibiting the DPP-IV enzyme, which helps increase levels of incretin hormones like GLP-1. This enhances the effects of GLP-1, including stimulating more insulin release from beta cells and suppressing glucagon secretion. Clinical studies showed vildagliptin lowers blood glucose levels and is well tolerated with a low risk of hypoglycemia and no weight gain.
This slide is about diabetes care I presented on April 9th, 2015. My audience is a group of elder people who has interest in this topic, some of them are patients, some are family members. Most of the slides are Chinese because my audience use Chinese most. My targets are to let people understand what are their sugar-control medicine do their jobs and what they should be aware while using them.
Etiopathogenesis and pharmacotherapy of hyperlipidemias
a. the pathophysiology of selected disease states and the rationale for drug therapy;
b. the therapeutic approach to management of these diseases;
c. the controversies in drug therapy;
d. the importance of preparation of individualised therapeutic plans based on diagnosis;
e. needs to identify the patient-specific parameters relevant in initiating drug therapy,
and monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects);
f. describe the pathophysiology of selected disease states and explain the rationale for
drug therapy;
g. summarise the therapeutic approach to management of these diseases including
reference to the latest available evidence;
h. discuss the controversies in drug therapy;
i. discuss the preparation of individualised therapeutic plans based on diagnosis; and
j. identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory indices of therapeutic response and adverse effects).
Anti hypertensives and diuretics drugs - pharmacology Areej Abu Hanieh
Hypertension is defined as blood pressure greater than 140/90 mmHg. It can be caused by increased vascular resistance or reduced venous capacitance. While often asymptomatic, long term effects include strokes, heart failure, kidney damage, etc. Treatment involves lifestyle modifications and medications like diuretics, beta blockers, ACE inhibitors, and calcium channel blockers to lower blood pressure and reduce risks. Careful management is needed as uncontrolled hypertension can lead to serious health issues.
This document discusses SGLT2 inhibitors and DPP-4 inhibitors for the treatment of type 2 diabetes. SGLT2 inhibitors work by increasing glucose excretion in the urine, independently of insulin. They modestly lower blood pressure and weight. DPP-4 inhibitors work by inhibiting the DPP-4 enzyme and increasing GLP-1 and GIP levels. Both classes have few hypoglycemia risks but SGLT2 inhibitors should be used with caution in those with kidney impairment. Empagliflozin and canagliflozin are recommended for patients with cardiovascular disease.
This document discusses bisoprolol, a beta-1 selective adrenoceptor blocking agent used to treat hypertension and angina. It provides details on bisoprolol's history, pharmacological properties, therapeutic indications, contraindications, adverse reactions, and toxicological studies. Bisoprolol is a highly selective beta-1 blocker that is well-absorbed orally and has a half-life of 10-12 hours. It is used to treat hypertension, angina, and heart failure by reducing heart rate and contractility. Adverse effects include fatigue, dizziness, and bronchospasm. Toxicology studies found it to be non-cytotoxic, non-mutagenic, and
Telmisartan is a new angiotensin receptor blocker (ARB) that has several potential advantages over other ARBs. It has the strongest binding affinity to the AT1 receptor compared to other ARBs. This may provide stronger and longer-lasting blood pressure lowering effects. Telmisartan also has partial agonist effects on peroxisome proliferator-activated receptor gamma, which can improve insulin resistance and exert anti-inflammatory and anti-proliferative effects in the vasculature. Studies in animals and cells suggest Telmisartan may have insulin sensitizing effects and protect against diabetic complications by blocking upregulation of VEGF and AGE-RAGE protein expression in the retina. While more randomized clinical trials
Vildagliptin is a DPP-IV inhibitor used to treat type 2 diabetes. It works by inhibiting the DPP-IV enzyme, which helps increase levels of incretin hormones like GLP-1. This enhances the effects of GLP-1, including stimulating more insulin release from beta cells and suppressing glucagon secretion. Clinical studies showed vildagliptin lowers blood glucose levels and is well tolerated with a low risk of hypoglycemia and no weight gain.
