ADA Clinical Guidelines

Question 1

ADA is used for loose or strict targets?

Answer 1

Loose

Question 2

ADA target A1C

Answer 2

<7.5%

Question 3

ADA target FBG

Answer 3

80-130 mg/dl

Question 4

ADA target PPG

Answer 4

<180 mg/dl

Question 5

What patients do you use the ADA guidelines for?

Answer 5

Patients >65 years old, or <65 with clinical ASCVD

Question 6

ADA first-line therapy

Answer 6

Metformin and lifestyle management

Question 7

Treatment for patients with ASCVD risk

Answer 7

GLP-1RA or SGLT2i with CVD benefit

Question 8

GLP-1RA with CVD benefit

Answer 8

liraglutide (Victoza)
SQ semaglutide (Ozempic)
dulaglutide (Trulicity)

Question 9

SGLT2i with CVD benefit

Answer 9

dapagliflozin (Farxiga)
empagliflozin (Jardiance)
canagliflozin (Invokana)

Question 10

If a patient has ASCVD but isn’t at goal with an SGLT2i or a GLP-1RA, what can you add?

Answer 10

If they’re on an SGLT2i, you can add a GLP-1RA or vice versa

Also: TZD, DDP4i if patient isn’t on GLP-1RA, basal insulin, SU

Question 11

Treatment for patients with HFrEF

Answer 11

SGLT2i with proven HF benefit

Question 12

SGLT2is with HF benefit

Answer 12

dapagliflozin (Farxiga)

empagliflozin (Jardiance)

Question 13

Treatment for patients with CKD with DKD and albuminuria

Answer 13

SGLT2is with evidence of slowing CKD progression or a GLP-1RA if SGLT2i isn’t tolerated or it’s CI’ed

Question 14

SGLT2is with evidence of slowing CKD progression

Answer 14

canagliflozin (Invokana)

dapagliflozin (Farxiga)

Question 15

Treatment for patients with CKD but no DKD and albuminuria

Answer 15

GLP-1RA or SGLT2i with proven CVD benefit

Question 16

Drugs used to minimize hypoglycemia

Answer 16

DPP4is, GLP-1RAs, SGLT2is, TZDs

Question 17

If A1C is above goal and a patient is on therapy to minimize hypoglycemia, what do you add?

Answer 17

DPP4is: add SGLT2i or TZD

GLP-1RA: add SGLT2i or TZD

SGLT2i: add GLP-1RA, DPP4i, TZD

TZD: add SGLT2i, DPP4i, GLP-1RA

You would keep adding on the other meds, but if they’re STILL above goal with all of that, consider basal insulin or SU

Question 18

Drugs used for weight loss

Answer 18

GLP-1RAs, SGLT2is

Question 19

GLP-1RAs with weight loss benefit

Answer 19

semaglutide (Ozempic)
liraglutide (Victoza)
dulaglutide (Trulicity)
exenatide (Byetta, Bydureon)
lixisenatide (Adlyxin)

Question 20

If a patient’s A1C is above target and they’re taking a GLP-1RA or SGLT2i for weight loss, what do you add?

Answer 20

If they’re on a GLP1-RA, add an SGLT2i or vice versa

If that doesn’t get them to goal, you can add a DPP4i (if they’re not on a GLP-1RA), SU, TZD, or basal insulin (but be careful with the last 3)

Question 21

Drugs used when cost is a major issue

Answer 21

TZD, SU

Question 22

If a patient’s A1C is above target and they’re taking an SU or TZD, what do you add?

Answer 22

If they’re on an SU, add a TZD or vice versa.

If that doesn’t work, you can add basal insulin with the lowest acquisition cost

Question 23

ADA guidelines on basal insulin

Answer 23

Consider a GLP-1RA first before adding basal insulin

Question 24

ADA guidelines on how to dose basal insulin

Answer 24

0.1-0.2 units/kg/day

Question 25

Types of basal insulin

Answer 25

Glargine, detemir, deglucdec

Question 26

Insulin glargine products

Answer 26

Lantus (U-100)
Toujeo and Toujeo Max (U-300)
Basaglar (U-100)
Semglee (U-100)

Question 27

Insulin detemir product

Answer 27

Levemir (U-100)

Question 28

Insulin degludec product

Answer 28

Tresiba (U-100 and U-200)

Question 29

ADA guidelines on prandial insulin

Answer 29

Give one dose with the largest meal or meal with the greatest PPG excursion

Question 30

ADA guidelines on how to dose prandial insulin

Answer 30

10% of basal dose

If A1C is <8%, consider lowering the basal dose by 10%

Question 31

Types of prandial insulin

Answer 31

Regular, fast-acting, ultra-rapid acting

Question 32

Regular insulin products

Answer 32

Humulin-R, Novolin-R

Question 33

Fast-acting insulin products

Answer 33

Insulin aspart, lispro, glulisine

Humalog (U-100 and U-200)
NovoLog (U-100)
Apidra (U-100)

Question 34

Ultra-rapid acting insulin products

Answer 34

Insulin lispro: Fiasp (U-100)

Insulin lispro-aabc: Lyumjev (U-100, U-200)