Newer Diabetic Agents

Question 1

What are the incretins based drug?

Answer 1

GLP-1 Receptor Agonist
DPP-4 Inhibitors

Question 2

What is the mode of action for GLP-1 receptor agonist?

Answer 2

Upon activation of GLP-1 receptors, GLP-1 receptors can help
- delay and decrease gastric emptying
- increase glucose-dependent insulin biosynthesis and secretion
- Decrease glucagon
- Decrease food intake and encourage weight loss

Question 3

Name the drug that is a GLP-1 receptor agonist

Answer 3

Liraglutide

Question 4

How is GLP-1 receptor agonist (Liraglutide) administered?

Answer 4

SC injection once daily

Question 5

What are the benefits for using GLP-1 receptor agonist, liraglutide?

Answer 5

No need for renal dosing adjustment

Decrease A1C by 0.7% - 1.5%

Weight loss

Help with DM + comorbidities such as ASCVD, HF and CKD (minimal)

Question 6

What are the adverse effects for use of GLP-1 receptor agonist?

Answer 6

Adverse side effects include
- Nausea and vomiting, diarrhea
- Acute pancreatitis
- Dyspepsia

Black box warning of thyroid cancer

Question 7

What is the mechanism of action of DPP-4 inhibitors?

Answer 7

Inhibition of DPP-4 enzyme causes an increase in concentration of endogenous incretins

Decrease inactive GLP-1

Question 8

Name the drugs that are DPP-4 inhibitors

Answer 8

Sitagliptin and Linagliptin

Question 9

Which of the DPP-4 inhibitors require dose adjustment and how should it be done?

Answer 9

Sitagliptin
30< CrCl < 50: halve dose
Severe renal impairment / ESRD: 25mg OD

Question 10

List the adverse effects associated with sitagliptin

Answer 10

Acute pancreatitis
Headache
Nausea and vomiting
Abdominal pain
Skin reaction
Angioedema

Black box: Disabling joint pain

Question 11

List the adverse effects associated with linagliptin

Answer 11

Nasopharyngitis

Disabling joint pain

Question 12

Comparing between GLP-1 receptor agonist, what are its advantages and disadvantages?

Answer 12

Advantage: Good ROA, lower incidence of GI adverse effects

Disadvantage: Weight neutral, smaller Hba1c reduction, no big 3 benefits

Question 13

What is the place in therapy for DPP-4 inhibitors?

Answer 13

Second/ third line agent in T2DM used as dual / triple combi therapy

Question 14

What is the mode of action for SGLT2i?

Answer 14

Inhibition of SGLT2 increases renal glucose excretion and decrease blood glucose

Question 15

Name the three agents that are SGLT2i

Answer 15

Canagliflozin
Empagliflozin
Dapagliflozin

Question 16

What are the adverse side effects of SGLT2i?

Answer 16

Hypotension, hypoglycemia, renal impairment, increase LDL

Urinary symoptoms such as increased urgency and genital mycotic infections

Diabetic ketoacidosis: euglycemic DKA

Fournier’s gangrene

Question 17

What are some ADR associated with Canagliflozin that is reducing its use?

Answer 17

Amputation
Hyperkalemia
Fractures

Question 18

When can I consider initiating SGLT2i?

Answer 18

Patients with Diabetes and CKD or eGFR > 30

Question 19

What are the other benefits beside glucosuria effect?

Answer 19

ASCVD: Canagliflozin and empagliflozin
HF and CKD: Class benefit