HYPERTENSION- THE LATEST MANAGEMENT
Dr. Awadhesh kumar sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college jhansi. Then he did his superspecilisation degree DM in Cardiology from PGIMER & DR Ram Manoher Lohia Hospital Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM.He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Smt Mayawati in 2009.He is also receiver of GEMS international award.He had many national & international publications.He is also in editorial board of international journal- Journal of clinical medicine & research(JCMR).He is also active member of reviewer board of many journals.He is also trainee fellow of American college of cardiology. He is currently working in NABH Approved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist.
This document discusses diabetic nephropathy and provides updates on the topic. It notes that diabetes is a leading global epidemic and cause of end-stage renal failure. Almost one third of people with type 2 diabetes develop kidney disease. The natural history and stages of progression of diabetic nephropathy are described. The definition, pathogenesis, risk factors, and treatment of diabetic nephropathy are summarized, including the roles of genetics, hypertension, the renin-angiotensin system, and other biochemical pathways in disease development and progression.
ACE ACE inhibitors and ARBs in Heart Failure -What Does the evidence say?Syed Raza
This document discusses evidence from landmark clinical trials regarding the use of ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in the treatment of heart failure. It summarizes that ACEIs such as enalapril have been shown to reduce mortality and hospitalizations in heart failure patients based on the SOLVD trial. ARBs such as candesartan were also shown to reduce cardiovascular outcomes compared to placebo in trials like CHARM. However, while ACEIs/ARBs may improve symptoms in heart failure with preserved ejection fraction, none have demonstrated a reduction in mortality for this subgroup according to trials such as PEP-CHF.
1. Heart failure affects 1.5-2% of the global population and is characterized by the heart's inability to pump an adequate amount of blood to meet the body's needs.
2. Common causes include coronary heart disease, hypertension, cardiomyopathies, and arrhythmias.
3. Heart failure progresses through stages from no limitation of physical activity to severe limitations where any physical activity causes deterioration of health. Treatment aims to reduce preload and afterload on the heart.
1) Dapagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor that works by inhibiting glucose reabsorption in the kidney and increasing glucose excretion in the urine.
2) Studies have shown that dapagliflozin reduces HbA1c and body weight when used as monotherapy or as add-on therapy to other glucose-lowering medications, including metformin, sulfonylureas, pioglitazone, and insulin. Reductions in HbA1c were sustained over 102 weeks.
3) Common side effects of dapagliflozin include increased urinary tract and genital infections, as well
SGLT2 Inhibitors (Gliflozins): A New Class of Drugs to treat Type 2 Diabetes:Naina Mohamed, PhD
Sodium-Glucose Linked Transporter 2 (SGLT2) inhibitors such as Dapagliflozin (Farxiga), Canagliflozin (Invokana) and Empagliflozin (Jardiance) are a new class of oral drugs available to treat type 2 diabetes mellitus (Type 2 DM).
1) Angiotensin receptor blockers (ARBs) are a class of drugs that block the renin-angiotensin-aldosterone system by selectively blocking the angiotensin II type 1 receptor.
2) Losartan was the first ARB developed and approved for clinical use in 1995. Since then, several other ARBs have been approved to treat hypertension, heart failure, diabetic nephropathy, and stroke.
3) ARBs are as effective as ACE inhibitors at lowering blood pressure and preventing cardiovascular events with fewer side effects like cough. They are considered a first-line treatment for hypertension by European guidelines.
This document provides an overview of diabetic kidney disease. It discusses how diabetes is the leading cause of chronic kidney disease and end-stage renal disease. It covers the diagnosis of diabetic kidney disease based on albuminuria and decreased estimated glomerular filtration rate. Risk factors, pathogenesis, natural history, and management strategies such as glycemic control, blood pressure control, angiotensin inhibition, and reducing proteinuria are described in detail. The roles of various drug classes and lifestyle modifications in slowing the progression of diabetic kidney disease are also summarized.
Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) can help optimize heart failure management. CRT improves symptoms, reduces hospitalizations, and increases survival in patients with reduced ejection fraction, left bundle branch block, and wide QRS duration. ICDs prevent sudden cardiac death in high-risk patients with prior heart failure, low ejection fraction, or history of dangerous arrhythmias. New devices use adaptive and multi-point pacing to better resynchronize the left ventricle. Device therapy improves outcomes when guided by clinical evidence and used in appropriate heart failure patients.
This document discusses hyperlipidemia and cholesterol. It defines important acronyms like HDL, LDL, VLDL and cholesterol levels. It lists major risk factors for high cholesterol like smoking, family history, age and obesity. It discusses therapeutic agents to treat high cholesterol like statins, fibric acids, niacin and bile acid resins. It provides an overview of their mechanisms of action, dosages and side effects. It emphasizes the importance of dietary changes like reducing fat and alcohol intake and increasing fiber for overall cholesterol management.
This document provides information about the beta blocker Betabis (Bisoprolol hemifumarate USP) including its composition, indications, dosage, side effects and positioning compared to other beta blockers. Betabis is a highly selective beta-1 blocker that effectively controls high blood pressure and angina. It shows no impact on lipid or blood glucose levels, making it safer for diabetes patients compared to non-selective beta blockers.
Updates On the Treatment of Type 2 Diabetes Mellitus Omar Kamal
This document summarizes recent updates on the treatment of type 2 diabetes mellitus. It discusses the pathophysiology of type 2 diabetes and reviews commonly used drug classes like sulfonylureas, thiazolidinediones, metformin, and insulin. It then introduces newer drug classes like SGLT2 inhibitors and GLP-1 receptor agonists. It also discusses the use of bariatric surgery and new basal insulins like insulin glargine U300 and insulin degludec. Finally, it considers whether GLP-1 receptor agonists should replace metformin as the first-line oral therapy for type 2 diabetes given their superior efficacy but higher cost compared to generic metformin.
Dapagliflozin is an SGLT2 inhibitor that has shown benefits in managing type 2 diabetes and reducing cardiovascular outcomes. The document summarizes results from several key studies on dapagliflozin. The DECLARE-TIMI trial showed that dapagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure compared to placebo in patients with type 2 diabetes with high cardiovascular risk. The DAPA-HF trial found that dapagliflozin reduced the risks of worsening heart failure or cardiovascular death compared to placebo in patients with heart failure regardless of diabetes status. Dapagliflozin also improved outcomes related to heart failure in the DEFINE-HF trial.
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
role of diuretics in the management of congestive heart failurePriyatham Kasaraneni
Diuretics are used to treat congestive heart failure (CHF) by reducing preload and removing edema. They work by increasing urination and fluid loss. Loop diuretics like furosemide are most effective for rapid fluid removal in moderate to severe CHF. Thiazide diuretics are used for mild to moderate cases. Both can cause side effects like hypokalemia and hyponatremia. K+ sparing diuretics and aldosterone inhibitors are also used alone or combined with other diuretics to prevent electrolyte loss. Diuretics relieve symptoms of CHF but do not cure its underlying causes.
This document provides information on hyperlipidemia and dyslipidemia, including their causes, risk factors, diagnostic testing, and treatment options. It notes that disorders of lipoprotein metabolism that increase LDL-C and total cholesterol while decreasing HDL-C raise cardiovascular disease risk. Genetic and environmental factors both contribute to primary dyslipidemia. Lifestyle changes and lipid-lowering medications, particularly statins, are used to treat abnormal lipid levels and reduce disease risk. The main drug classes for treatment include statins, fibrates, bile acid sequestrants, cholesterol absorption inhibitors, and niacin.
