Lixisenatide: A Case Study

This article discusses the use of dulaglutide and sitagliptin in the management of type 2 diabetes. Dulaglutide is a recombinant GLP-1 Fc fusion protein, which acts by linking GLP-1 analog peptide and a variant of lgG4 Fc fragments in humans. As such, the analog of GLP-1 has posed effects and has shown elevated efficacies in the management of type 2 diabetes. The primary efficacy in the baseline of HbA was altered during the end of 52nd week. The objective of secondary efficacy included a change in HbA during the end of the 26th and 104th week. The percentage of patients achieved HbA targets ranged between 7.5% to 6.5% in a central laboratory and the body changed significantly. However, current treatment majorly focuses on increasing

Everybody knows that obesity is a big factor in developing type-2 diabetes, and that part of coping with this metabolic disorder is lifestyle change. If blood glucose does not go down, then medicines are introduced. Some type-2 diabetics even have to administer insulin in order to keep their blood glucose levels

According to the member’s insurance plan, the preferred short-acting insulin analog of choice is Humalog. They note that Novolog is covered if “the member has had previous treatment, contraindication, or intolerance to Humalog.” It further states that this needs to be documented by filling out a specific form. Per the records submitted, no such documentation of “previous treatment, contraindication, or intolerance to Humalog” had been

Diabetes is a growing but preventable health concern in the United States.1 It is a problem in the body where blood glucose levels rise higher than normal.1 According to the facts released by the American Diabetes Association in 2013, 25.8 million Americans (8.3%) have diabetes 2 and approximately 90% of all cases of diabetes worldwide are considered type 2 diabetes.3 Type 2 diabetes is a progressive disease where the body cannot use insulin properly and the patient ends up using an oral hypoglycemic agent.1 One of the many classes of medications to help manage diabetes is sulfonylureas, including glyburide and glipizide. These drugs close K-ATP channels on Beta cell membranes and cause the pancreas to release more insulin to lower blood sugar.4 Both glipizide and glyburide are metabolized in the liver5, have high protein binding5, and can decrease hemoglobin A1c (HbA1c) up to 1%-2%.6 According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury".7 Insurance companies always strive to achieve their target glycemic goal via the most effective and cost effective therapeutic strategy.8 A literature search was conducted to find data on the benefits of converting patients from glyburide to glipizide to find out why insurance prefers the switch.

Managing blood glucose (BG) level in diabetic patients proves to be a challenging goal to insulin. The stand-alone method in many adult acute setting is the use of sliding scale insulin (SSI) to treat hyperglycemia. The goal within these settings is to maintain the BG level below 180 mg/dl (Trotter, Conaway & Burns, 2008).

SGLT2 inhibitors are the new boys on the block and they work by stopping your kidneys from reabsorbing sugar into the blood and eliminating it in the urine. These medications include Canagliflozin and Dapagliflozin. The negative side effects may be yeast and urinary tract infections along with an increase

Dipeptidyl peptidase-4 inhibitors is a medication which reduces blood glucose by blocking DPP-4, which reduces glucagon production and increases insulin secretion. Side effects include slowed gastric emptying. A systematic review of oral medication found that most guidelines for oral medications

Wow! Group C your case study was very thorough and educative. I concur with your treatment plan for all chronic disease the pt has. As you mentioned, metformin is the first line therapy for diabetes patients with uncontrolled A1c. During metformin therapy the pt should be monitored for lactose acidosis, symptoms include, abdominal pain, tachycardia, hypotension, tachypnea, and nausea (Edmunds & Mayhew 2014). Laboratory test to obtain include, lytes, ketones, lactate, blood pH, pyruvate, and serum creatinine. According to Edmunds & Mayhew (2014), metformin decreases a1c by o.9 to 1.4 %.

Many patients need not only a preventive or reactive drug, but adapted a combination of both types of drugs in order to allow maximum relief of their disease. Most doctors agree that the result for maximum relief of the minimum amount of medication

Adding basal insulin to a patient who is already receiving OHAs + GLP-1 Analogues and discuss the results. What I do in my practice is

Sodium linked Glucose Co- Transporter-2 (SGLT-2) inhibitors form a new class of agents that act on the kidney by competitively blocking the SGLT-2 channels. These agents are approved by FDA to be used as monotherapy or in combination with Metformin, Sulphonylurea (SU), Pioglitazone, or insulin. The ADA practice guidelines have added SGLT-2 inhibitors as the first add on to Metformin along with other drugs like SU, Dipeptyl Peptidase 4 (DPP4) inhibitors, thiazolidinedione and basal insulin. SGLT-2 inhibitors also finds a place as a second add on drug after 2 of the other drugs are

People who have the disorder have their glucose levels lower known as hypoglycemia. Studies revealed that this is caused by mutations in the gene for SGLT-2 which gave an opinion that SGLT-2 could be turned off, decreasing blood sugars without causing hypoglycemia. This made it to be "a good target" for SGLT-2 inhibitors. This symporter mainly targets the kidneys, reducing the blood glucose by eliminating excess sugar through urine.

There is growing concern that intense glucose lowering or the use of certain agents may be associated with adverse cardiovascular outcomes.

Below are data from a Phase 2, randomised, double-blind, placebo-controlled clinical trials, testing the effectiveness of two doses of a new drug designed to lower glucose concentrations in patients suffering from type 2 diabetes. In each trial, patients with Type 2 diabetes were randomised to receive one of two doses of drug or matching placebo once daily for 10 weeks. Whilst the drug has been well tolerated in earlier testing, it has been noted that higher doses are associated with unwanted side effects such as dizziness and nausea.

This studies suggests that SGLT2 inhibitors are better, if not equivalent, to the other medications on efficacy parameters, which may suggest that insurance companies need to adopt them on their formulary list of medications or that further research needs to be assessed for other parameter comparison. By comparing SGLT2 inhibitors to the other oral diabetes medications, SGLT2 inhibitors showed a lower relative risk via the statistical tests conducted in lowering cardiovascular mortality, and an at least equal effect on reducing A1C values. Though some pioneer studies point to metformin as the mainstay treatment, most oral antidiabetic treatments prove similarly efficacious when collaborating studies and examining effect from a meta-analytic point of view. Based on the research, I would not make a change in recommending metformin, but I would recommend that further research be evaluated to determine a more appropriate role for SGLT2 inhibitors in clinical practice. The main criticism of the SGLT2 inhibitors is the price