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First Generation Sulfonylurea

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81. Glibenclamide (Amglidia) - Diabetes Mellitus

mellitus. The hypoglycaemic effect of sulfonylureas is due to a stimulation of insulin secretion from pancreatic ß-cells via blockade of the ATP-sensitive K + (K ATP ) channel (Sturgess et al. 1985; Trube et al. 1986; Zünkler et al. 1988a; Panten et al. 1989; review in Panten et al. 1996). The K ATP channel couples cellular metabolism to membrane excitability. The K ATP channel has first been described in guinea pig and rabbit cardiac myocytes (Trube and Hescheler 1984; Noma 1983) and later (...) . INSULINS, Sulfonylureas (A10BB01) Therapeutic indication: Amglidia is indicated for the treatment of neonatal diabetes mellitus, for use in newborns, infants and children. Sulphonylureas like Amglidia have been shown to be effective in patients with mutations in the genes coding for the ß-cell ATP-sensitive potassium channel and chromosome 6q24-related transient neonatal diabetes mellitus. Pharmaceutical form Oral suspension Strengths: 0.6 mg/ml and 6 mg/ml Route of administration: Oral use Packaging

2018 European Medicines Agency - EPARs

82. Ertugliflozin l-pyroglutamic acid / sitagliptin phosphate monohydrate (Steglujan) - Diabetes Mellitus, Type 2

for the assessment of the product The Rapporteur and Co-Rapporteur appointed by the CHMP were: Rapporteur: Kristina Dunder Co-Rapporteur: Agnes Gyurasics • The application was received by the EMA on 1 February 2017. • The procedure started on 23 February 2017. • The Rapporteur's first Assessment Report was circulated to all CHMP members on 15 May 2017. The Co-Rapporteur's first Assessment Report was circulated to all CHMP members on 22 May 2017. The PRAC Rapporteur's first Assessment Report was circulated to all (...) agent or in combination, may provide effective glycaemic control for some patients, many do not achieve their target A1C levels, and glycaemic control deteriorates over time. Current guidelines from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recommend a stepwise and individualized treatment approach to T2DM. These guidelines recommend metformin as the optimal first-line anti-hyperglycaemic agent (AHA), unless the patient has

2018 European Medicines Agency - EPARs

83. Pharmacological management of glycaemic control in people with type 2 diabetes

intensive treatment with metformin and intensive treatment with chlorpropamide, glibenclamide, or insulin (n=951). 11 R Metformin should be considered as the first-line oral treatment option for people with type 2 diabetes. Pharmacological management of glycaemic control in people with type 2 diabetes 4 • Metformin 1 ++ 1 ++ 1 + 1 ++ 1 ++ 1 ++12 | 5 Sulphonylureas Sulphonylureas increase endogenous release of insulin from pancreatic ß-cells. First-generation agents (acetohexamide, chlorpropamide (...) sustainable forests.Scottish Intercollegiate Guidelines Network Pharmacological management of glycaemic control in people with type 2 diabetes A national clinical guideline November 2017Scottish Intercollegiate Guidelines Network Gyle Square, 1 South Gyle Crescent Edinburgh EH12 9EB www.sign.ac.uk First published November 2017 ISBN 978 1 909103 61 0 Citation text Scottish Intercollegiate Guidelines Network (SIGN). Pharmacological management of glycaemic control in people with type 2 diabetes. Edinburgh

2017 SIGN

84. Metformin Use in Patients with Historical Contraindications or Precautions

cohort n = 253,690 Sulfonylurea versus metformin MACE or mortality HR 1.18 (95% CI 1.09, 1.28) MACE: HR 1.13 (95% CI 1.03, 1.24) Tzoulaki, 2009 64 Retrospective cohort n = 91,521 Second- generation sulfonylurea versus metformin Rosiglitazone versus metformin Subgroup age ³ 65 years: Mortality: HR 1.35 (95% CI 1.28, 1.42) Myocardial infarction: HR 1.22 (95% CI 1.10, 1.35) CHF: HR 1.18 (95% CI 1.10, 1.26) No difference in mortality or myocardial infarction. Increased CHF (HR 1.32, 95%CI 1.07, 1.63 (...) RCT n = 59 Metformin vs sulfonylurea OR 0.24 (95% CI, 0.01 to 5.17)* Schweizer, 2009 57 RCT n = 322 Metformin + sulfonylurea versus metformin + pioglitazone OR 5.12 (95% CI 0.24 to 107.51)* a OR and 95% CI calculated from data reported. The nested case-control study with low ROB used data from the UK-based General Practice Research Database to compare rates of hypoglycemia in current sulfonylurea users with current metformin users. 59 Overall, 2,025 case subjects with hypoglycemia were compared

2017 Veterans Affairs Evidence-based Synthesis Program Reports

85. CRACKCast E182 – Drug Therapy in the Geriatric Patient

for peptic ulcer disease at full dose for >8 weeks NSAID’s in patients with moderate to severe hypertension Long-term use of opioids Aspirin without adequate cardiovascular risk Warfarin and NSAID used together Beta blocker in patients with COPD Prolonged use of first-generation antihistamines NSAID use in patients with chronic renal failure This post was formatted and copyedited by Dillan Radomske ( ) (Visited 640 times, 1 visits today) Chris Lipp is one of the founding Fathers for CrackCast. He (...) in older patients Drug Adverse Event ACE Inhibitors/ARB’s Hyperkalemia Benzos and Sedative-Hypnotics Fractures, Falls CCB’s Hypotension Digoxin Toxicity Lithium Toxicity Phenytoin Toxicity Sulfonylureas Hypoglycemia Theophylline Toxicity Warfarin Bleeding [5] What are the top 10 STOPP criteria? REMEMBER: STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) are newer criteria to identify potentially inappropriate medications in the elderly, including drug–drug and drug

2018 CandiEM

86. Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association

are generally younger at the time of their first MI. , Dyslipidemia Dyslipidemia is likely an important factor contributing to the increased CVD risk observed in South Asian populations. The typical lipoprotein pattern seen in individuals of South Asian descent who are living in Western societies is characterized by hypertriglyceridemia and low levels of HDL cholesterol (HDL-C). Although levels of low-density lipoprotein (LDL) cholesterol (LDL-C) may not appear elevated, this population has a high incidence (...) of expertise on South Asians and CVD. A general framework outlined by the committee chairs was used to conduct a comprehensive literature review to summarize existing evidence, to indicate gaps in current knowledge, and to formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and US Census data as secondary resources. Inductive methods and descriptive studies

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2018 American Heart Association

87. AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm

Beaumont School of Medicine, Visiting Professor, Internal Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic, Past President, American Association of Clinical Endocrinologists, President Elect, American College of Endocrinology; 14 Medical Director & Principal Investigator, Metabolic Institute of America, Chair, AACE Diabetes Scientific Committee, Tarzana, California; 15 Professor of Medicine, University of Washington School of Medicine, Seattle, Washington; 16 Professor (...) - tions-centric model that incorporates 3 disease stages: Stage 0 (elevated BMI with no obesity complications), Stage 1 (1 or 2 mild to moderate obesity complications), and Stage 3 (>2 mild to moderate obesity complications, or =1 severe complications) (41,42). The patients who will benefit most from medical and surgical intervention have obesity- related complications that can be classified into 2 general categories: insulin resistance/cardiometabolic disease and biomechanical consequences of excess

2018 American Association of Clinical Endocrinologists

88. SMFM Statement Pharmacological treatment of gestational diabetes

; 361 : 1339–1348 | | | Although medical nutritional therapy is the first-line intervention for GDM, some evidence suggests that up to 30% of women require pharmacologic treatment to maintain euglycemia. x 2 Mendez-Figueroa, H., Schuster, M., Maggio, L., Pedroza, C., Chauhan, S.P., and Paglia, M.J. Gestational diabetes mellitus and frequency of blood glucose monitoring: a randomized controlled trial. Obstet Gynecol . 2017 ; 130 : 163–170 | | | In the United States, 3 pharmacologic therapies are used (...) . and others x 4 Nankervis, A. and Conn, J. Gestational diabetes mellitus: negotiating the confusion. Aust Fam Physician . 2013 ; 42 : 528–531 | , x 5 Hod, M., Kapur, A., Sacks, D.A. et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet . 2015 ; 131 : S173–S211 | | support the use of oral hypoglycemic agents as first-line therapy. Despite U.S. providers’ decades

