Regimens for DM2

Question 1

Treating DM2

Answer 1

• Always start with metformin (unless clear contraindication)
• As DM progresses, there are multiple organ defects and metformins ability to control the glucose is NOT sustainable

Question 2

SGLT2

Drug Use Dont

Answer 2

-gliflozin

Use: CVD/risk, HF, Overweight
Dont: renal impairment, diuretic use, risks of amputation, hx of GU fungal infections, fracture risk

Question 3

GLP1

Drug Use Dont

Answer 3

-glutide

Use: CVD/risk, overweight
Dont: fam/hx of medullary thyroid cancer, endocrine neoplasia type 2

Question 4

Sulfonylurea

Drug Use Dont

Answer 4

• glipizide, glimepiride, glyburide

Use: cost concerns (cheap)
Dont: hypoglycemic risk, overweight

Question 5

Insulin

Use Dont

Answer 5

Use: high A1C
Dont: hypoglycemic risk, overweight

Question 6

Glitazone

Drug Use Dont

Answer 6

-azone

Use: high triglycerides, CVD/risk
Dont: HF, Risk of bladder cancer, pts on insulin

Question 7

DDP4

Drug Use Dont

Answer 7

-gliptins

Use: post prandial effect desired, overweight
Dont: HF (saxagliptin, alogliptin)

Question 8

Alpha Glucosidase

Answer 8

acarbose + miglitol

Use: post prandial effect desired, overweight
Dont: A1C&raquo_space; 8.5

Question 9

Drug to use in CVD

Answer 9

empagliflozin + canagliflozin

liraglutide + semaglutide

Question 10

ADA Glycemic Recs

Answer 10

A1C — < 7.0
Pre Prandial capillary PG – 90-130
Peak Post Prandial capillary PG <180

only 37% of adults achieve A1C < 7

PPG measurement 1-2 hours after beginning meal

Question 11

Important

Answer 11

Insulin should NOT be withheld 2/2 concerns of lb gain

sulf may negate lb loss benefit of GLP and MET