Other Meds for T2D and Combo Meds

What are the alpha-glucosidase inhibitors?

Acarbose and miglitol

What is the MOA of alpha-glucosidase inhibitors?

Inhibit metabolism of complex carbohydrates and disaccharides such as sucrose, delaying glucose absorption

When should alpha-glucosidase inhibitors be taken?

With the first bite of each meal

What are common GI side effects of alpha-glucosidase inhibitors?

Flatulence and diarrhea

Do alpha-glucosidase inhibitors cause hypoglycemia when used alone?

No

How MUST hypoglycemia be treated in a patient taking an alpha-glucosidase inhibitor?

Glucose tablets or glucose gel

Why should sucrose NOT be used to treat hypoglycemia in a patient taking an alpha-glucosidase inhibitor?

Alpha-glucosidase inhibitors delay sucrose breakdown, so table sugar, candy, and fruit juice may not adequately treat hypoglycemia

Which bile acid sequestrant is approved for T2D?

Colesevelam (Welchol)

What is the primary indication for colesevelam?

Dyslipidemia, but it is also approved for T2D

What is the most common side effect of colesevelam?

Constipation

What important drug interaction can occur with colesevelam?

It can bind other drugs and decrease their absorption

Which dopamine agonist can be used in specific situations for T2D?

Bromocriptine

In which patients is bromocriptine contraindicated?

Patients with syncopal migraines and patients who are postpartum and/or breastfeeding

Why is bromocriptine contraindicated in patients with syncopal migraines?

It can cause hypotension and orthostasis

Why is bromocriptine contraindicated postpartum or during breastfeeding?

It inhibits lactation

What drugs should not be used with bromocriptine?

Metoclopramide or other dopamine agonists

Which amylin analog is used for diabetes?

Pramlintide (Symlin)

How is pramlintide administered?

Subcutaneous injection

What is the MOA of pramlintide?

Slows gastric emptying, suppresses post-meal glucagon secretion, and increases satiety to control postprandial glucose

Which type of diabetes is pramlintide indicated for?

type 1 or 2

When should pramlintide be administered?

Before each meal; skip the dose if the meal is skipped

What major hypoglycemia precaution is required when starting pramlintide?

Reduce the mealtime insulin dose by 50%

In which condition is pramlintide contraindicated?

Gastroparesis

What are common side effects of pramlintide?

Nausea, vomiting, anorexia, and weight loss

What are the metformin + sulfonylurea combinations?

Metformin/glipizide and metformin/glyburide

What is the metformin + TZD combination?

Metformin/pioglitazone (Actoplus Met)

What are the metformin + DPP-4 inhibitor combinations?

Metformin/alogliptin;

metformin/linagliptin (Jentadueto);

metformin/sitagliptin (Janumet, Zituvimet);

metformin/saxagliptin

What are the metformin + SGLT2 inhibitor combinations?

Metformin/canagliflozin (Invokamet);

metformin/dapagliflozin (Xigduo XR);

metformin/empagliflozin (Synjardy);

metformin/ertugliflozin (Segluromet)

What is the metformin + SGLT2 inhibitor + DPP-4 inhibitor combination?

Metformin/empagliflozin/linagliptin (Trijardy XR)

What is the sulfonylurea + TZD combination?

Glimepiride/pioglitazone (Duetact)

What is the DPP-4 inhibitor + TZD combination?

Alogliptin/pioglitazone (Oseni)

What are the DPP-4 inhibitor + SGLT2 inhibitor combinations?

Linagliptin/empagliflozin (Glyxambi);

saxagliptin/dapagliflozin;

sitagliptin/ertugliflozin (Steglujan)

What are the GLP-1 agonist + insulin combinations?

Liraglutide/insulin degludec (Xultophy)

lixisenatide/insulin glargine (Soliqua)