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2018 Society for Maternal-Fetal Medicine

89. Sodium-glucose co-transporter 2 (SGLT2) inhibitors for type 2 diabetes mellitus

Sodium-glucose co-transporter 2 (SGLT2) inhibitors for type 2 diabetes mellitus '); } else { document.write(' '); } ACE | Sodium-glucose co-transporter 2 (SGLT2) inhibitors for type 2 diabetes mellitus Search > > Sodium-glucose co-transporter 2 (SGLT2) inhibitors for type 2 diabetes mellitus - Sodium-glucose co-transporter 2 (SGLT2) inhibitors for type 2 diabetes mellitus First published on 3 May 2017 Guidance Recommendations The Ministry of Health’s Drug Advisory Committee has recommended (...) : Dapagliflozin 5 mg and 10 mg tablets, and empagliflozin 10 mg and 25 mg tablets for managing type 2 diabetes mellitus, in the following circumstances: as a dual therapy in combination with metformin for patients with HbA1c measurement greater than 7% despite treatment with metformin monotherapy and when sulfonylureas are contraindicated or not tolerated, or the person is at significant risk of hypoglycaemia or its consequences; or as a dual therapy in combination with a sulfonylurea for patients with HbA1c

2018 Appropriate Care Guides, Agency for Care Effectiveness (Singapore)

90. Insulin Degludec (Tresiba, Novo Nordisk A/S) for the Treatment of Diabetes: Effectiveness, Value, and Value-Based Price Benchmarks

. The VA/DOD recommends considering the risk of hypoglycemia when setting HbA1c goals for any patient. Diet and exercise modification should be the first-line therapy in all patients with type 2 DM. Insulin should be considered for all patients with severe hyperglycemia. Metformin or a sulfonylurea should be used as a first-line pharmacological agents, and patients unable to tolerate either should attempt monotherapy with a TZD, AG inhibitor, meglitinide, DPP-4 inhibitor, or GLP-1 agonist. The VA/DOD (...) , Endocrinology and Metabolism Division and Director of Diabetes Center for High Risk Populations, San Francisco General Hospital; Professor of Clinical Medicine, UCSF Manuel Quiñones, MD Internal Medicine and Diabetology, Healthcare Partners - Anaheim Tony Van Goor, MD, MMM, CPE, FACP Senior Director, Medical Affairs, Medical Director for Policy and Technology Assessment, Blue Shield of California The roundtable discussion was facilitated by Jed Weissberg, MD, Senior Fellow at ICER. The main themes

2017 California Technology Assessment Forum

91. Nine different drug classes reviewed for type 2 diabetes

does current guidance say on this issue? The NICE guideline for treating type 2 diabetes in adults, last updated in July 2016, recommends metformin (standard release) as initial drug treatment. If metformin is not appropriate, initial treatment should be with a dipeptidyl peptidase-4 (DPP-4) inhibitor, a sulfonylurea or pioglitazone (a thiazolidinedione). Individual needs and preferences should be taken into account. If single drug treatment is ineffective, the first intensification step is dual (...) Nine different drug classes reviewed for type 2 diabetes Nine different drug classes reviewed for type 2 diabetes Discover Portal Discover Portal Nine different drug classes reviewed for type 2 diabetes Published on 17 January 2017 doi: Metformin worked best at keeping blood sugar levels under control and remains a good first choice as single therapy. Overall, the nine classes of blood sugar-lowering drugs had similar effect on risk of death from cardiovascular causes and overall mortality

