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First Generation Sulfonylurea

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81. Treatment of Diabetes in Older Adults Full Text available with Trip Pro

Press Permissions Icon Navbar Search Filter Mobile Microsite Search Term Close search filter search input Abstract Objective The objective is to formulate clinical practice guidelines for the treatment of diabetes in older adults. Conclusions Diabetes, particularly type 2, is becoming more prevalent in the general population, especially in individuals over the age of 65 years. The underlying pathophysiology of the disease in these patients is exacerbated by the direct effects of aging on metabolic (...) remark: This recommendation is most applicable to high-risk patients with any of the following characteristics: overweight or obese, first-degree relative with diabetes, high-risk race/ethnicity ( e.g. , African American, Latino, Native American, Asian American, Pacific Islander), history of cardiovascular disease, hypertension (≥140/90 mm Hg or on therapy for hypertension), high-density lipoprotein cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L), sleep

2019 The Endocrine Society

82. CRACKCast E206 – Seizures

activity and increased synchronicity allows you to both explain the initial presentation and progression of seizure activity. Seizures can be characterized as falling into one of the categories: Primary versus Secondary Primary seizures are by definition unprovoked and not linked to some inciting event Secondary seizures occur as the result of some underlying pathophysiologic process such as toxic ingestion, trauma, metabolic disturbances, structural lesions etc… Generalized versus Focal Generalized (...) seizures are typified by abnormal neuronal activity in BOTH hemispheres of the brain, resulting in a loss of consciousness or change in level of alertness Generalized seizures can be further categorized as being either: Tonic-clonic Absence-type Atonic Myoclonic Focal seizures occur in one hemisphere, thus allowing the patient to maintain consciousness It is important to note that these seizures can become secondarily generalized Convulsive versus Non-convulsive Convulsive seizures are typified

2019 CandiEM

83. Heart Disease and Stroke Statistics Full Text available with Trip Pro

–0.92) mortality than those treated at noncertified hospitals, after adjustment for demographic and clinical factors. Hospitals certified between 2009 and 2013 also had lower in-hospital and 30-day mortality than centers certified before 2009. Congenital Cardiovascular Defects and Kawasaki Disease (Chapter 15) Although estimates of birth prevalence/overall prevalence of congenital cardiovascular defects appear relatively stable, a general trend toward improved outcome/survival continues, which has (...) led to an expanding population of adult congenital heart disease patients. Although there remains increased mortality in patients with congenital cardiovascular defects compared with the general population, the standardized mortality ratios after congenital heart disease surgery continue to decrease. In a recent study from the Pediatric Cardiac Care Consortium’s US-based multicenter data registry, which examined 35 998 patients with a median follow-up of 18 years, the overall standardized

2019 American Heart Association

84. Semaglutide (Ozempic) - the treatment of adults with insufficiently controlled type 2 diabetes mellitus (T2DM) as an adjunct to diet and exercise

Information The starting dose is 0.25mg semaglutide once weekly. After 4 weeks the dose should be increased to 0.5mg once weekly. After at least 4 weeks with a dose of 0.5mg once weekly, the dose can be increased to 1.0mg once weekly to further improve glycaemic control. Semaglutide 0.25mg is not a maintenance dose. Weekly doses higher than 1.0mg are not recommended. When semaglutide is added to existing therapy of sulfonylurea or insulin, a reduction in the dose of sulfonylurea or insulin should (...) be considered to reduce the risk of hypoglycaemia. When initiating treatment with semaglutide in combination with a sulfonylurea or an insulin, blood glucose self-monitoring may become necessary to adjust the dose of the sulfonylurea or the insulin to reduce the risk of hypoglycaemia. Semaglutide is to be administered once weekly at any time of the day, with or without meals. Semaglutide is to be injected subcutaneously in the abdomen, in the thigh or in the upper arm. The injection site can be changed

