Diabetes Quiz

Question 1

Metformin

Answer 1

-decreases A1c by 1.5-2%
-no weight gain
-minimal risk of hypoglycemia
-decreases TG and LDL by 8-15%
-increases fibrinolysis = CV protection
-may cause lactic acidosis

Question 2

SGLT2 inhibitors (canagliflozin-Invokana; Dapagliflozin-Farxiga; Empagliflozin-Jardiance)

Answer 2

-recommend w/ or w/o metformin as initial therapy for T2DM with or at high risk for atherosclerotic cardiovascular disease, heart failure, and/or CKD
-decreases a1c by 0.5-1.0%, decreases weight by 1-5 kg, BP
-most common AE’s include UTIs, female/male genital fungal infections, hypotension, DKA, dehydration, necrotizing fasciitis of the perinuem-Fournier’s gangrene

Question 3

SGLT2 Inhibitors dosing

Answer 3

Canagliflozin (Invokana) 100 mg; MAX: 300 mg 100 mg daily if eGFR 30-60 if no albuminuria
Dapagliflozin (Farxiga) 5 mg; MAX: 10 mg daily
Empagliflozin (Jardiance) 10 mg; MAX: 25 mg

Question 4

GLP-1 agonists (Liraglutide-Victoza; Dulaglutide-Trulicity, Semaglutide-Ozempic & Rybelsus)

Answer 4

-recommended as intitial therapy for T2DM with or at high risk for atherosclerotic cardiovascular disease, heart failure, and/or CKD
-decreases A1c by 0.7-1.6%
-decreases weight by 1.5-3kg
-titrate the dose to decrease symptoms
-AE’s include nausea, vomiting, diarrhea, actute pancreatitis (avoid w/patients with a history); thyroid c-cell tumors including medullary thyroid carcinomas, gall bladder disease, gastroparesis, severe non-proliferative disease and proliferative diabetic retinopathy

Question 5

Mounjaro (Tirzepitide)

Answer 5

-decreases A1c by 1.5-2.3%, weight by 6-11 kg