Chlorthalidone has been shown to be more effective at lowering blood pressure than hydrochlorothiazide, especially at night, due to its longer half-life. Evidence from large clinical trials also indicates that chlorthalidone reduces cardiovascular outcomes more than hydrochlorothiazide when used for hypertension. As a result, clinical guidelines now recommend chlorthalidone as the first-line thiazide-type diuretic for treating hypertension.
This document presents a case study of a 53-year-old African American woman (Patient A) with a 17-year history of type 2 diabetes, hypertension, and hyperlipidemia who presents with shortness of breath, pruritus, and leg edema. Laboratory tests show abnormal kidney and liver function as well as poor diabetes control. The likely diagnosis is diabetic nephropathy based on her medical history and test results. Treatment goals should focus on improving blood pressure and glucose control as well as reducing albuminuria through medication changes and lifestyle modifications.
This document discusses the management of type 2 diabetes. It outlines lifestyle modifications like diet, exercise and weight loss that can help control blood glucose levels. It also discusses various classes of diabetic medications, including their mechanisms of action, indications, side effects and examples of drugs in each class. The goal of treatment is to achieve adequate glycemic control while preventing complications through a stepped care approach involving lifestyle changes and gradual escalation of medications if needed.
HYPERTENSION- THE LATEST MANAGEMENT
Dr. Awadhesh kumar sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college jhansi. Then he did his superspecilisation degree DM in Cardiology from PGIMER & DR Ram Manoher Lohia Hospital Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM.He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Smt Mayawati in 2009.He is also receiver of GEMS international award.He had many national & international publications.He is also in editorial board of international journal- Journal of clinical medicine & research(JCMR).He is also active member of reviewer board of many journals.He is also trainee fellow of American college of cardiology. He is currently working in NABH Approved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist.
This document discusses diabetic nephropathy and provides updates on the topic. It notes that diabetes is a leading global epidemic and cause of end-stage renal failure. Almost one third of people with type 2 diabetes develop kidney disease. The natural history and stages of progression of diabetic nephropathy are described. The definition, pathogenesis, risk factors, and treatment of diabetic nephropathy are summarized, including the roles of genetics, hypertension, the renin-angiotensin system, and other biochemical pathways in disease development and progression.
ACE ACE inhibitors and ARBs in Heart Failure -What Does the evidence say?Syed Raza
This document discusses evidence from landmark clinical trials regarding the use of ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in the treatment of heart failure. It summarizes that ACEIs such as enalapril have been shown to reduce mortality and hospitalizations in heart failure patients based on the SOLVD trial. ARBs such as candesartan were also shown to reduce cardiovascular outcomes compared to placebo in trials like CHARM. However, while ACEIs/ARBs may improve symptoms in heart failure with preserved ejection fraction, none have demonstrated a reduction in mortality for this subgroup according to trials such as PEP-CHF.
1. Heart failure affects 1.5-2% of the global population and is characterized by the heart's inability to pump an adequate amount of blood to meet the body's needs.
2. Common causes include coronary heart disease, hypertension, cardiomyopathies, and arrhythmias.
3. Heart failure progresses through stages from no limitation of physical activity to severe limitations where any physical activity causes deterioration of health. Treatment aims to reduce preload and afterload on the heart.
1) Dapagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor that works by inhibiting glucose reabsorption in the kidney and increasing glucose excretion in the urine.
2) Studies have shown that dapagliflozin reduces HbA1c and body weight when used as monotherapy or as add-on therapy to other glucose-lowering medications, including metformin, sulfonylureas, pioglitazone, and insulin. Reductions in HbA1c were sustained over 102 weeks.
3) Common side effects of dapagliflozin include increased urinary tract and genital infections, as well
SGLT2 Inhibitors (Gliflozins): A New Class of Drugs to treat Type 2 Diabetes:Naina Mohamed, PhD
Sodium-Glucose Linked Transporter 2 (SGLT2) inhibitors such as Dapagliflozin (Farxiga), Canagliflozin (Invokana) and Empagliflozin (Jardiance) are a new class of oral drugs available to treat type 2 diabetes mellitus (Type 2 DM).
