The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
This document discusses hypoglycemia (low blood sugar), including its causes, symptoms, and consequences. It notes that hypoglycemia is a common side effect of insulin therapy that can lead to emergency hospitalizations. Episodes of hypoglycemia have been associated with increased levels of inflammatory markers and acute cardiovascular events. The symptoms of hypoglycemia involve abnormalities in heart rhythms and electrical activity. Over time, frequent hypoglycemia can cause patients to lose awareness of their symptoms, increasing risk. The body's natural defenses against falling blood sugar, such as hormone releases, are reduced during sleep, increasing risk of nighttime hypoglycemia. Many episodes go unnoticed by patients. The fear of hypoglycemia tends to increase with its
This document provides an overview of the clinical profile and long-term data of GLP-1 receptor agonists for the treatment of type 2 diabetes. It summarizes recommendations for anti-hyperglycemic therapy based on BMI levels and stages of treatment. It also outlines the mechanisms by which various antidiabetic agents act to reduce hyperglycemia. Finally, it compares the pharmacokinetic profiles of short-acting and long-acting GLP-1 receptor agonists, noting differences in half-life and time to maximum concentration.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
This document discusses hypoglycemia (low blood sugar), including its causes, symptoms, and consequences. It notes that hypoglycemia is a common side effect of insulin therapy that can lead to emergency hospitalizations. Episodes of hypoglycemia have been associated with increased levels of inflammatory markers and acute cardiovascular events. The symptoms of hypoglycemia involve abnormalities in heart rhythms and electrical activity. Over time, frequent hypoglycemia can cause patients to lose awareness of their symptoms, increasing risk. The body's natural defenses against falling blood sugar, such as hormone releases, are reduced during sleep, increasing risk of nighttime hypoglycemia. Many episodes go unnoticed by patients. The fear of hypoglycemia tends to increase with its
This document provides an overview of the clinical profile and long-term data of GLP-1 receptor agonists for the treatment of type 2 diabetes. It summarizes recommendations for anti-hyperglycemic therapy based on BMI levels and stages of treatment. It also outlines the mechanisms by which various antidiabetic agents act to reduce hyperglycemia. Finally, it compares the pharmacokinetic profiles of short-acting and long-acting GLP-1 receptor agonists, noting differences in half-life and time to maximum concentration.
The document discusses Januet XR, a new extended-release formulation combining sitagliptin and metformin for the treatment of type 2 diabetes. Januet XR provides glycemic control through the complementary mechanisms of action of sitagliptin and metformin. Studies showed Januet XR has similar pharmacokinetic properties to immediate-release sitagliptin and provides effective reduction in blood sugar levels with once-daily dosing. Its extended-release formulation aims to improve adherence by reducing dosing frequency compared to the individual components.
Combining insulin and GLP-1 receptor agonists like Victoza provides complementary benefits for managing type 2 diabetes. Studies show adding Victoza to basal insulin regimens results in: improved glycemic control as shown by greater reductions in HbA1c levels of around 1%; weight loss or weight neutral effects compared to weight gain with insulin alone; and a low risk of hypoglycemia. The combination helps address insulin's limitations of weight gain and variability in glucose lowering by enhancing insulin's effects and reducing glucagon secretion from Victoza. Overall, combining these therapies provides effective glycemic control while minimizing side effects.
This document discusses SGLT2 inhibitors as a treatment option for type 2 diabetes mellitus. It provides background on normal glucose homeostasis and the pathophysiology of hyperglycemia in diabetes. SGLT2 inhibitors work by inhibiting glucose reabsorption in the kidneys, causing it to be excreted in the urine. Clinical trial data shows SGLT2 inhibitors like dapagliflozin provide glycemic control as monotherapy or add-on therapy with other oral agents or insulin, with additional benefits of weight loss and blood pressure reduction. Long-term studies over 4 years show sustained glycemic control with dapagliflozin compared to other oral antidiabetic drugs.
This document discusses the complications of diabetes mellitus. It begins by defining diabetes and describing the different types. It then explains the acute and chronic complications that can occur, including microvascular complications affecting the eyes, kidneys, and nerves, as well as macrovascular complications increasing the risk of cardiovascular disease. The document outlines the main mechanisms behind these complications, such as the accumulation of sorbitol and the glycation of proteins, which can cause tissue damage. Finally, it discusses the importance of glycemic control through diet, exercise and medication in managing diabetes and preventing associated health issues.
1) Exenatide once weekly (QW), also known as Bydureon, provides glycemic control through reductions in HbA1c of 1.3-1.9% over 24-30 weeks according to clinical trials.
2) Head-to-head trials show Exenatide QW results in similar or greater HbA1c reductions and more weight loss compared to other GLP-1 receptor agonists such as liraglutide.
3) Exenatide QW has been shown to maintain glycemic control over the long term with reductions in HbA1c of 1.5% maintained out to 6 years, along with significant and sustained weight loss from
A 63-year-old man with a history of IHD, 1VD, HTN, hyperlipidemia, and an HbA1c of 8.2% is taking 26 units of insulin glargine daily. His LDL is 80 mg/dL and TG is 160 mg/dL. His BMI is 26. The document discusses treatment options with pioglitazone given his medical history and risk factors. Pioglitazone has been shown to improve insulin sensitivity and reduce cardiovascular events and microvascular complications in patients with type 2 diabetes when used as monotherapy or in combination with other antidiabetic agents. However, pioglitazone can cause side effects like edema,
This document summarizes information about the basal insulin Toujeo and compares it to Lantus. It discusses Toujeo's flat and prolonged activity profile, its ability to lower HbA1c levels similarly to Lantus while reducing hypoglycemic events and weight gain. Real-world evidence shows patients switching to Toujeo experienced an average 0.96% drop in HbA1c without changing their basal insulin dose. Toujeo provides flexibility in dosing time and has the potential to improve glycemic control while minimizing side effects for patients.
This document discusses the clinical profile and efficacy of the combination drug GLYXAMBI, which contains empagliflozin and linagliptin. It summarizes clinical trial results showing that GLYXAMBI provides significant reductions in HbA1c and body weight compared to the individual components alone in patients with type 2 diabetes. Guidelines from major diabetes organizations have been updated to recommend SGLT2 inhibitors like empagliflozin and GLP-1 receptor agonists to reduce cardiovascular risk based on positive cardiovascular outcomes trial results.
The document discusses Januet XR, a new extended-release formulation combining sitagliptin and metformin for the treatment of type 2 diabetes. Januet XR provides glycemic control through the complementary mechanisms of action of sitagliptin and metformin. Studies showed Januet XR has similar pharmacokinetic properties to immediate-release sitagliptin and provides effective reduction in blood sugar levels with once-daily dosing. Its extended-release formulation aims to improve adherence by reducing dosing frequency compared to the individual components.
Combining insulin and GLP-1 receptor agonists like Victoza provides complementary benefits for managing type 2 diabetes. Studies show adding Victoza to basal insulin regimens results in: improved glycemic control as shown by greater reductions in HbA1c levels of around 1%; weight loss or weight neutral effects compared to weight gain with insulin alone; and a low risk of hypoglycemia. The combination helps address insulin's limitations of weight gain and variability in glucose lowering by enhancing insulin's effects and reducing glucagon secretion from Victoza. Overall, combining these therapies provides effective glycemic control while minimizing side effects.
This document discusses SGLT2 inhibitors as a treatment option for type 2 diabetes mellitus. It provides background on normal glucose homeostasis and the pathophysiology of hyperglycemia in diabetes. SGLT2 inhibitors work by inhibiting glucose reabsorption in the kidneys, causing it to be excreted in the urine. Clinical trial data shows SGLT2 inhibitors like dapagliflozin provide glycemic control as monotherapy or add-on therapy with other oral agents or insulin, with additional benefits of weight loss and blood pressure reduction. Long-term studies over 4 years show sustained glycemic control with dapagliflozin compared to other oral antidiabetic drugs.
This document discusses the complications of diabetes mellitus. It begins by defining diabetes and describing the different types. It then explains the acute and chronic complications that can occur, including microvascular complications affecting the eyes, kidneys, and nerves, as well as macrovascular complications increasing the risk of cardiovascular disease. The document outlines the main mechanisms behind these complications, such as the accumulation of sorbitol and the glycation of proteins, which can cause tissue damage. Finally, it discusses the importance of glycemic control through diet, exercise and medication in managing diabetes and preventing associated health issues.
1) Exenatide once weekly (QW), also known as Bydureon, provides glycemic control through reductions in HbA1c of 1.3-1.9% over 24-30 weeks according to clinical trials.
