DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

More documents

Recommendations

Info

Version 4.0 VA/DoD Clinical Practice Guideline for the Management of Diabetes Mellitus Sulfonylureas 2 nd generation Glipizide Glipizide XL Glyburide Glyburide miconized Glimepiride 1 st generation sulfonylureas (chlorpropamide, tolbutamide, tolazamide) seldom used 1.0-2.0% Minimalsignificant risk (glipizide is associated with the least risk and glyburide with the most risk) • Use well-established • No difference in long-term efficacy or failure rate has been demonstrated among the sulfonylureas • Contraindicated in those with hypersensitivity • Use in patients with sulfonamide allergy is not specifically contraindicated in product labeling, however, a risk of crossreaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe. • Concomitant use of glyburide and bosentan is contraindicated • Glyburide not recommended if Clcr
Version 4.0 VA/DoD Clinical Practice Guideline for the Management of Diabetes Mellitus Biguanides Metformin Metformin XR 1.0-2.0% Negligible risk as monotherapy • Use well-established • May restore ovulation in premenopausal anovulatory females • Monitor renal function prior to and at least annually thereafter • Weight neutral or slight weight loss • Decrease LDL-C • Contraindicated in: o Renal dysfunction (serum creatinine ≥ 1.5mg/dL [males]; ≥ 1.4mg/dL [females] or abnormal creatinine clearance , 30ml/min) o Acute or chronic metabolic acidosis • Temporarily discontinue metformin at the time of or prior to intravascular iodinated radio contrast studies and withhold for 48 hours after the procedure. Reinstitute only after renal function has been reevaluated and found to be normal. • Temporarily discontinue for surgical procedures (except minor procedures not associated with restricted intake of food or fluids). Do not restart until oral intake has resumed and renal function has been evaluated as normal. • