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First Generation Sulfonylurea

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81. 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

82. 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

83. 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

84. 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

85. 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

86. 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

87. 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

88. 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

90. 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

2018 NIHR Dissemination Centre

91. Glucagon-Like Peptide-1 receptor analogues

Glucagon-Like Peptide-1 receptor analogues | Published December 2016 1 London Medicines Evaluation Network Overview: Glucagon-Like Peptide-1 receptor analogues The first stop for professional medicines advice | Published December 2016 2 Metformin Sulphonylurea Pioglitazone Sulphonylurea & Pioglitazone Metformin & Pioglitazone Basal Insulin + Metformin Basal Insulin + Sulphonylurea Basal Insulin + pioglitazone Basal Insulin + metformin + pioglitazone L L L L L NICE (...) monitoring and subsequent dose adjustment on an individual level Licensing(L)/NICE Approval(N) Hypoglycaemic events According to NICE's meta-analysis, three non- insulin based drug combinations (including 2nd intensification with GLP-1 analogues) were generally associated with less hypoglycaemic events compared to the metformin-NPH insulin combination. Not addressed by NICE guidance London Medicines Evaluation Network Overview: Glucagon-Like Peptide-1 receptor analogues Basal Insulin In adults with type

2017 Specialist Pharmacy Services

92. Drugs That May Cause or Exacerbate Heart Failure

and other comorbidities, as well as the increasing comorbidity burden in an aging population that may warrant an increasing number of specialist and provider visits. , The HF syndrome is accompanied by a broad spectrum of both cardiovascular and noncardiovascular comorbidities. Five or more cardiovascular and noncardiovascular chronic conditions are present in 40% of Medicare patients with HF. This estimate is much higher compared with the general Medicare population, in which only 7.6% have ≥3 chronic (...) that diabetes mellitus (31%), chronic obstructive pulmonary disease (26%), ocular disorders (24%), osteoarthritis (16%), and thyroid disorders (14%) predominated. As the burden of noncardiovascular comorbidities increases, the number of medications, medication costs, and complexity also may increase. In the general population, patients with ≥5 chronic conditions have an average of 14 physician visits per year compared with only 1.5 for those with no chronic conditions. Medicare beneficiaries with HF see 15

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2016 American Heart Association

93. Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

; 95% CI, 0.91–1.08). 140 Some observation studies have sug- gested improved survival with metformin compared with sulfonylurea. 138,141 Prospective, randomized, controlled trials on sulfonylurea use in patients with HF have not been performed. Important adverse effects relevant to patients with HF include the risk of hypoglycemia and weight gain associated with sulfonylurea therapy. The new-generation sulfonylureas (eg, glyburide, gliclazide, glipizide, glimepiride) have largely replaced the first (...) - generation agents (eg, acetohexamide, chlorpropamide, tolazamide, tolbutamide) in routine use because they are more potent, can be administered in lower doses, and can be given on a once-daily basis. A few studies based on older-generation sulfonylureas have led to conflicting results for cardiovascular risk. Some evidence suggests greater risk of mortality with first-generation sulfonyl- ureas 164 compared with more recent ones that have been implicated in marginal cardiovascular benefit. 165

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2016 American Heart Association

94. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

pathophysiology of obesity and present an impetus to our health care system to provide effective treatment and prevention. In May of 2014, AACE and the American College of Endocrinology (ACE) sponsored their first Consensus Conference on Obesity (CCO) in Washington, DC, to establish an evidence base that could be used to develop a comprehensive plan to combat obesity (14 [EL 4; NE]). The conference convened a wide array of national stake- holders (the “pillars”) with a vested interest in obesity (...) , intuitive, and pragmatic questions that address key and germane aspects of obesity care: screening, diagnosis, clinical evaluation, treatment options, therapy selection, and treatment goals. In aggregate, these questions evalu- ate obesity as a chronic disease and consequently outline a comprehensive care plan to assist the clinician in caring for patients with obesity. This approach may differ from other CPGs. Specifically, in other CPGs: the scientific evi- dence is first examined and then questions

2016 American Association of Clinical Endocrinologists

95. Treatment of Drug-Susceptible Tuberculosis: Official ATS/CDC/IDSA Clinical Practice Guidelines

? Previous treatment for active or latent tuberculosis Abbreviation: HIV, human immunodeficiency virus. Figure 2. Baseline and follow-up evaluations for patients treated with first-line tuberculosismedications.Shadingaroundboxesindicatesactivitiesthatareoptional or contingent on other information. 1 Obtain sputa for smear and culture at baseline, then monthly until 2 consecutive specimens are negative. Collecting sputa more often early in treatment for assessment of treatment response and at end of treat (...) mass index >25 kg/m 2 , first-degree relative with diabetes, and race/ethnicity of African American, Asian, Hispanic, American Indian/Alaska Native, or Hawaiian Native/Pacific Islander. Abbreviations: ALT, ala- nine aminotransferase; AST, aspartate aminotransferase. ATS/CDC/IDSAClinical Practice Guidelines for Drug-Susceptible TB ? CID 2016:63 (1 October) ? 859 by guest on December 12, 2016 Downloaded from interruption are also important considerations (see “Interrup

