Metformin
Off label use for the prevention of this disease
Type 2 Diabetes
Age < 60, BMI >/= 35, GDM hx with IGT, IFG, A1c 5.7-6.4%
This is the only available oral form in the US
Rybelsus (Semaglutide)
Canagliflozin
Empagliflozin
This sulfonylurea should be avoided in CKD
Glyburide
Approved for weight loss in those with BMI >/= 30 or >/= 27 with one weight related comorbid condition
Wegovy (semaglutide)
Causes this vitamin deficiency
Vitamin B12
Animal studies demonstrated hyperplasia in these types of cells
thyroid C-cells
human relevance not determined, avoid in MEN syndromes, FH of medullary thyroid cancer
These 3 reduce progression of diabetic kidney disease
cangliflozin (Invokana)
dapagliflozin (Farxiga)
empagliflozin (Jardiance)
Two classes of oral medications that increase insulin secretion (independent of glucose levels) and their common side effects
Sulfonylureas
Meglitinides
Hypoglycemia and weight gain
This is a Dual-acting GLP-1 and GIP receptor agonist that results in greater weight loss than GLP1 RAs
Tirzepatide
This is a common side effect
GI distress
To help mitigate:
Slow titration
Extended release
administration with food
This is a common side effect
GI side effects
To help mitigate:
slow titration, reduction of meal size/mindful eating, decrease high fat/spicy food
These are 4 side effects to counsel on (2 common, 2 serious)
1) UTIs
2) Genital yeast infections
3) Euglycemic DKA (discontinue 3-4 days pre-op, during critical illness, prolonged fasting)
4) Necrotizing fasciitis of the perineum
This class of DM medications are contraindicated in patients with NYHA Class III or IV heart failure
Thiazolidinediones (TZDs) -Pioglitazone, Rosiglitazone
These two 2nd generation sulfonylureas do not appear to have increased CV risk
Glipizide and glimperide
Due to risk of lactic acidosis, this eGFR is the cutoff for use
<30
These three have shown both ASCVD benefit (MACE) and kidney benefit (reduced progression of DKD, albuminuria)
1) Liraglutide (Victoza)
2)Semaglutide (Ozempic)
3) Dulaglutide (Trulicity)
These 4 have been shown to have heart failure benefit
1) canagliflozin
2) dapagliflozin
3) empagliflozin
4) ertugliflozin
This DPPIV inhibitor increases heart failure hospitalizations
saxagliptin (onglyza)
This class of drugs should be used with caution in those at risk for foot amputations
SGLT2i
These are 2 mechanisms of action
Decreases hepatic glucose output
Increases insulin-mediated glucose utilization in peripheral tissues (such as muscle and liver)
These are 4 mechanisms of action
1) glucose dependent insulin secretion
2) delayed gastric emptying
3) decreased postprandical glucagon secretion
4) decreased food intake
Mechanism of action and the renal location of the SGLT2 receptor
mediates reabsorption of approximately 90 percent of the filtered glucose load in the proximal tubule
This medication has shown benefit in NASH
pioglitazone
This microvascular complication unexpectedly occurred more frequently in a trial with pts treated with this weekly subq GLP1RA ( 2 answers)
Retinopathy and semaglutide