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First Generation Sulfonylurea

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101. Empagliflozin/Metformin

referred to as “the company”) presented a study of direct comparison and 2 indirect comparisons for research question A (empagliflozin/metformin 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 discrepancies between the company’s analyses in Module 4 A and the corresponding clinical study reports (CSRs). Furthermore (...) in the first benefit assessment of empagliflozin [3]. In its dossier on empagliflozin/metformin [2], the company presented results of study 1245.28 on the subpopulation of patients who received a daily dose of at least 1700 mg metformin. This corresponded to the relevant subpopulation for the assessment of empagliflozin/ metformin. It comprised about 70% of the total study population. In its dossier, the company did not present results on several patient-relevant outcomes, however, although it was already

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

102. SMFM Statement Pharmacological treatment of gestational diabetes Full Text available with Trip Pro

; 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

2018 Society for Maternal-Fetal Medicine

103. Lichen Planus

. Department of Dermatology, Hospital del Mar, Barcelona, Spain 12. Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. 13. Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands Corresponding author: Professor Dimitrios Ioannides Head, 1st Department of Dermatology and Venereology, Aristotle University Medical School, Hospital of Skin and Venereal Diseases - Hippokration General Hospital Thesssaloniki, Greece Tel.: (+30) 2310-992262 Fax: (+30 )2310-992221 Email: dem (...) @auth.gr Mobile: +306948109109 2 Table of Contents 1. Introduction 4 2. Methods 4 3. Definition 5 4. Epidemiology 6 5. Pathophysiology-etiopathogenesis 6 6. Clinical Picture 7 7. Diagnosis 9 8. Clinical Variants of Lichen Planus 11 Cutaneous LP 12 Appendegeal LP 13 Mucosal LP 14 Other Forms of LP 15 9. Complications 17 10. Therapeutic Management-Objectives 18 11. Management of cutaneous LP 18 12. Management of mucosal-oral LP-General measures 21 13. Management of oral LP 22 14. Management of genital LP

2018 European Dermatology Forum

104. Heart Failure Full Text available with Trip Pro

, the ventricle fills with blood. An inability to fill with blood without increased filling pressure (generally due to reduced ventricular compliance or active relaxation, or both) results in symptoms and signs of congestion of the vasculature and end organs. Impairs the ability of the heart to eject sufficient blood : Intuitively, if the heart is regarded first and foremost as a pump, a reduction in blood ejection, and therefore in cardiac output, to the degree that it is insufficient for the metabolising (...) Trials Unit, Canberra Hospital & Health Services, Canberra, Australia , FRACP, FACC, PhD p , q , x Liza Thomas Affiliations Department of Cardiology, Westmead Hospital Department of Medicine, University of Sydney Department of Medicine, University of New South Wales , MBBS, FRACP, PhD r , s , t , x Ralph Audehm Affiliations Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Australia , MBBS, DipRACOG u , x Phillip Newton Affiliations Western Sydney Nursing

2018 Cardiac Society of Australia and New Zealand

105. 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

106. 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

107. 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

2018 American Heart Association

108. 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)

109. 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

111. Type 2 diabetes mellitus in adults: high-strength insulin glargine 300 units/ml (Toujeo)

in an increased risk of hypoglycaemic events, mainly in the first week after the switch – the dose of insulin glargine 100 units/ml should therefore be reduced. Close metabolic monitoring is required during any switch and in the initial weeks thereafter. T oujeo is available in a pack containing 3 pens. Each pen contains 1.5 ml of insulin glargine 300 units/ml solution for injection, equivalent to 450 units. A dose of 1 to 80 units per injection, in steps of 1 unit, can be injected. The dose window shows (...) for 6 months. For people previously using Lantus or once-daily NPH, the starting dose of T oujeo or Lantus was the basal insulin dose used in the 3 days before randomisation. For people taking NPH insulin more than once daily, the dose of T oujeo or Lantus was reduced by approximately 20%. Basal insulin dose was generally adjusted weekly aiming for a pre-breakfast self-measured plasma glucose of 4.4 to 5.6 mmol/litre based on the median of the previous 3 days. Mealtime insulin doses were adjusted