1) Angiotensin receptor blockers (ARBs) are a class of drugs that block the renin-angiotensin-aldosterone system by selectively blocking the angiotensin II type 1 receptor.
2) Losartan was the first ARB developed and approved for clinical use in 1995. Since then, several other ARBs have been approved to treat hypertension, heart failure, diabetic nephropathy, and stroke.
3) ARBs are as effective as ACE inhibitors at lowering blood pressure and preventing cardiovascular events with fewer side effects like cough. They are considered a first-line treatment for hypertension by European guidelines.
This document provides an overview of diabetic kidney disease. It discusses how diabetes is the leading cause of chronic kidney disease and end-stage renal disease. It covers the diagnosis of diabetic kidney disease based on albuminuria and decreased estimated glomerular filtration rate. Risk factors, pathogenesis, natural history, and management strategies such as glycemic control, blood pressure control, angiotensin inhibition, and reducing proteinuria are described in detail. The roles of various drug classes and lifestyle modifications in slowing the progression of diabetic kidney disease are also summarized.
Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) can help optimize heart failure management. CRT improves symptoms, reduces hospitalizations, and increases survival in patients with reduced ejection fraction, left bundle branch block, and wide QRS duration. ICDs prevent sudden cardiac death in high-risk patients with prior heart failure, low ejection fraction, or history of dangerous arrhythmias. New devices use adaptive and multi-point pacing to better resynchronize the left ventricle. Device therapy improves outcomes when guided by clinical evidence and used in appropriate heart failure patients.
This document discusses hyperlipidemia and cholesterol. It defines important acronyms like HDL, LDL, VLDL and cholesterol levels. It lists major risk factors for high cholesterol like smoking, family history, age and obesity. It discusses therapeutic agents to treat high cholesterol like statins, fibric acids, niacin and bile acid resins. It provides an overview of their mechanisms of action, dosages and side effects. It emphasizes the importance of dietary changes like reducing fat and alcohol intake and increasing fiber for overall cholesterol management.
This document provides information about the beta blocker Betabis (Bisoprolol hemifumarate USP) including its composition, indications, dosage, side effects and positioning compared to other beta blockers. Betabis is a highly selective beta-1 blocker that effectively controls high blood pressure and angina. It shows no impact on lipid or blood glucose levels, making it safer for diabetes patients compared to non-selective beta blockers.
Updates On the Treatment of Type 2 Diabetes Mellitus Omar Kamal
This document summarizes recent updates on the treatment of type 2 diabetes mellitus. It discusses the pathophysiology of type 2 diabetes and reviews commonly used drug classes like sulfonylureas, thiazolidinediones, metformin, and insulin. It then introduces newer drug classes like SGLT2 inhibitors and GLP-1 receptor agonists. It also discusses the use of bariatric surgery and new basal insulins like insulin glargine U300 and insulin degludec. Finally, it considers whether GLP-1 receptor agonists should replace metformin as the first-line oral therapy for type 2 diabetes given their superior efficacy but higher cost compared to generic metformin.
Dapagliflozin is an SGLT2 inhibitor that has shown benefits in managing type 2 diabetes and reducing cardiovascular outcomes. The document summarizes results from several key studies on dapagliflozin. The DECLARE-TIMI trial showed that dapagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure compared to placebo in patients with type 2 diabetes with high cardiovascular risk. The DAPA-HF trial found that dapagliflozin reduced the risks of worsening heart failure or cardiovascular death compared to placebo in patients with heart failure regardless of diabetes status. Dapagliflozin also improved outcomes related to heart failure in the DEFINE-HF trial.