2019 NIHR Dissemination Centre

92. CRACKCast E126 – Diabetes Mellitus and Disorders of Glucose Homeostasis

fluid requirements and administer NS – use the worksheet or estimate using 4-2-1- rule ******Wait 1-2 hrs before starting IV insulin***** Insulin given in the first 1–2 h of DKA repair is thought to increase mortality. This insulin rate fully inhibits ketogenesis and gluconeogenesis and should be maintained if possible. Replace: Calculate and start a piggyback insulin drip at 0.05–0.1 units/kg BW/h: No insulin boluses When you start insulin, you should be adding potassium to the IV fluids! (could (...) add it to the maintenance fluid) Replace lost electrolytes Reassess: Add dextrose to keep serum glucose between 10-15 mmol/L Keep [K+] >4.0 mmol/L; Correct Mg. Notes: Bicarbonate is not generally recommended Q1 hr glucose checks Q2-3 hrs electrolyes and creatinine checks. Watch for cerebral edema Here’s a breakdown for adults: Remember, we’re typically looking for the triad of: Hyperglycemia, acidosis, and ketosis However, various states can knock one of these things out of the triad (e.g. severe

2017 CandiEM

93. Sex Effects in High-impact Conditions for Women Veterans - Depression, Diabetes, and Chronic Pain

. Center Directors are recognized leaders in the field of evidence synthesis with close ties to the AHRQ Evidence-based Practice Centers. The ESP is governed by a Steering Committee comprised of participants from VHA Policy, Program, and Operations Offices, VISN leadership, field-based investigators, and others as designated appropriate by QUERI/HSR&D. The ESP Centers generate evidence syntheses on important clinical practice topics. These reports help: · Develop clinical policies informed by evidence (...) in older adults More adverse effects on sexual dysfunction Paroxetine Depressive symptoms Antidepressants overall, quality improvement, self-help a Combined antidepressant and psychotherapy for dysthymia Adverse effects overall Antidepressants Diabetes Fracture risk Lower for sulfonylureas (compared with thiazolidinediones) Glycemic control Linagliptin a , vildagliptin a Weight loss Bariatric surgery Chronic pain b Greater improvement in CLBP Quality improvement CLBP Antidepressants a Findings are from

2016 Veterans Affairs Evidence-based Synthesis Program Reports

94. American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease

School of Medicine, Professor, Internal Medicine, Oakland University William Beaumont School of Medicine, Visiting Professor, Internal Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic, Immediate Past President of the American Association of Clinical Endocrinologists, Chancellor of the American College of Endocrinology; 11 Clinical Assistant Professor of Medicine, University of California San Diego, San Diego, California, Immediate Past-President of the California (...) to individuals with diabe- tes, familial hypercholesterolemia, women, and youth with dyslipidemia. Both clinical and cost-effectiveness data are provided to support treatment decisions. (Endocr Pract. 2017:Suppl2;23:1-87) I. INTRODUCTION In 2016, approximately 660,000 U.S. residents will have a new coronary event (defined as a first hospitalized myocardial infarction [MI] or atherosclerotic cardiovascu- lar disease [ASCVD] death), and approximately 305,000 will have a recurrent event. The estimated annual

2017 American Association of Clinical Endocrinologists

95. Management of Type 2 Diabetes Mellitus

of atherosclerotic disease. However, only very limited trial data evaluate the effectiveness of lowering triglycerides on cardiovascular outcomes. The first-line of treatment for hypertriglyceridemia is optimization of glucose and thyroid (if hypothyroid) control. Use of fibrates is generally discouraged as there is no evidence of benefit in trials using fibrates alone or in combination with statins. If triglycerides are markedly elevated (e.g., over 1000 mg/dL), then treatment may be warranted to avoid (...) Management of Type 2 Diabetes Mellitus Quality Department Guidelines for Clinical Care Ambulatory Diabetes Mellitus Guideline Team Team Leaders Connie J Standiford, MD General Internal Medicine Sandeep Vijan, MD General Internal Medicine Team Members Hae Mi Choe, PharmD College of Pharmacy R Van Harrison, PhD Medical Education Caroline R Richardson, MD Family Medicine Jennifer A Wyckoff, MD Metabolism, Endocrinology & Diabetes Consultants Martha M Funnell, MS, RN, CDE Diabetes Research

