ADA Clinical Guidelines Flashcards
ADA is used for loose or strict targets?
Loose
ADA target A1C
<7.5%
ADA target FBG
80-130 mg/dl
ADA target PPG
<180 mg/dl
What patients do you use the ADA guidelines for?
Patients >65 years old, or <65 with clinical ASCVD
ADA first-line therapy
Metformin and lifestyle management
Treatment for patients with ASCVD risk
GLP-1RA or SGLT2i with CVD benefit
GLP-1RA with CVD benefit
liraglutide (Victoza)
SQ semaglutide (Ozempic)
dulaglutide (Trulicity)
SGLT2i with CVD benefit
dapagliflozin (Farxiga)
empagliflozin (Jardiance)
canagliflozin (Invokana)
If a patient has ASCVD but isn’t at goal with an SGLT2i or a GLP-1RA, what can you add?
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
Treatment for patients with HFrEF
SGLT2i with proven HF benefit
SGLT2is with HF benefit
dapagliflozin (Farxiga)
empagliflozin (Jardiance)
Treatment for patients with CKD with DKD and albuminuria
SGLT2is with evidence of slowing CKD progression or a GLP-1RA if SGLT2i isn’t tolerated or it’s CI’ed
SGLT2is with evidence of slowing CKD progression
canagliflozin (Invokana)
dapagliflozin (Farxiga)
Treatment for patients with CKD but no DKD and albuminuria
GLP-1RA or SGLT2i with proven CVD benefit
Drugs used to minimize hypoglycemia
DPP4is, GLP-1RAs, SGLT2is, TZDs
If A1C is above goal and a patient is on therapy to minimize hypoglycemia, what do you add?
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
Drugs used for weight loss
GLP-1RAs, SGLT2is
GLP-1RAs with weight loss benefit
semaglutide (Ozempic) liraglutide (Victoza) dulaglutide (Trulicity) exenatide (Byetta, Bydureon) lixisenatide (Adlyxin)
If a patient’s A1C is above target and they’re taking a GLP-1RA or SGLT2i for weight loss, what do you add?
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)
Drugs used when cost is a major issue
TZD, SU
If a patient’s A1C is above target and they’re taking an SU or TZD, what do you add?
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
ADA guidelines on basal insulin
Consider a GLP-1RA first before adding basal insulin
ADA guidelines on how to dose basal insulin
0.1-0.2 units/kg/day
Types of basal insulin
Glargine, detemir, deglucdec
Insulin glargine products
Lantus (U-100)
Toujeo and Toujeo Max (U-300)
Basaglar (U-100)
Semglee (U-100)
Insulin detemir product
Levemir (U-100)
Insulin degludec product
Tresiba (U-100 and U-200)
ADA guidelines on prandial insulin
Give one dose with the largest meal or meal with the greatest PPG excursion
ADA guidelines on how to dose prandial insulin
10% of basal dose
If A1C is <8%, consider lowering the basal dose by 10%
Types of prandial insulin
Regular, fast-acting, ultra-rapid acting
Regular insulin products
Humulin-R, Novolin-R
Fast-acting insulin products
Insulin aspart, lispro, glulisine
Humalog (U-100 and U-200)
NovoLog (U-100)
Apidra (U-100)
Ultra-rapid acting insulin products
Insulin lispro: Fiasp (U-100)
Insulin lispro-aabc: Lyumjev (U-100, U-200)