2019 Scottish Medicines Consortium

85. Cardiovascular Risk Reduction in Patients with Type 2 Diabetes and Atherosclerotic Cardiovascular Disease

OF CARDIOLOGY VOL. -,NO. -,2018 ª 2018 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIERTABLE OF CONTENTS PREFACE - 1.INTRODUCTION - 1.1. A Focus on Comprehensive CV Risk Reduction in T2D - 2.METHODS - 3.ASSUMPTIONS AND DEFINITIONS - 3.1 General Clinical Assumptions - 3.2 De?nitions - 4.PATHWAY SUMMARY GRAPHIC - 5.DESCRIPTION AND RATIONALE - 5.1. SGLT2 Inhibitors . - 5.1.1. SGLT2 Inhibitors: Mechanism of Action ... . - 5.1.2. SGLT2 Inhibitors: CV Bene?ts . - 5.1.3. SGLT2 Inhibitors: Non (...) AND DEFINITIONS To facilitate interpretation of the recommendations provided in this Expert Consensus Decision Pathway, speci?c assump- tions were made by the Writing Committee as follows: 3.1. General Clinical Assumptions 1. The focus of this effort, including Expert Consensus Decision Pathway recommendations, only applies to patients with both T2D and clinically evident athero- sclerotic cardiovascular disease (ASCVD), which is de?ned below. Extending inferences beyond this spe- ci?c population should

2019 American College of Cardiology

86. Type 2 Diabetes Mellitus and Heart Failure Full Text available with Trip Pro

. Common side effects: nausea, diarrhea, potential for vitamin B 12 deficiency with prolonged use Cardiovascular side effects: chest discomfort, palpitations Sulfonylureas (2nd generation) Glipizide Glimepiride Glyburide Oral Low Yes Weight gain Glyburide not recommended; glipizide and glimepiride can be used with caution Do not affect progression of kidney disease Common side effects: dizziness/ nervousness Cardiovascular side effects: may increase cardiovascular mortality, syncope Thiazolidinediones (...) in patients hospitalized with HF, with some reports of >40%. In patients with DM, the prevalence of HF is between 9% and 22%, which is 4 times higher than the general population, and the prevalence is even higher in patients with DM who are ≥60 years old. DM as a Risk Factor for HF Observational studies have consistently demonstrated a 2- to 4-fold increased risk of HF in individuals with DM compared with those without DM ( ). In the Framingham Heart Study, DM was associated with a nearly 2-fold increase

2019 American Heart Association

87. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures

and Endocrinology, Diabetes and Metabolism Fellowship Director, University of Arizona College of Medicine, Phoenix, Arizona 15 Technical Analysis (AACE); Board-certified endocrinologist, Heartland Endocrine Group, Davenport, Iowa 16 Writer (ASMBS); Massachusetts General Hospital Weight Center, Boston, Massachusetts 17 Writer (AACE); Associate Professor, Department of Surgery, University of Alabama at Birmingham; Staff Surgeon, Birmingham VA Medical Center, Birmingham, Alabama 18 Writer (AACE); Division (...) process within the context of an evolving obesity-care model, increasingly detailed management strategies and protocols, and the need for a more transparent tactical plan in a probing and scrutinizing health-care environment. New diagnostic terms, structured lifestyle approaches, pharmaceutical options, and surgical and nonsurgical procedures have reshaped the obesity-care space. A general overview of the clinical pathway for bariatric surgery is provided in Figure 1. Readers are advised to refer

2019 American Association of Clinical Endocrinologists

88. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss. 5. Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity. 6. For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations, are crucial. If medication is indicated, metformin is first-line therapy, followed (...) by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist. 7. All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit. 8. Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit. 9. Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low- density lipoprotein cholesterol

2019 American Heart Association

89. Primary Prevention of Cardiovascular Disease

with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations, are crucial. If medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist. 7. All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit. 8. Aspirin should be used infrequently (...) in the routine primary prevention of ASCVD because of lack of net benefit. 9. Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low- density lipoprotein cholesterol levels (=190 mg/dL), those with diabetes mellitus, who are 40 to 75 years of age, and those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion. 10. Nonpharmacological interventions are recommended for all adults with elevated blood pressure or hypertension. For those

2019 American College of Cardiology

90. AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm Full Text available with Trip Pro

to the new Endocrine Practice website. Click to access your account and reset your password if this is your first visit. TheIP ranges for your institution have already been added to your account. You maywish to review this information under the Institutional administration tab inyour User Profile. Not Yet Registered? Benefits of Registration Include: A Unique User Profile that will allow you to manage your current subscriptions (including online access) The ability to create favorites lists down (...) Physician, Birmingham VAMC, Birmingham, Alabama 13 Chairman, Grunberger Diabetes Institute, Clinical Professor, Internal Medicine and Molecular Medicine & Genetics, Wayne State University 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, Past President, American Association of Clinical Endocrinologists 14 Medical Director & Principal

