Treatment Advances in

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Treatment Advances in Type 2 Diabetes Panhandle
Nurse Practitioner Symposium April 11, 2015
Dr. Caleb Kim
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Diagnosis of Diabetes Climbing Dramatically
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Type 1 verses Type 2
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Diagnostic Criteria

• HbA1c gt6.5
• Fasting BG gt 126
• oral glucose tolerance test

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Concerns of DM Medications Causing Hypoglycemia
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Treatment Paradigm

• Step 1
• metformin
• Step 2
• DPP-4 vs GLP-1
• Step 3
• SGLT-2, Actos
• (sulfonylureas if needed)
• Step 4
• insulin

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3 New Diabetes Medication Classes Within the
Past 10 Years

• DPP-4 Inhibitors
• SGLT-2 Inhibitors
• GLP-1 Agonists

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DPP-4 Medications

• Tradjenta
• Jentadueto (combo Tragjenta and metformin)
• Onglyza
• Kombiglyze (combo Onglyza and metformin)
• Nesina
• Kazano (combo Nesina and metformin)
• Oseni (combo Nesina and pioglitazone)
• Januvia
• Janumet (combo Januvia and metformin)

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DPP-4 Mechanism of Action
inhibits dipeptidyl peptidase-4
slows incretin metabolism
increases insulin synthesis/release
decreases glucagon levels
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SGLT-2 Medications

• Farxiga
• Xigduo (combination farxiga and metformin)
• Invokana
• Invokamet (combination Inovokana and metformin)
• Jardiance

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GLP-1

• Bydureon
• Byetta
• Tanzeum
• Victoza
• Trulicity

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• 44 year old female presents to establish PCP.
• PMH DM II, BMI 32
• Medication
• Lantus 97 units Q AM
• Novolog 50 units before meals
• Pt. taken off metformin 3 months prior due to
  renal insufficiency
• HbA1c 13