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
role of diuretics in the management of congestive heart failurePriyatham Kasaraneni
Diuretics are used to treat congestive heart failure (CHF) by reducing preload and removing edema. They work by increasing urination and fluid loss. Loop diuretics like furosemide are most effective for rapid fluid removal in moderate to severe CHF. Thiazide diuretics are used for mild to moderate cases. Both can cause side effects like hypokalemia and hyponatremia. K+ sparing diuretics and aldosterone inhibitors are also used alone or combined with other diuretics to prevent electrolyte loss. Diuretics relieve symptoms of CHF but do not cure its underlying causes.
This document provides information on hyperlipidemia and dyslipidemia, including their causes, risk factors, diagnostic testing, and treatment options. It notes that disorders of lipoprotein metabolism that increase LDL-C and total cholesterol while decreasing HDL-C raise cardiovascular disease risk. Genetic and environmental factors both contribute to primary dyslipidemia. Lifestyle changes and lipid-lowering medications, particularly statins, are used to treat abnormal lipid levels and reduce disease risk. The main drug classes for treatment include statins, fibrates, bile acid sequestrants, cholesterol absorption inhibitors, and niacin.
Chlorthalidone has been shown to be more effective at lowering blood pressure than hydrochlorothiazide, especially at night, due to its longer half-life. Evidence from large clinical trials also indicates that chlorthalidone reduces cardiovascular outcomes more than hydrochlorothiazide when used for hypertension. As a result, clinical guidelines now recommend chlorthalidone as the first-line thiazide-type diuretic for treating hypertension.
This document presents a case study of a 53-year-old African American woman (Patient A) with a 17-year history of type 2 diabetes, hypertension, and hyperlipidemia who presents with shortness of breath, pruritus, and leg edema. Laboratory tests show abnormal kidney and liver function as well as poor diabetes control. The likely diagnosis is diabetic nephropathy based on her medical history and test results. Treatment goals should focus on improving blood pressure and glucose control as well as reducing albuminuria through medication changes and lifestyle modifications.
This document discusses the management of type 2 diabetes. It outlines lifestyle modifications like diet, exercise and weight loss that can help control blood glucose levels. It also discusses various classes of diabetic medications, including their mechanisms of action, indications, side effects and examples of drugs in each class. The goal of treatment is to achieve adequate glycemic control while preventing complications through a stepped care approach involving lifestyle changes and gradual escalation of medications if needed.
This is to introduce the evolution of Hyperlipidemia Guideline in the US and Taiwan. SInce low dose Crestor threapy is common in Taiwan, we survey the efficacy of Crestor therapy at the dose lower than 5mg per day. Meanwhile, we compare the effect of daily and alternative day dosing of Crestor.
5. Markers on timeline represent trial completion (except for VERTIS CV, AMPLITUDE-O and SOUL, for which estimated trial completion dates are provided), all of which
come from ClinicalTrials.gov. Primary endpoint is 3P-MACE unless indicated otherwise
See slide notes for abbreviations and full list of references
TECOS5
Sitagliptin
N=14,671
4P-MACE
ELIXA4
Lixisenatide
N=6068
4P-MACE
EMPA-REG OUTCOME6
Empagliflozin
N=7020
CARMELINA13
Linagliptin
N=6979
EXSCEL12
Exenatide
N=14,752
DECLARE-TIMI 5817
Dapagliflozin
N=17,160
3P-MACE and
CV death or HHF
CANVAS Program11
Canagliflozin
N=10,142
FREEDOM-CVO8,9
ITCA 650
N=4156
4P-MACE
PIONEER 619
Semaglutide (oral)
N=3183
CAROLINA18
Linagliptin
N=6041
Harmony
Outcomes14
Albiglutide
N=9463
REWIND15,16
Dulaglutide
N=9901
LEADER7
Liraglutide
N=9340
SUSTAIN-610
Semaglutide (inj.)
