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Objectives

  • Identify drug categories used in diabetes treatment.
  • Understand exemplar drugs, adverse effects, patient education, and monitoring principles.

Diabetes Types

  • Type 1 Diabetes (T1D)
  • Type 2 Diabetes (T2D): 90-95% of cases.
  • Gestational Diabetes Mellitus (GDM)
  • Other specific types of diabetes.

Diabetes Pharmacology Principles

  • Understand drug classes, MOA, contraindications, adverse effects, and appropriate use.

Noninsulin Agents for T2DM

  • Biguanide: Metformin (Glucophage)
  • DPP-4 Inhibitors: Sitagliptin (Januvia), Linagliptin (Tradjenta)
  • GLP-1 Receptor Agonists: Semaglutide (Ozempic), Dulaglutide (Trulicity)
  • SGLT2 Inhibitors: Empagliflozin (Jardiance)
  • Sulfonylureas: Glimepiride, Glipizide
  • Thiazolidinediones (TZDs): Pioglitazone (Actos)
  • Meglitinides: Repaglinide (Prandin)
  • Alpha-glucosidase Inhibitors: Acarbose (Precose)

Glycemic Targets (ADA 2023)

  • Target A1c < 7%
  • Pre-meal glucose: 80-130 mg/dL
  • Postprandial glucose: <180 mg/dL
  • Individualization based on age, comorbidities, and pregnancy.

Anticipated Glycemic & Weight Effects

  • Cost considerations for medications vary widely.
  • Medications with weight loss benefits: GLP-1 RAs, SGLT2 inhibitors.

Metformin

  • First-line therapy for T2DM.
  • Decreases hepatic glucose production, improves insulin sensitivity.
  • Effective A1c lowering (1-2%).
  • Side effects: GI disturbances, B12 deficiency risk, lactic acidosis.

GLP-1 Receptor Agonists

  • Indications: T2DM and cardiovascular event risk reduction.
  • Benefits: Significant A1c reduction (~1.5-2%); low hypoglycemia risk; weight loss.
  • Potential side effects: Nausea, pancreatitis, thyroid tumors.

SGLT2 Inhibitors

  • Medications: Dapagliflozin, Empagliflozin.
  • Benefits: Moderate A1c lowering; weight loss; cardiovascular and renal benefits.
  • Risks: Genitourinary infections; risk of DKA.

DPP-4 Inhibitors

  • Low A1c-lowering effects (~0.5-0.8%).
  • Generally well-tolerated; low hypoglycemia risk.
  • Caution: pancreatitis risk.

Sulfonylureas and Meglitinides

  • Enhance insulin secretion.
  • Risk of hypoglycemia; weight gain concerns.

Prescribing Considerations

  • Individualize therapy based on A1c levels, renal function, and patient preferences.
  • Important to monitor for adverse effects and adjust treatment accordingly.

Patient Education

  • Discussion on risks and benefits of therapies.
  • Self-monitoring blood glucose recommendations vary per patient needs.

Special Populations

  • Adjustments for pediatric and geriatric populations, especially concerning comorbidities and risk of hypoglycemia.
  • Management during pregnancy emphasizes insulin as standard treatment with glycemic control.