Diabetes Drugs

What are the drug classes for diabetes medications?

1) Biguanides

2) GLP-1 RA (receptor agonist)

3) GIP/GLP-1 RA

4) SGLT2 inhibitors

Metformin - brand/class

Glucophage

Biguanides

What is the MOA of metformin?

1) decrease hepatic gluconeogenesis (liver’s production of glucose)

2) decreased glucose absorption in the intestines

3) increase insulin sensitivity

What are the ADRs for metformin?

• N/V/D

• Flatulence

• abdominal pain/discomfort

• metallic taste

• b12 deficiency

What are rare ADRs for metformin?

lactic acidosis

What are contraindications for metformin?

• hypersensitivity

• eGFR < 30 mL/min/1.73 m

• metabolic acidosis

• hold for 48 hours before/after radiocontrast dye

How to monitor efficacy for metformin?

• A1C

• FPG (fasting plasma glucose)

How to measure safety for metformin?

• SCr, eGFR (O)

• b12 level (O)

• CBC (O)

• lactate (O)

• s/s lactic acidosis (S)

• GI symptoms (S)

What drugs are in the GLP-1 RA class?

1) Duraglutide* (Trulicity)

2) Liraglutide* (Victoza)

3) Semaglutide (Ozempic [SQ]; Rybelsus [PO]

What drugs are in the GIP/GLP-1 RA class?

1) Tirzepatide (Mounjaro)

What is the MOA for GLP-1 RA and GIP/GLP-1 RA?

1) increase glucose dependent insulin secretion

2) decrease inappropriate glucagon secretion

3) slows gastric emptying

4) increases satiety (feeling full)

What are the ADRs for GLP-1 RA and GIP/GLP-1 RA?

• N/V/D/C

• decrease appetite

• abdominal pain

• tachycardia

• injection site reactions

• dyspepsia (digestive disorder)

• eructation (belch)

• weight loss

What are rare ADRs for GLP-1 RA and GIP/GLP-1 RA?

• pancreatitis

• gallbladder disease

• AKI (secondary to dehydration)

• retinopathy

What are contraindications of GLP-1 RA and GIP/GLP-1 RA?

• hypersensitivity

• personal/family hx MTC

• personal hx of MEN2

• caution: hx of pancreatitis

How to monitor efficacy for GLP-1 RA and GIP/GLP-1 RA?

• A1C

• FPG

• PPG

• weight

How to monitor safety for GLP-1 RA and GIP/GLP-1 RA?

• amylase/lipase (pancreatitis) (O)

• HR (O)

• triglycerides (O)

• SCr, eGFR (O)

• weight (O)

• GI symptoms (S)

• S/S pancreatitis (S)

• S/S gallbladder disease (S)

• worsening retinopathy (S)

What medications are in the SGLT2i class?

1) Bexagliflozin (Brenzavvy)

2) Canagliflozin* (Invokana)

3) Dapagliflozin* (Farxiga)

4) Empagliflozin (Jardiance)

5) Ertugliflozin (Steglatro)

What is the MOA of SGLT2i?

1) decrease kidney glucose reabsorption

2) increase glucosuria (presence of glucose in the urine)

What are the ADRs for SGLT2i?

1) genital mycotic/urinary infections

2) glucosuria

3) polyuria

4) dehydration

5) hypotension

6) dizziness

What are the rare ADRs for SGLT2i?

1) euglycemic DKA

2) fournier gangrene

3) limb amputation

4) bone fracture

5) AKI (first 2 weeks of taking)

What are the contraindications of SGLT2i?

1) hypersensitivity

2) GFR < 20

3) kidney dose adjustments

4) caution: hold 3-5 days prior to surgery

How to monitor for SGLT2i?

1) A1C

2) FPG

3) PPG

4) weight

How to monitor for safety of SGLT2i?

1) SCr, eGFR (kidney function) (O)

2) BP, electrolytes, Hct (volume status) (O)

3) serum bicarbonate, ketones, arterial pH (ketoacidosis) (O)

4) urinalysis (glycosuria, UTI) (O)

5) LDL (O)

6) weight (if normal, low BMI) (O)

7) S/S UTI (S)

8) S/S mycotic infections - fungal infections (S)

9) S/S ketoacidosis - break down fat for energy (S)

A patient has ASCVD, what diabetic drug would you use?

1) GLP-1 RA: dulaglutide (Trulicity, Liraglutide (Victoza), Semaglutide SC (Ozempic)

2) SGLT2i: canagliflozin (Invokana) or empagliflozin (Jardiance)