2015 National Institute for Health and Clinical Excellence - Advice

112. Type 2 diabetes: insulin degludec/liraglutide (Xultophy)

are broadly in line with those of the 2 included components. Regulatory status: Regulatory status: Insulin degludec/liraglutide (Xultophy) was launched in the UK in November 2014. It is the first fixed-ratio combination basal insulin and glucagon-like peptide-1 [GLP-1] receptor agonist preparation to be licensed in the UK. Insulin degludec (Tresiba: 100 units per ml and 200 units per ml) and liraglutide (Victoza) are available in the UK as the individual component preparations. © NICE 2018. All rights (...) in HbA1c from baseline (1 RCT; n=413; 26 weeks). Safety Safety The European public assessment (EPAR) report concluded that the safety profile is in general similar to that of the 2 included components. Long-term safety concerns are the same as for the other GLP-1 receptor agonists and long-acting insulin analogues. The most commonly reported adverse reactions listed in the summary of product characteristics (SPC) are hypoglycaemia, decreased appetite, nausea, diarrhoea, vomiting constipation, dyspepsia

2015 National Institute for Health and Clinical Excellence - Advice

113. Type 2 diabetes: dulaglutide

(treatment difference - 0.66 mmol/mol [0.06% points]) for change in HbA1c from baseline (1 RCT, n=599, 26 weeks). Safety Safety According to the summary of product characteristics, the most common adverse events (1 in 10 people or more) are hypoglycaemia, particularly in combination with a sulfonylurea or insulin, and gastrointestinal disorders. According to the European public assessment report (EPAR) possible long-term safety concerns of pancreatitis and pancreatic and thyroid cancers are consistent (...) inappropriate due to intolerance or contraindications. Add-on therapy: in combination with other glucose-lowering medicinal products including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control. The recommended dose is 0.75 mg once weekly as monotherapy and 1.5 mg once weekly as add-on therapy, by subcutaneous injection. A reduction in the dose of sulfonylurea or prandial insulin may be considered to reduce the risk of hypoglycaemia when dulaglutide is used

2015 National Institute for Health and Clinical Excellence - Advice

114. 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

115. 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

116. Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline from the American College of Physicians Full Text available with Trip Pro

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

2017 American College of Physicians

117. 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

118. 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

119. Interventions to Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer's-Type Dementia

to describe dementia and cognitive impairment is inconsistent and changing, although the National Institute on Aging (NIA) and the Alzheimer’s Association have jointly issued criteria and guidelines. 6 Diagnosis of a neurocognitive disorder due to Alzheimer’s disease requires steadily progressive cognitive decline from a previous level, generally with predominant early impairment in learning and memory that occurs outside the context of delirium and is not better explained by other mental disorders (...) evidence that estrogen replacement with or without progesterone therapy increased the risk of MCI and CATD. A few intervention types show more potential than others at benefiting cognitive performance. We found moderate-strength evidence that cognitive training can improve cognitive function in the domain trained up to 2 years (low strength of evidence at 5 and 10 years), but generalization/transfer to other domains was rare. Although there was some evidence ES-6 for improvement in instrumental

2017 Effective Health Care Program (AHRQ)

120. Interventions to Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer's-Type Dementia

to describe dementia and cognitive impairment is inconsistent and changing, although the National Institute on Aging (NIA) and the Alzheimer’s Association have jointly issued criteria and guidelines. 6 Diagnosis of a neurocognitive disorder due to Alzheimer’s disease requires steadily progressive cognitive decline from a previous level, generally with predominant early impairment in learning and memory that occurs outside the context of delirium and is not better explained by other mental disorders (...) evidence that estrogen replacement with or without progesterone therapy increased the risk of MCI and CATD. A few intervention types show more potential than others at benefiting cognitive performance. We found moderate-strength evidence that cognitive training can improve cognitive function in the domain trained up to 2 years (low strength of evidence at 5 and 10 years), but generalization/transfer to other domains was rare. Although there was some evidence ES-6 for improvement in instrumental

2017 Effective Health Care Program (AHRQ)

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