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First Generation Sulfonylurea

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101. 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

102. Glucagon-Like Peptide-1 receptor analogues

Glucagon-Like Peptide-1 receptor analogues www.sps.nhs.uk | Published December 2016 1 London Medicines Evaluation Network Overview: Glucagon-Like Peptide-1 receptor analogues The first stop for professional medicines advice www.sps.nhs.uk | 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

103. 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

104. 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

105. 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 http://cid.oxfordjournals.org/ Downloaded from interruption are also important considerations (see “Interrup

2016 American Thoracic Society

106. 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)

107. 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

108. 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

109. 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

110. Chronic kidney disease

is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare. How up-to-date is this topic? How up-to-date is this topic? Changes Changes February to March 2019 — reviewed. A literature search was conducted in February 2019 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has been updated in line with the National Institute for Health (...) found during the review of this topic. QOF indicators QOF indicators Table 1. Indicators related to chronic kidney disease (CKD) in the Quality and Outcomes Framework (QOF) of the General Medical Services (GMS) contract. Indicator Points CKD005 The contractor establishes and maintains a register of patients aged 18 or over with CKD with classification of categories G3a to G5 (previously stage 3 to 5) 6 SMOK002 The percentage of patients with any or any combination of the following conditions: CHD

2019 NICE Clinical Knowledge Summaries

111. Diabetes - type 2

diabetes have a twofold increased risk of stroke within the first five years of diagnosis compared with the general population. About 20% of hospital admissions for heart failure, myocardial infarction, and stroke are in people with diabetes (type 1 or 2). Microvascular complications — nephropathy, retinopathy, and neuropathy. Nephropathy — kidney damage is the largest cause of renal failure in people of working age in the UK. About 3 in 4 people with diabetes will develop some stage of chronic kidney (...) , planning a pregnancy, or breastfeeding. It also does not cover the diagnosis and management of impaired glucose regulation, or make detailed recommendations on the diagnosis and management of other types of diabetes. There are separate CKS topics on and . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare. How up-to-date is this topic? How up-to-date is this topic? Changes Changes September 2019 — minor

2019 NICE Clinical Knowledge Summaries

112. MI - secondary prevention

. The British Heart Foundation (BHF) estimates that in 2016, 2.3 million people in the UK were living with a diagnosis of CHD and around 1 million people had survived an MI. The commonest cause of MI is an atheromatous plaque rupturing or eroding in a coronary artery; this causes a coronary thrombus to form, which partially or completely obstructs the artery. MIs are divided into 2 types, depending on the ECG changes. ST-segment elevation myocardial infarction (STEMI), which is generally caused by complete (...) antiplatelet therapy. A beta-blocker. A statin. Common concerns that may need to be discussed with a person following an MI include: returning to work and normal activities, driving, sexual activity, erectile dysfunction, air travel, stress, anxiety, and competitive sport. Routine further assessment post-MI that should normally be arranged by secondary care include the following: An assessment of left ventricular function. An assessment of bleeding risk (usually at a first follow-up hospital appointment

2019 NICE Clinical Knowledge Summaries

113. 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

114. 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)

115. Diabetes Care

if patient presents with depression, falls, cognitive impairment, perceptual difficulties, or urinary incontinence. Use sulfonylureas (especially glyburide) with caution as the risk of hypoglycemia increases with age. Generally, initial doses can be half of those for younger people and increased more slowly. Monitor postural blood pressure. Consider less strict glycemic targets (7.1 - 8.5% A1C) if the individual has limited life expectancy, high functional dependency, extensive disease or multiple co (...) standard targets in people with hypertension and diabetes, although there may be a small reduction in risk for stroke. , Due to the lack of convincing evidence to support more intensive blood pressure control, this guideline recommends the same desirable blood pressure reading in adults with diabetes and hypertension as the general population. Controversies in Care: Sulfonylureas There is some conflicting evidence about the cardiovascular safety of sulfonylureas. Some studies suggest that sulfonylureas

