Exploring the Science and Practice of GLP-1 Receptor Agonists: An Update on Current and Emerging Evidence.
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John B. Buse, MD, PhD, discusses type 2 diabetes in this CME activity titled "Exploring the Science and Practice of GLP-1 Receptor Agonists: An Update on Current and Emerging Evidence." For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2oL19BK. CME credit will be available until October 21, 2020.
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Here are my recommendations for the cases:
Case 1:
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- Refer to dietician and encourage weight loss through calorie restriction
- Start statin and advise to control other risk factors like smoking
Case 2:
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- It presents guidelines that recommend starting with basal insulin for patients still above HbA1c targets on dual or triple oral therapy, and then considering adding mealtime insulin, GLP-1 RA, or continuing uptitration of basal insulin if still above targets.
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Anti-Diabetics For Cardiac Patients The Proper Selection
Cardiovascular Disease and Type 2 Diabetes.Tight glycaemic control can reduce microvascular complications of T2DM, but does not lower CV risk sufficiently.
Multifactorial intervention, comprising of lowering lipid levels and BP, and use of aspirin, has been shown to reduce vascular complications and mortality.Shifting the Paradigm in Diabetes Care
Treating Diabetes Beyond A1C :Considerations for Cardiovascular Protection.
Choosing Appropriate OAD for Diabetes Management by Dr Shahjada Selim
Choosing Appropriate OAD for Diabetes Management by Dr Shahjada SelimBangabandhu Sheikh Mujib Medical University
Here are my recommendations for the cases:
Case 1:
- Start metformin 1000mg bid along with lifestyle modification focusing on weight loss through diet and exercise
- Add DPP4i or SGLT2i as second agent if target not achieved in 3 months
- Refer to dietician and encourage weight loss through calorie restriction
- Start statin and advise to control other risk factors like smoking
Case 2:
- Switch from SU to DPP4i or SGLT2i to reduce risk of hypoglycemia
- Add GLP1RA if target not achieved to address obesity and heart failure
- Monitor kidney function and adjust doses based on eGFR
- Emphasize lifestyle changestest 1.pptx
This document provides guidelines for selecting first and second line medication therapies for treating type 2 diabetes. First line therapy includes metformin, weight loss, and increased physical activity. For patients not meeting HbA1c targets, treatment depends on whether the patient has established cardiovascular or kidney disease. For those patients, preferred second line therapies include GLP-1 receptor agonists or SGLT2 inhibitors. For patients without these conditions, preferred second line therapies aim to minimize hypoglycemia and weight gain/promote loss and include DPP-4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors, or thiazolidinediones. Basal insulin may be added if further glycemic control is needed. Cost
DM Holistic Fam Med 2019
This document discusses the holistic approach to treatment of type 2 diabetes mellitus (T2DM). The objectives of T2DM treatment are to correct hyperglycemia, prevent acute complications, prevent chronic complications like retinopathy and nephropathy, and improve quality of life. Chronic complications are caused by microvascular and macrovascular damage. Intensive control of blood glucose, blood pressure, cholesterol and other risk factors can help prevent cardiovascular disease and mortality according to studies like STENO-2 and UKPDS. Treatment should be individualized based on factors like age, weight, comorbidities. Drugs like SGLT2 inhibitors and GLP-1 receptor agonists that provide cardiovascular protection are preferred. Metformin
Overview of Therapeutic options in Diabetes Mellitus
This document discusses various aspects of diabetes mellitus including diagnostic criteria, treatment targets, therapeutic options, insulin types, continuous subcutaneous insulin infusion, and inpatient management. It describes the differences between type 1, type 2, and LADA diabetes. First line treatment is usually metformin, but sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, and SGLT2 inhibitors are also discussed as therapeutic options. Insulin therapy including various insulin types is summarized. Inpatient management goals are outlined as well as HbA1c testing on hospital admission.
Metformina de un siglo a otro. años locos.
The document discusses metformin, an insulin-sensitizing drug that is the first-line treatment for polycystic ovary syndrome (PCOS). Metformin reduces insulin levels, restores ovulation and fertility in women with PCOS, and results in weight loss. A clinical trial found that metformin led to resumption of ovulation and menses in most women with PCOS and significantly more pregnancies than placebo. Metformin is thus an effective first-line treatment for restoring fertility and ovulation in women with PCOS.
American Diabetes Association clinical practice recommendations 2012
1. The document outlines new clinical practice recommendations from the American Diabetes Association for 2012 regarding diagnosis, treatment, and management of diabetes.
2. It provides updated criteria for diagnosing diabetes based on HbA1c, fasting plasma glucose, and oral glucose tolerance tests.
3. The recommendations address screening asymptomatic individuals and those with risk factors, managing gestational diabetes, preventing and delaying type 2 diabetes, glucose monitoring, glycemic goals, and treating hypertension, dyslipidemia, and complications of diabetes.
Beyond metformin dr clayton feb 22
The document discusses treatment options for type 2 diabetes beyond metformin, focusing on balancing glycemic control, weight gain, and risk of hypoglycemia. It reviews factors to consider when selecting antihyperglycemic agents and assessing individual patient needs. A case study of a patient named Jason is presented at various stages over 5 years to demonstrate applying treatment principles in clinical practice.
20130418 糖尿病治療策略
This document summarizes guidelines for treating type 2 diabetes with a patient-centered approach. It discusses:
1) Glycemic targets and treatments should be individualized based on patient factors like age, weight, and comorbidities.
2) Lifestyle modifications like diet, exercise, and education are the foundation of diabetes treatment but may not be enough on their own.