N=3297
VERTIS CV20
Ertugliflozin
N=8000
DPP-4 inhibitor
SGLT2 inhibitor
GLP-1 RA
EXAMINE3
Alogliptin
N=5380
SAVOR-TIMI 532
Saxagliptin
N=16,492
2013 2014 2015 2016 2017 2018 2019 2020 2021
AMPLITUDE-O21
Efpeglenatide
N=4076
SOUL22
Semaglutide (oral)
N=9642
2024
Since the 2008 FDA mandate, more than 190,000 patients have been
enrolled in outcomes trials
6. 3P MACE SGLT2i 與 GLP1 部分藥物表現優於安慰劑
0.25 0.5 1 2
Drug class Trial (study drug) HR (95% CI) p-value
SGLT2 inhibitor EMPA-REG OUTCOME1 (empagliflozin) 0.86 (0.74, 0.99) 0.04
CANVAS Program2 (canagliflozin) 0.86 (0.75, 0.97) 0.02
DECLARE-TIMI 583 (dapagliflozin) 0.93 (0.84, 1.03) 0.17
GLP-1 RA ELIXA4 (lixisenatide) 1.02 (0.89, 1.17) 0.81
LEADER5 (liraglutide) 0.87 (0.78, 0.97) 0.01
SUSTAIN-66 (inj. semaglutide) 0.74 (0.58, 0.95) 0.02
PIONEER 6†7 (oral semaglutide) 0.79 (0.57, 1.11) 0.17
EXSCEL8 (exenatide) 0.91 (0.83, 1.00) 0.06
Harmony Outcomes9 (albiglutide) 0.78 (0.68, 0.90) 0.0006
REWIND†10 (dulaglutide) 0.88 (0.79, 0.99) 0.026
DPP-4 inhibitor SAVOR-TIMI 5311 (saxagliptin) 1.00 (0.89, 1.12) 0.99
EXAMINE12 (alogliptin) 0.96 (≤1.16)‡ 0.315
TECOS13 (sitagliptin) 0.99 (0.89, 1.10) 0.84
CARMELINA14 (linagliptin) 1.02 (0.89, 1.17) <0.001§
Comparison of trials should be interpreted with caution due to differences in study design, populations and methodology
ELIXA and TECOS data are for 4P-MACE, all other data are for 3P-MACE
*FDA-mandated upper 95% CI of the HR for CV safety is a margin of 1.3 for post-approval trials and 1.8 for pre-approval trials. SUSTAIN-6 and PIONEER 6 were pre-approval trials;
†3P-MACE included death from unknown causes; ‡Upper bound of the one-sided 95% CI, α=0.01; §p-value for non-inferiority, all others are for superiority
See slide notes for full list of references
1.3
FDA-mandated upper
95% CI for CV safety*
1.8
Favours study drug Favours placebo
7. HHF SGLT2i 呈現一致的趨勢
Drug class Trial (study drug) HR (95% CI) p-value
SGLT2 inhibitor EMPA-REG OUTCOME1 (empagliflozin) 0.65 (0.50, 0.85) 0.002*
CANVAS Program2 (canagliflozin) 0.67 (0.52, 0.87) NR†
DECLARE-TIMI 583 (dapagliflozin) 0.73 (0.61, 0.88) NR†
GLP-1 RA ELIXA4 (lixisenatide) 0.96 (0.75, 1.23) 0.75
LEADER5 (liraglutide) 0.87 (0.73, 1.05) 0.14
SUSTAIN-66 (inj. semaglutide) 1.11 (0.77, 1.61) 0.57
PIONEER 67 (oral semaglutide) 0.86 (0.48, 1.55) NR†
EXSCEL8 (exenatide) 0.94 (0.78, 1.13) NR†
Harmony Outcomes‡9 (albiglutide) 0.85 (0.70, 1.04) 0.113
REWIND§10 (dulaglutide) 0.93 (0.77, 1.12) 0.46
DPP-4 inhibitor SAVOR-TIMI 5311 (saxagliptin) 1.27 (1.07, 1.51) 0.007*
EXAMINE12 (alogliptin) 1.19 (0.90, 1.58) 0.22¶
TECOS**13 (sitagliptin) 1.00 (0.83, 1.20) 0.98
CARMELINA14 (linagliptin) 0.90 (0.74, 1.08) 0.26
Comparison of trials should be interpreted with caution due to differences in study design, populations and methodology