2019 American Association of Clinical Endocrinologists

91. Sitagliptin - Benefit assessment according to §35a Social Code Book V

[glibenclamide, glimepiride]) (research question A1) and, additionally, versus glipizide (research question A2) in this assessment in 2 separate research questions. Research question A1: sitagliptin versus sulfonylurea (glibenclamide, glimepiride) As in the first assessment, the company included one study of direct comparison (P251) for research question A1. This study was unsuitable for the assessment of the added benefit because it can be assumed that the majority of the patients enrolled did not fulfil (...) a joint consideration of all studies versus sulfonylurea, the company also derived an added benefit for all-cause mortality. 2.4.3.3 Subgroups and other effect modifiers As in the first assessment, the subgroup analysis on all-cause mortality is presented according to sex in the present benefit assessment because all deaths occurred in the subgroup of men. In its new dossier, the company additionally presented data on possible effect modifications by region. It considered an influence of the effects

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

92. Empagliflozin - Addendum to Commission A16-12

] of its dossier on empagliflozin, the pharmaceutical company (hereinafter referred to as “the company”) had presented a study of direct comparison and 2 indirect comparisons for research question B (empagliflozin plus another blood-glucose lowering drug except insulin in comparison with metformin plus sulfonylurea). All studies used for this were already known from the first assessment A14-26 [3]. The data presented by the company were incomplete, however. In addition, there were noticeable (...) presented study 1245.28 for the comparison of empagliflozin in combination with another blood-glucose lowering drug except insulin in comparison with metformin in combination with a sulfonylurea (glibenclamide, glimepiride). 2.1.2.1 Study design and study characteristics A detailed description of study 1245.28, its limitations, as well as tables presenting the study characteristics, the interventions, and the study population can be found in the first benefit assessment of empagliflozin [3]. 2.1.2.2

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

93. Saxagliptin - Benefit assessment according to §35a Social Code Book V

identified the SAVOR-TIMI 53 study and, on the other, 2 studies for an indirect comparison: study CV181040 (saxagliptin versus placebo) and study Tovi 1998 (sulfonylurea versus placebo). Together with 4 other studies on the ACT, the company had already presented the 2 studies CV181040 and Tovi 1998 for the first assessment of saxagliptin. Based on this, the company had conducted an indirect comparison, which was irrelevant for the benefit assessment. The indirect comparison now presented on the basis (...) D1680L00006 (saxagliptin plus metformin plus sulfonylurea versus placebo plus metformin plus sulfonylurea). The company had already presented the D1680L00006 study and an indirect comparison based on it for the first assessment of saxagliptin. This was irrelevant for the benefit assessment because the studies on the ACT were unsuitable. The analysis of the SAVOR-TIMI 53 study presented by the company for research question D was unsuitable for the present benefit assessment. From the total population

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

94. Sitagliptin/metformin - Benefit assessment according to §35a Social Code Book V

. In both cases, this added benefit is limited to patients in whom near-normal blood glucose levels are aimed at. For patients without such a treatment goal, there is no proof of added benefit of sitagliptin/metformin. Research question B: sitagliptin/metformin plus sulfonylurea As in the first assessment, the company identified no study on the combination of sitagliptin/metformin plus sulfonylurea versus the ACT. Hence the added benefit of sitagliptin/metformin plus sulfonylurea is not proven. Research (...) comparisons from the steps of information retrieval mentioned: HARMONY 3, P803 and P024. Two of these studies investigated the comparison of sitagliptin/metformin versus the ACT specified by the G-BA (sulfonylurea [glibenclamide, glimepiride] plus metformin) and one study (P024) investigated the comparison of sitagliptin/metformin versus glipizide plus metformin. The studies P803 and P024 had already been presented for the first benefit assessment of sitagliptin (see Commission A13-02 [8]). The multi-arm