3) When choosing medications, priorities include minimizing hypoglycemia risk, weight gain, and total costs while considering fasting and post-meal blood sugar levels.
4) Incretin-based therapies that augment the GLP-1 and DPP-4 pathways are reasonable initial or add-on options due to their effects on
12- DM for Undergraduate.ppt
This document discusses diabetes mellitus and its management. It provides information on:
1) The classification and prevalence of diabetes in Saudi Arabia, finding an overall prevalence of 23.7% with higher rates in males.
2) The diagnostic criteria and thresholds for diabetes based on HbA1c, fasting plasma glucose, and oral glucose tolerance tests. Screening is recommended for those over 45 or with risk factors.
3) Treatment involves lifestyle modifications, metformin as first line therapy, and additional oral medications or insulin as needed to achieve glycemic targets. Managing associated cardiovascular risk factors is also emphasized.
Aace algorithm
This document presents the 2015 AACE/ACE Comprehensive Diabetes Management Algorithm. It includes algorithms for prediabetes, glycemic control, adding/intensifying insulin, cardiovascular risk factor modification, and profiles of antidiabetic medications. The principles of the algorithm emphasize the importance of lifestyle optimization and education. Treatment of overweight/obesity should proceed according to the obesity algorithm. Glycemic targets should be individualized based on patient factors. A stepwise approach is recommended for adding and intensifying medications to achieve glycemic goals.
2015 diabetes aace algorithm
This document provides guidelines for comprehensive diabetes management from the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE). It includes algorithms and treatment protocols for prediabetes, glycemic control, adding or intensifying insulin, and modifying cardiovascular disease risk factors like hypertension and dyslipidemia. The document is intended to guide clinicians in providing optimized care for patients with diabetes or prediabetes.
Aace algorithm 2015
This document presents the 2015 AACE/ACE Comprehensive Diabetes Management Algorithm. It includes algorithms for prediabetes, glycemic control, adding/intensifying insulin, cardiovascular risk factor modification, and profiles of antidiabetic medications. The principles of the algorithm emphasize lifestyle optimization and education. Glycemic targets should be individualized based on patient factors. A complications-centric model is recommended for overweight/obese patients, with treatment intensity based on complication staging.
Diabetes treatment
This document provides a review of diabetes mellitus including its pathophysiology, diagnostic criteria, treatment goals, pharmacological treatment options, and monitoring parameters for type 2 diabetes. It discusses the epidemiology of diabetes and reviews the signs and symptoms of hypoglycemia and hyperglycemia. Treatment options are reviewed including their efficacy, risk of hypoglycemia, effects on weight, adverse effects, and costs.
Ueda2015 lilly.the art of insulin dr.mesbah sayed
This document discusses the treatment of a 52-year-old patient with type 2 diabetes who has an HbA1c of 9.4% despite treatment with oral medications. It considers adding insulin therapy to help control the patient's blood glucose levels and reach treatment targets. Specifically, it compares the effectiveness of premixed insulin versus basal insulin when initiating insulin in type 2 diabetes patients. A study is summarized that found premixed insulin administered twice daily in combination with metformin was more effective at reducing HbA1c and post-prandial blood glucose compared to a basal insulin administered once daily plus metformin. The document advocates for patient-centered treatment approaches and discusses factors to consider when choosing between premixed versus basal-bolus insulin reg
SGLT2I The paradigm change in diabetes management
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Diabetes disease modified drugs. Types and mechanism of action
Diabetes disease modified drugs. Types and mechanism of actionFaculty of Medicine And Health Sciences
Types of diabetic disease modified drugs updates in management of Diabetes mellitus
Diabetes is a worldwide disease .Many anti diabetic drugs play a role in hypoglycemic control with a different mechanism of action
109.06.23-2020糖尿病治療指引及健保審查規範
This document summarizes guidelines for diabetes treatment and health insurance coverage of diabetes medications in Taiwan. It discusses how GLP-1 receptor agonists (RA) and SGLT2 inhibitors have changed diabetes treatment based on their cardiovascular and renal benefits shown in clinical trials. It then reviews the 2020 guidelines for diabetes management and consensus on health insurance coverage and review of diabetes medications. Key points covered include the use of these new drug classes in patients with atherosclerotic cardiovascular disease, chronic kidney disease, or heart failure based on the guidelines.
3. Dapagliflozin.pptx
BRAND PLAN, Marketing activity, Pharma Brand Plan, Pharma Marketing.branding promotion, diclofenac injection brand plan, launch plan, marketing activity, pharma brand plan, pharma marketing
Similar to Exploring the Science and Practice of GLP-1 Receptor Agonists: An Update on Current and Emerging Evidence. (20)
Anti-Diabetics For Cardiac Patients The Proper Selection
Anti-Diabetics For Cardiac Patients The Proper Selection
Choosing Appropriate OAD for Diabetes Management by Dr Shahjada Selim
Choosing Appropriate OAD for Diabetes Management by Dr Shahjada Selim
Overview of Therapeutic options in Diabetes Mellitus
Overview of Therapeutic options in Diabetes Mellitus
American Diabetes Association clinical practice recommendations 2012
American Diabetes Association clinical practice recommendations 2012
Diabetes disease modified drugs. Types and mechanism of action
Diabetes disease modified drugs. Types and mechanism of action
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Olfactory Genes:
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Membrane Potential and Action Potential:
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Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
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Behavioral and emotional influences of smell.
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MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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The Electrocardiogram - Physiologic Principles
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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