2016 American Thoracic Society

96. Pharmacological Management of Obesity

to the generous providing of disk space by the Internet Archive, multi-terabyte datasets can be made available, as well as in use by the , providing a path back to lost websites and work. Our collection has grown to the point of having sub-collections for the type of data we acquire. If you are seeking to browse the contents of these collections, the Wayback Machine is the best first stop. Otherwise, you are free to dig into the stacks to see what you may find. The Archive Team Panic Downloads are full (...) suggests adding at least one of the following: metformin, pramlintide, or GLP-1 agonists to mitigate associated weight gain due to insulin. The first-line insulin for this type of patient should be basal insulin. This is preferable to using either insulin alone or insulin with sulfonylurea. The Task Force also suggests that the insulin therapy strategy be considered a preferential trial of basal insulin prior to premixed insulins or combination insulin therapy. ( 2|+++O ) The Task Force recommends

2016 National Guideline Clearinghouse (partial archive)

97. Obeticholic acid for treatment of nonalcoholic steatohepatitis

or liver transplantation. All patients with NASH have a higher cardiovascular mortality compared to the general population, which was based on published ©Institute for Clinical and Economic Review, 2016 Page 23 Draft Evidence Report - OCA for the treatment of NASH Return to Table of Contents studies 53 and incorporated into the model. Background mortality risk was based on patients’ age and sex and estimated from US life tables. 54 Transplant patients have higher risk of mortality for the first year (...) Obeticholic acid for treatment of nonalcoholic steatohepatitis ©Institute for Clinical and Economic Review, 2016 Obeticholic Acid for the Treatment of Nonalcoholic Steatohepatitis: Comparative Clinical Effectiveness and Value Evidence Report June 23, 2016 Institute for Clinical and Economic Review ©Institute for Clinical and Economic Review, 2016 Page i Draft Evidence Report - OCA for the treatment of NASH AUTHORS ICER Staff Massachusetts General Hospital, Institute for Technology Assessment

2016 California Technology Assessment Forum

98. Heart Failure - Systolic Dysfunction

initiating ivabradine. Minor drugs. Other frequently relevant drugs include calcium channel blockers, inotropes, anti-arrhythmic drugs, and lipid-lowering agents. Calcium channel blockers. Currently, no evidence supports the use of CCBs for treatment of systolic heart failure (HF). However, if CCB’s are needed for management of hypertension, second generation agents appear to be safe. First generation agents (verapamil, diltiazem) were shown to have adverse outcomes in post-MI patients with systolic (...) Heart Failure - Systolic Dysfunction 1 Quality Department Guidelines for Clinical Care Ambulatory Heart Failure Guideline Team Team Leader William E Chavey, MD Family Medicine Team Members Barry E Bleske, PharmD Pharmacy R Van Harrison, PhD Medical Education Robert V Hogikyan, MD, MPH Geriatric Medicine Yeong Kwok, MD General Medicine John M Nicklas, MD Cardiology Consultant Todd M Koelling, MD Cardiology Initial Release August, 1999 Most Recent Major Update August, 2013 Interim/Minor Revision

2016 University of Michigan Health System

99. Obese, overweight with risk factors: liraglutide (Saxenda)

with obstructive sleep apnoea. However, the clinical significance of this is unclear as there is no established minimum clinically significant difference for this measure. The European Public Assessment Report (EPAR) for liraglutide (Saxenda) reports that the general adverse event profile is in-line with that for liraglutide (Victoza). The EPAR states that there is currently insufficient data to assess if uncommon events (pancreatitis/neoplasms) occur more frequently with liraglutide 3.0 mg daily compared (...) were taking concomitant sulfonylureas (Davies et al. 2015, RCT, n=846, 56 weeks). P Patient factors atient factors Liraglutide is given by subcutaneous injection. Orlistat is an oral treatment, which may be preferable to some patients. Orlistat and liraglutide have different adverse effect profiles, which also need to be considered. More participants in the liraglutide 3.0 mg groups withdrew from the studies due to adverse events compared with the placebo groups (from 9.2% to 13.0% with liraglutide

2017 National Institute for Health and Clinical Excellence - Advice

100. Exercise for type 2 diabetes

Exercise for type 2 diabetes RACGP - Exercise: type 2 diabetes Search Become a student member today for free and be part of the RACGP community A career in general practice Starting the GP journey Enrolments for the 2019.1 OSCE FRACGP exams closing 29 March 2019 Fellowship FRACGP exams Research Practice Experience Program is a self-directed education program designed to support non vocationally registered doctors on their pathway to RACGP Fellowship Fellowship International graduates FRACGP (...) exams RACGP offer courses and events to further develop the knowledge you need to develop your GP career Re-entry to general practice Supervisors and examiners Mental Health (GPMHSC) Research Discover a world of educational opportunities to support your lifelong learning Courses and events QI&CPD Online learning Conferences Become a provider with the QI&CPD Program and be recognised for the quality education and training you offer GPs Curriculum for Australian General Practice Programs for educators

2014 Handbook of Non-Drug interventions (HANDI)

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