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

95. Saxagliptin/metformin - Benefit assessment according to §35a Social Code Book V

the treating physician apparently considered sulfonylureas to be unsuitable or not necessary. From the placebo group, however, only patients were chosen who received sulfonylureas for the first 3 months after randomization. These different selection criteria chosen by the company for both treatment arms were another reason why structural equality of the comparator groups formed by the company was not ensured. 4) The company selected post hoc patients in the placebo arm who received sulfonylureas within 3 (...) /metformin (type 2 diabetes mellitus) 29 September 2016 Institute for Quality and Efficiency in Health Care (IQWiG) - 1 - 2 Benefit assessment 2.1 Executive summary of the benefit assessment Background In accordance with §35a Social Code Book (SGB) V, the Federal Joint Committee (G-BA) commissioned the Institute for Quality and Efficiency in Health Care (IQWiG) to assess the benefit of saxagliptin/metformin. The pharmaceutical company (hereinafter referred to as “the company” submitted a first dossier

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

96. 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

97. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

York General Hospital and LMC Diabetes & Endocrinology, Thornhill, ON Doreen Rabi MD MSc FRCPC Co-Chair, Methods Associate Professor Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, AB Diana Sherifali RN PhD CDE Co-Chair, Methods Associate Professor School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON Vincent Woo MD FRCPC Past Chair Endocrinologist Section of Endocrinology and Metabolism John Buhler Research Centre (...) , and Healthy Policy Management & Evaluation, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Jeremy Gilbert MD FRCPC Sub-Group Co-Chair, Management Assistant Professor Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON Ron Goldenberg MD FRCPC FACE Sub-Group Chair, Diagnosis & Classification Consultant Endocrinologist North York General Hospital and LMC Diabetes & Endocrinology, Thornhill, ON Noah Ivers MD PhD

2018 Diabetes Canada

98. Saxagliptin/metformin (type 2 diabetes) - Benefit assessment according to §35a Social Code Book V

approved in June 2017: ? saxagliptin/metformin in combination with other medicinal products for the treatment of diabetes (except insulin and sulfonylurea) (as an adjunct to diet and exercise in patients with type 2 diabetes mellitus inadequately controlled with metformin and these medicinal products) The assessment was conducted in comparison with the G-BA’s ACT. This ACT is shown in Table 2. Table 2: Research question of the benefit assessment of saxagliptin/metformin in type 2 diabetes mellitus (...) Subindication ACT a Saxagliptin/metformin plus other drugs for the treatment of diabetes (except insulin and sulfonylurea) ? Human insulin b plus metformin or ? human insulin plus empagliflozin c or ? human insulin if, according to the SPC, metformin and empagliflozin are unsuitable or not sufficiently effective due to intolerance or contraindication a: Presentation of the respective ACT specified by the G-BA. In cases where the company, because of the G-BA’s specification of the ACT, could choose

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

99. Insulin glargine 300 IU/mL solution (Toujeo) for diabetes mellitus

on the PBS. It has a similar efficacy and tolerability profile to that of Gla-100 in the treatment of type 1 and type 2 diabetes. Areas of uncertainty Safety data for this formulation have not been collected beyond 12 months. In clinical trials, hypoglycaemia was generally less frequent with Gla-300 than with Gla-100 in patients with type 2 diabetes, including in the predefined study secondary endpoint, which reported on nocturnal hypoglycaemia (confirmed and/or severe events). This difference (...) not been established in patients under 18 years. Where does it fit? Gla-300 joins Gla-100 and detemir on the list of long-acting basal insulins currently available in Australia. Unlike the insulin glargine formulations that have an Unrestricted benefits listing on the PBS, detemir is only available on the PBS for patients with type 1 diabetes. Type 1 diabetes: first-line therapy An insulin regimen consisting of basal insulin plus mealtime bolus insulin is recommended as a first-line treatment

2018 National Prescribing Service Limited (Australia)

100. Empagliflozin/metformin - benefit assessment

specified by the G-BA. These are shown in Table 2. Table 2: Research questions of the benefit assessment of empagliflozin/metformin Research question Subindication a ACT specified by the G-BA A Fixed combination of empagliflozin and metformin in patients inadequately controlled on their maximally tolerated dose of metformin alone as an adjunct to diet and exercise Metformin plus sulfonylurea (glibenclamide, glimepiride) B Combination therapy with other blood-glucose lowering drugs except insulin (...) in the first dossier and in the corresponding commenting procedure on empagliflozin (single agent). Irrespective of the question whether the data presented by the company were at all relevant for the benefit assessment, the company’s assessment was incomplete with regard to content because it did not analyse all relevant outcomes. Moreover, the documents presented by the company were self-contradictory. Direct comparison The company presented study 1245.28 to prove the added benefit of empagliflozin

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

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