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Glycemic Control Medications

Glycemic Control Medications. Sulfonylureas (2 nd generation). Percent of CVD Demonstration programs with unrestricted & restricted use of glycemic control medications:. Pearls: Sulfonylureas. Generally, little benefit beyond 50% of maximal dose;

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Glycemic Control Medications

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  1. Glycemic Control Medications

  2. Sulfonylureas (2nd generation)

  3. Percent of CVD Demonstration programs with unrestricted & restricted use of glycemic control medications:

  4. Pearls: Sulfonylureas • Generally, little benefit beyond 50% of maximal dose; • Metabolized in the liver: caution with liver disease; • Cleared by the kidneys: glyburide has partially active metabolites and should be avoided in renal disease.

  5. Biguanides * Uncommon side effect: Lactic Acidosis Thiazolidinediones

  6. Percent of CVD Demonstration programs with unrestricted & restricted use of glycemic control medications:

  7. Pearls: Metformin • Renally cleared: do not use if creatinine 1.5 in men,  1.4 in women • Major Risk: LACTIC ACIDOSIS • Very rare: 1/30,000 patient-years • Contraindicated in renal insufficiency, dehydration, hemodynamic instability, alcoholism, CHF requiring medication therapy, metabolic acidosis • Check AST/ALT and creatinine every 6-12 months

  8. Pearls: Metformin • Hold for radio-contrast studies the day of procedure and restart 48 hours after procedure • Optimal dose 2,000mg/day. No additional benefit at higher dose • Does not cause hypoglycemia unless used with sulfonylurea or insulin

  9. Pearls: TZDs • Weight gain and pedal edema can be a problem for patients, especially at higher dose • Caution in hepatic dysfunction • Check LFT every 6 months • Safe in renal dysfunction • Delayed onset of action: may take 4 – 12 weeks to achieve peak effect

  10. Insulin Types * Pharmacokinetics of insulins are influences by dose, injection site, and other factors: as a result, certain patients may experience variable onsets, peaks and durations of insulins.

  11. Pearls: Insulins • Rapid-Acting Insulin; • May be given no more than 15 minutes before meal • Can also be given at the end of the meal. May be helpful for patients with delayed gastric emptying • Long-Acting Insulin glargine: cannot be mixed with other insulins

  12. Percent of CVD Demonstration programs with unrestricted & restricted use of insulin:

  13. Lipid Control Medications

  14. HMG CoA Reductase Inhibitors (Statins)

  15. Fibrates: Used to lower Triglyercides

  16. Percent of CVD Demonstration programs with unrestricteduse of lipid control medications:

  17. Hypertension Control Medications

  18. JNC-7 Algorithm for the treatment of hypertension in patients with diabetes NOT AT BP GOAL < 130/80 NOT AT BP GOAL < 130/80

  19. Percent of CVD Demonstration programs with unrestricted use of hypertension control medications:

  20. Selected References: • Hypertension: Konzen, S et a. Controlling Hypertension in Patients with Diabetes: American Family Physician 2002; 66: 1209-14 The physician reference card from the JNC 7 (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) is available at the following website: http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf • Blood cholesterol and lipids: The appendix of the At-A-Glance: Quick Desk Reference by the NCEP ADP III (National Cholesterol Education Program Adult Treatment Panel III) provides further information on the risk determination and treatment for elevated cholesterol levels. The quick reference guide, as well as the full report, are available at the following website: http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm • Blood glucose control: Luna, B. Fienglas, M: Oral Agent in the Management of Type 2 Diabetes. American Family Physician. 2001; 63:1747-56, 1759-80. Clear presentation on oral agents in DM care with excellent stepped approach to glycemic management. • CVD Risk Reduction: Garvin, J et alReducing Cardiovascular Disease Risk in Patients with Type 2 Diabetes: American Family Physician 2003; 68: 1569-74, 1577-8

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