Dapagliflozin is FDA-approved to reduce the risk of HHF in adults with T2D and established CV disease or multiple CV risk factors
*Nominal p-value; †p-value not reported in publication; ‡CV death or HHF was a composite secondary endpoint; HHF data alone were not reported in the primary publication; §HF outcome
was hospital admission for HF or urgent visit; ¶Post hoc analysis value; **Adjusted for history of HF at baseline
See slide notes for abbreviations and full list of references
0.25 0.5 1 2
Favours study drug Favours placebo
8. Composite kidney outcomes SGLT2i 與 GLP1 表現不錯
Patients Events Weights (%) HR (95% CI) HR (95% CI)
SGLT2 inhibitor*†1
EMPA-REG OUTCOME (empagliflozin) 6185 913 24.9 0.61 (0.53, 0.70)
CANVAS Program (canagliflozin) 10,142 847 25.0 0.57 (0.50, 0.66)
DECLARE-TIMI 58 (dapagliflozin) 17,160 1675 50.1 0.66 (0.60, 0.73)
GLP-1 RA1*‡
ELIXA (lixisenatide) 5286 375 20.0 0.84 (0.68, 1.02)
LEADER (liraglutide) 9340 605 32.2 0.78 (0.67, 0.92)
SUSTAIN-6 (inj. semaglutide) 3297 162 7.7 0.64 (0.46, 0.88)
EXSCEL (exenatide) 14,752 773 40.1 0.88 (0.76, 1.01)
REWIND (dulaglutide)2 9901 1338 – 0.76 (0.68, 0.84)
DPP-4 inhibitor
CARMELINA (linagliptin)3 6979 633 – 1.04 (0.89, 1.22)
Comparison of trials should be interpreted with caution due to differences in study design, populations and methodology
p-value for subgroup differences between SGLT2 inhibitors and GLP-1 RAs was 0.01
*New-onset macroalbuminuria, sustained doubling of serum creatinine or a 40% decline in eGFR, end-stage kidney disease or death due to kidney
causes; †Q statistic=2.99; p=0.22, I2=33.2%; ‡Q statistic =3.60; p=0.31, I2=16.6% (excluding REWIND)
1. Zelniker TA et al. Circulation 2019;139:2022; 2. Gerstein HC et al. Lancet 2019;394:131; 3. Rosenstock J et al. JAMA 2019;321:69
Favours study drug Favours placebo
0.25 0.5 1 2
14. | 14
PHARMACOLOGIC APPROACHES TO GLYCEMIC TREATMENT
Glucose-
lowering
Medication in
Type 2
Diabetes:
Overall
Approach
Pharmacologic
Approaches to
Glycemic
Management:
Standards of Medical
Care in Diabetes -
2020. Diabetes Care
2020;43(Suppl. 1):S98-
S110
39. CKD is defined as abnormalities of kidney structure or function, present for >3 months, with implications for health. CKD is classified
based on Cause, GFR category (G1–G5), and Albuminuria category (A1–A3), abbreviated as CGA.
40. Figure 2 | Kidney–heart risk factor management.
SGLT2i and RAS blockade are recommended for most patients
41. Figure 4 | Monitoring of serum creatinine and potassium during ACEi or ARB treatment—dose adjustment and monitoring of side effects.
ACEI/ARB
42. Figure 18 | Treatment algorithm for selecting antihyperglycemic drugs for patients with T2D and CKD
Metformin
43. Figure 24 | Algorithm for initiation of SGLT2 inhibitor therapy for patients with T2D, CKD, and eGFR 30 ml/min per 1.73 m2, who are
already being treated with antihyperglycemic medications.
SGLT2i