Non- insulin Diabetes Treatment Flashcards
ideal treatment
preserve beta cell function, prevent weight gain, prevent hypoglycemia, and improve/not worsen concomitant disease states
Metformin brand name
Glucophage, Fortamet, Glumetza
Metformin MOA
Decreased, hepatic production of glucose
increases intestinal glucose utilization and decreases glucose uptake into circulation
can increase GLP1 secretion
modest effect on increasing tissue uptake and utilization
Metformin clinical use (ADA recs)
ADA rec: consider for use in all T2 patients.
reduce risk of mortality and death
minimal hypoglycemia
positive or neutral effect on weight
Metformin Efficacy/ excretion
A1c: - 1.5-2%
FBG: -60-80 mg/dL
Weight: 2-3 kg
excreted unchanged (adjust dose w kidney function)
Metformin advantages
less hypoglycemia
lipid: - TG and LDL by 8-15%
fibrinolysis= CV protective
- macrovascular complication and the risk of total mortality
- stroke risk
- diabetes related death
Metformin disadvantages
lactic acidosis for select pt populations
GI effect (diarrhea, flatulence, nausea, and vomiting)
vitamin B12 deficiency
Metformin dosing
Initial- 500 BID or 850 QD with meals
Titrate dose weekly or bi monthly and increase by 250-500 mg/day
Max- 2 g/day
Renal adjustment: monitor if <60 eGFR and CI if <30
SGLT-2 Inhibitors brand and generic
Canagliflozin (invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance)
SGLT2-I MOA
increased renal glucose excretion by inhibiting the major transporter of renal glucose to assist in glucose reabsorption.
SGLT2 Clinical
Adjunct to diet and exercise in T2
recommended with or without metformin as initial therapy
good for pts at high risk for atherosclerotic cardiovascular disease, heart failure, and/ chronic kidney disease
SGLT2 efficacy and excretion
A1c+ -0.5-1%
FBG: -25-35 mg/dL
PPG: -40-60 mg/dL
Weight: -1-5 kg
BP: SBP - 3-6 and DBP: 2-3 mmHg
Excreted as inactive metabolite in feces