2015 Clinical Practice Guidelines and Protocols in British Columbia

116. Harm of HPV vaccine: Latest information and examination of epidemiological studies

influenced and distorted by the pharmaceutical industry. "The Informed Prescriber" (TIP: founded in 1986) for professionals and "Med Check, Save Lives" (founded in 2001) targetting general public have provided evidence based rational information which meets the needs of professionals and the general public. This is possible, because they are completely independent: i.e. free from advertisement, funding or any other assistance from industry. The Japanese edition of this bulletin "Med Check - The Informed (...) tumours. Renal, hepatic and gastrointestinal adverse reactions MED CHECK - TIP APRIL 2015 / Vol.1 No.1 · Page 5 Translated as synopsis from Med Chec k TIP 05; 5 (Mar; #58); 7-0. Methadone :Limited use: Useful only in opioid rotation with special precautions Synopsis: Methadone hydrochloride (“methadone”, brand name: Methapain)[1] was first synthesized in Germany in 1937. It was approved in the United States in 1947 as an opioid. Vincent Dole et al. reported in 1964 that it was useful as an alternative

2015 Med Check - The Informed Prescriber

117. Obesity Interventions Delivered in Primary Care for Patients with Diabetes

with either metformin, a sulfonylurea (SFU), or both. Patients on other antidiabetic medications were excluded. Interventions and comparators Two studies, 3,7 evaluated pharmacological interventions for weight loss while three others 4,8,12 investigated lifestyle interventions for weight loss. Pharmacological Interventions The BLOOM-DM study 7 randomized 604 participants in a 1:1:1 ratio to placebo, lorcaserin 10 mg once daily (QD) or lorcaserin 10 mg twice daily (BID) for a 1 year (52 week) study. Only (...) metformin or an antidiabetic medication from the sulfonylurea class was allowed as background therapy. Medication use was well balanced across study arms with most participants in each arm (91% to 95%) treated with metformin, nearly 50% receiving sulfonylurea, and between 41% and 47% treated with both metformin and sulfonylurea. In the second pharmacological intervention study, 3 505 patients were randomized to receive a daily dose of 32 mg naltrexone and 360 mg bupropion (NB) in fixed-dose combination

2014 Canadian Agency for Drugs and Technologies in Health - Rapid Review

118. Sinusitis

, and providing first contact or primary health care. How up-to-date is this topic? How up-to-date is this topic? Changes Changes May to June 2018 — reviewed. A literature search was conducted in May 2018 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of this topic. Sections have been added on prevalence, complications, and antibiotic choice for acute sinusitis, and a prescribing information section is now available. There have been minor (...) medicine use and Antimicrobial stewardship: changing risk-related behaviours in the general population. Review and, if appropriate, optimise current prescribing practice and use implementation techniques to ensure prescribing is in line with NICE antimicrobial prescribing guidelines or Public Health England (PHE) guidance on Managing common infections in primary care , the Department of Health’s guidance Start smart − then focus , local trust antimicrobial guidelines, and the Antimicrobial Stewardship

2018 NICE Clinical Knowledge Summaries

119. Hypertension - not diabetic

during pregnancy, or hypertension caused by other conditions such as renal or hormonal disease. There are separate CKS topics on , , , , , , , and . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary health care. How up-to-date is this topic? How up-to-date is this topic? Changes Changes January 2018 — minor update. Revised SPC for Istin (amlodipine) 5 and 10mg tablets. Drug interactions updated as per (...) . Audit criteria Audit criteria No audit criteria were found during the review of this topic. QOF indicators QOF indicators Table 1. Indicators related to hypertension and blood pressure in the Quality and Outcomes Framework (QOF) of the General Medical Services (GMS) contract. Indicator Points Payment stages Hypertension HYP001 The contractor establishes and maintains a register of patients with established hypertension 6 — HYP006 The percentage of patients with hypertension in whom the last blood

2018 NICE Clinical Knowledge Summaries

120. Dyspepsia - proven peptic ulcer

inhibitor (PPI) should be prescribed for 2 months, followed by first-line H. pylori eradication therapy. If there is no associated NSAID use, eradication therapy should be offered. If the test is negative, full-dose PPI therapy should be offered for 4–8 weeks. All people with a proven gastric ulcer should have a repeat endoscopy arranged and H. pylori re-testing (if appropriate) 6–8 weeks after starting treatment. If the test is positive, second-line H. pylori eradication therapy should be offered (...) disease and dyspepsia in adults: investigation and management [ ]. This CKS topic covers the management of people with a confirmed diagnosis of duodenal or gastric ulcer following endoscopy. There are separate CKS topics on , , , , , and . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare. How up-to-date is this topic? How up-to-date is this topic? Changes Changes October 2019 — minor update. Topic

2018 NICE Clinical Knowledge Summaries

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