Treatment Advances in Type 2 Diabetes Panhandle Nurse Practitioner Symposium April 11, 2015 Dr. Caleb Kim

3 Diagnosis of Diabetes Climbing Dramatically

4 Type 1 verses Type 2

5 Diagnostic Criteria  HbA1c >6.5  Fasting BG > 126  oral glucose tolerance test

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10 Concerns of DM Medications Causing Hypoglycemia

11 Treatment Paradigm  Step 1 ◦ metformin  Step 2 ◦ DPP-4 vs GLP-1  Step 3 ◦ SGLT-2, Actos ◦ (sulfonylureas if needed)  Step 4 ◦ insulin

12 3 New Diabetes Medication Classes Within the Past 10 Years  DPP-4 Inhibitors  SGLT-2 Inhibitors  GLP-1 Agonists

13 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)

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

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16 SGLT-2 Medications  Farxiga ◦ Xigduo (combination farxiga and metformin)  Invokana ◦ Invokamet (combination Inovokana and metformin)  Jardiance

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19 GLP-1  Bydureon  Byetta  Tanzeum  Victoza  Trulicity

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25  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