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Medication Therapy Management of Diabetes

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by

Marilyn Redd

on 15 December 2010

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Transcript of Medication Therapy Management of Diabetes

Medication Therapy Management of T2DM Objectives
I. List 3 prevention strategies for T2DM
II. Identify glycemic goals for patients with T2DM
III. Discuss the pharmacology and precautions of 4 classes of diabetes medications PREVENTION
I. Weight loss
a. Refer to reputable support program
b. Increased physical activity
i. Increased insulin sensitivity
ii. Reduction in A1c
c. Follow up is important for successful weight loss
II. Consider metformin
a. A1c >6%
b. Comorbidities (high cholesterol or triglycerides, HTN)
c. Family History
III. Yearly monitoring GOALS
I. A1c <7%
II. Preprandial plasma glucose 70-130 mg/dL
III. Postprandial plasma glucose <180 mg/dL
*If glycemic goals are not met, consider giving patient
insulin self-titration algorithm*
IV. BP <130/80
V. LDL Cholesterol
a. Without CVD <100 mg/dL
b. With CVD <70 mg/dL METFORMIN Pharmacology
Decreases hepatic glucose production
Decreases intestinal glucose absorption
Increases peripheral insulin sensitivity Adverse Events
GI: N/V/D, flatulence
Neuromuscular/skeletal weakness Drug Interactions
Some diuretics may alter effect
Cephalexin increases metformin serum levels Precautions
Renal dysfunction (acidosis)
Heart Failure SULFONYLUREAS Pharmacology
Stimulates pancreatic beta cells to secrete insulin
Decreases hepatic glucose production
Increases peripheral insulin sensitivity
Elimination does NOT depend on renal function Adverse effects
Hypoglycemia
ER formulation matrix will pass in stool Precautions
Sulfa allergy
Patients with severe liver disease
Beta-blockers mask signs of hypoglycemia
*Cardioselective beta-blocker preferred Drug Interactions
CYP2C9: Azole antifungals THIAZOLIDINEDIONES Pharmacology
Increases cellular sensitivity to insulin
Dependent on insulin presence Adverse Effects
Edema
Upper Respiratory Tract Infection
Weight gain
Visual Changes (routine ophthalmic exams) Precautions
May exacerbate heart failure
Increases risk of fracture
Anemia; may decrease H&H Drug Interactions
Insulin increases fluid retention and edema
Pregabalin increases fluid retention
Trimethoprim decreases metabolism DPP4 INHIBITORS Pharmacology
Increases incretin levels, stimulatin insulin release
Decreases glucagon secretion and hepatic glucose release Adverse Effects
Nasopharyngitis
GI Upset
Edema Precautions
Hypersensitivity reactions
Pancreatitis
Dose adjust for renal dysfunction Drug Interaction
May increase serum digoxin levels MEDICATIONS GENERAL CONSIDERATIONS Many drugs can induce hyperglycemia
Corticosteroids
Calcium Channel Blockers
Phenytoin

Take with or without food?

Diabetes medications may alter nutrient absorption

Due to increased cardiac risk and edema, do not use triple therapy with:
Metformin
Sulfonylureas
Thiazolidinediones REFERENCES 1. Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug Information Handbook, 17th ed. Hudson, Ohio, Lexi-Comp, Inc.; 2008-2009.

2. Segerstrom AB, Glans F, Ericksson KF, et al. Impact of exercise intensity and duration on insulin sensitivity in women with T2D. European Journal of Internal Medicine. 2010;21(5):404-408.

3. Standards of Medical Care in Diabetes. American Diabetes Association. 2010;33:S11-S61
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