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Type 2 DM Treatment

Class & GenericDosingMOAEfficacy & TargetADRsClinical Pearls
DPP-4 inhibitors: sitagliptan saxagliptan linagliptan alogliptin Daily Inhibits GLP-1 breakdown <1 Postprandial HA Nasopharyngitis Peripheral edema Pancreatitis Take w/ or w/out food High cost C/I: Hx of pancreatitis
SGLT-2 inhibitors: canagliflozin dapagliflozin empagliflozin Daily Increase urinary Glu excretion by blocking reabsorption in proximal convoluted tubule <1 Genital mycotic infections UTIs Hypotension Bone Fractures Increases urination Expensive C/I: severe renal impairment
GLP-1 agonists: exenatide liraglutide albiglutide dulaglutide Weekly-BID Increase insulin secretion; Decrease glucogon secretion; Reduce gastric emptying; Promote satiety <1 Postprandial GI Pancreatitis Medullary thyroid tumors Injectable Expensive Liraglutide indicated for weight loss C/I: Hx of pancreatitis, renal inpairment
Amylin analog: pramlintide TID Decrease glucagon secretion; Slow gastric emptying; Promote satiety <1 Postprandial GI HA Hypoglycemia Administered w/insulin (injectable) Expensive Weight loss C/I: hypoglycemia unawareness, gastroparesis
Bile Acid Binding Resin: colesevelam Daily-BID Unclear; Reduce hepatic gluconeogenesis or intestinal Glu absorption <1 Postprandial GI Expensive C/I: bowel obstruction, TGs >500
Dopamine agonist: bromocriptine Daily Unclear: Affect circadian activities the reduce caloric intake and storage <1 Fasting GI HA DZ Can decrease antipsychotic effectiveness Expensive C/I: syncopal migraine, breastfeeding, uncontrolled HTM
Biguanide: metformin Daily-BID Decrease hepatic Glu production; Decrease intestinal Glu absorption; Increase insulin sensitivity >1 Fasting GI Lactic acidosis (BBW) B12 deficiency Take w/food for GI Hold 48 hrs for contrast C/I: GFR <30, metabolic acidosis, HF
Sulfonylureas: glyburide glipizide glimepiride Daily-BID Increase insulin secretion >1 Fasting & postprandial Hypoglycemia Weight gain Skip dose if meal is skipped C/I: hypoglycemia unawareness, renal dysfunction, T1DM Glipizide for renal dysfunction
Meglitinides: repaglinide nateglinide TID Increase insulin secretion ~1 Postprandial Hypoglycemia Weight gain URTIs Skip dose if meal is skipped C/I: repaglinide + gemfibrozil, T1DM
TZDs: pioglitazone rosiglitazone Daily Increase insulin sensitivity >1 Fasting & postprandial Fluid retention Weight gain Increase lipids Fracture risk Bladder cancer (pioglitazone) Slow onset C/I: Class III/IV HF, LFTs >3x ULN
alpha-Glucosidase inhibitors: acarbose miglitol TID Slows intestinal carb digestion/absorption <1 Postprandial GI Take w/1st bite of food Use Glu to treat hypoglycemia C/I: IBD, colonic ulcerations, intestinal obstructions, cirrhosis (acarbose)
Created by: kcapizzi