2) Head-to-head trials show Exenatide QW results in similar or greater HbA1c reductions and more weight loss compared to other GLP-1 receptor agonists such as liraglutide.
3) Exenatide QW has been shown to maintain glycemic control over the long term with reductions in HbA1c of 1.5% maintained out to 6 years, along with significant and sustained weight loss from
A 63-year-old man with a history of IHD, 1VD, HTN, hyperlipidemia, and an HbA1c of 8.2% is taking 26 units of insulin glargine daily. His LDL is 80 mg/dL and TG is 160 mg/dL. His BMI is 26. The document discusses treatment options with pioglitazone given his medical history and risk factors. Pioglitazone has been shown to improve insulin sensitivity and reduce cardiovascular events and microvascular complications in patients with type 2 diabetes when used as monotherapy or in combination with other antidiabetic agents. However, pioglitazone can cause side effects like edema,
This document summarizes information about the basal insulin Toujeo and compares it to Lantus. It discusses Toujeo's flat and prolonged activity profile, its ability to lower HbA1c levels similarly to Lantus while reducing hypoglycemic events and weight gain. Real-world evidence shows patients switching to Toujeo experienced an average 0.96% drop in HbA1c without changing their basal insulin dose. Toujeo provides flexibility in dosing time and has the potential to improve glycemic control while minimizing side effects for patients.
This document discusses the clinical profile and efficacy of the combination drug GLYXAMBI, which contains empagliflozin and linagliptin. It summarizes clinical trial results showing that GLYXAMBI provides significant reductions in HbA1c and body weight compared to the individual components alone in patients with type 2 diabetes. Guidelines from major diabetes organizations have been updated to recommend SGLT2 inhibitors like empagliflozin and GLP-1 receptor agonists to reduce cardiovascular risk based on positive cardiovascular outcomes trial results.
7. Treatment Strategies: Glucose Triad
Ceriello et al. Diabet Med 2008;25(10):1151-6.
HbA1C
Postmeal
glucose
(PPG)
Fasting
glucose
(FPG)
Treatment strategy should target all three components
HbA1C=hemoglobin A1C.
PPG and FPG control important to
bring HbA1C levels to target
Woerle et al. Diabetes Res Clin Pract 2007;77(2):280-5.
10. האוכל לאחר הסוכר רמות חשיבות-PPG
Data derived from Monnier L, et al. Diabetes Care. 2003;26:881-885.
• PPG is a major contributor in mild to moderate hyperglycaemia (HbA1c <8.4%)
Controlling PPG should be an important part of every therapeutic plan
Fasting Postprandial
Contributiontooverallhyperglycaemia(%)
HbA1c (%) Quintiles
11. CVD=cardiovascular; HbA1c=haemoglobin A1c; T2DM=type 2 diabetes mellitus.
American Diabetes Association. Diabetes Care. 2011; 34 (Suppl 1): S4–S10.
ADA guidelines recommend HbA1c levels <7% for all patients
• More stringent HbA1c goals may be suitable for selected
patients with early stage disease, if this can be achieved
without significant hypoglycaemia or other adverse effects
• Less stringent HbA1c goals may be appropriate for patients
with a history of hypoglycaemia, CVD or late-stage disease
Normal Controlled T2DM Uncontrolled T2DM
≥7%6.1–6.9%HbA1c <6%
Initiate or change
treatment whenever
HbA1c levels are ≥7%
Initiate or change therapy when HbA1c ≥7%
13. הסוכרת איגודי הנחיותEASD ADA
סוג בסוכרת לטיפול2
Source: American Diabetes Association and European Association for the Study of Diabetes, Diabetes Care, Diabetologia. 19 April 2012 [Epub ahead of print]
14. None of the Major Oral Monotherapies Are Able to
Address All 3 Core Defects in Type 2 Diabetes
Oral Monotherapies
α-Glucosidase
Inhibitors
Lowers hepatic
glucose
production
SUs
Glinides
TZDs
Improves
insulin
resistance
Improves
insulin
secretion
DPP-4
Inhibitor
sMetformin
MechanismsofAction
26. Type 2 diabetes anti-hyperglycemic therapy:
General recommendations
Source: American Diabetes Association and European Association for the Study of Diabetes, Diabetes Care, Diabetologia. 19 April 2012 [Epub ahead of print]