2017 University of Michigan Health System

96. Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline from the American College of Physicians

randomized, controlled trials and 13 observational studies, mostly 1 year or less in duration) was either low quality or insufficient for evaluating clinical outcomes, such as mortality, cardiovascular mortality and morbidity, retinopathy, nephropathy, and neuropathy. All-Cause Mortality Low-quality evidence comparing metformin monotherapy with sulfonylurea monotherapy showed that metformin was associated with lower all-cause mortality; however, results were inconsistent across studies ( ). Generally (...) , and SGLT-2 inhibitors. The CGC generally agreed with the evidence review that all evidence from comparisons of monotherapies and combination therapies with respect to overall and cardiovascular mortality, as well as cardiovascular morbidity, was of low quality. However, the committee felt that the evidence showing greater cardiovascular mortality with sulfonylureas than metformin monotherapy was of low rather than moderate quality. The committee also noted that the comparisons between metformin

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2017 American College of Physicians

97. Management of Diabetes Mellitus in Primary Care

Practice Guideline 8 A. Methods 8 B. Summary of Patient Focus Group Methods and Findings 12 C. Conflict of Interest 13 D. Scope of this Clinical Practice Guideline 14 E. Highlighted Features of this Clinical Practice Guideline 15 F. Shared Decision-making and Patient-centered Care 15 G. Implementation 16 IV. Guideline Work Group 17 V. Algorithm 18 A. Algorithm 19 VI. Recommendations 21 A. General Approach to T2DM Care 23 B. Glycemic Control Targets and Monitoring 28 C. Non-pharmacological Treatments 36 (...) . Sulfonylureas 91 J. Thiazolidinediones 92 Appendix C: FDA Approved/ Studied Combination Therapy .. .93 Appendix D: Patient Focus Group Methods and Findings 94 A. Methods 94 B. Patient Focus Group Findings 95 Appendix E: Evidence Table 97 Appendix F: 2010 Recommendation Categorization Table 101 Appendix G: Participant List 131 Appendix H: Literature Review Search Terms and Strategy 133 A. Topic-specific Search Terms 133 Appendix I: Acronym List 148 References 151 VA/DoD Clinical Practice Guideline

2017 VA/DoD Clinical Practice Guidelines

98. Acute and Chronic Heart Failure

and the patient's caregiver where appropriate and/or necessary. It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription. 2. Introduction The aim of all the ESC Guidelines is to help health professionals to make decisions in their everyday life based on the best available evidence. We will soon be celebrating the 30th anniversary of clinical trials that for the first time incontrovertibly demonstrated that the miserable (...) outcomes. Detailed summaries of the key evidence supporting generally recommended treatments have been provided. For diagnostic recommendations a level of evidence C has been typically decided upon, because for the majority of diagnostic tests there are no data from randomized controlled trials (RCTs) showing that they will lead to reductions in morbidity and/or mortality. Practical guidance is provided for the use of the important disease-modifying drugs and diuretics. When possible, other relevant

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2016 European Society of Cardiology

99. Atopic Dermatitis - Guidelines for Prescribing Topical Corticosteroids

atopic dermatitis is a part of. Eczema is a non-specific inflammatory skin reaction. Atopic dermatis is a type of eczema, usually considered the most severe and long lasting. Other types of eczema include contact dermatitis or seborrheic dermatitis. Once thought to be an allergic disorder, but there is now little support for this theory of pathogenesis. Typically, first appears in early childhood (i.e. the first year of life) and subsides with advancing age. Caused by a combination of skin barrier (...) , cracking, bleeding and oozing. Possible alteration of skin pigmentation. Major impact on sleep and daily activities. Atopic dermatitis is assessed based on signs, symptoms and history. Rule out the following conditions that may present with similar signs / symptoms: - Recent contact with unknown plant? chemical? topical medicine? - generalized, severe itching; burrows in finger webs and sides of fingers - May cause skin flaking similar to atopic dermatitis, but otherwise looks different. Tinea corporis

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2017 medSask

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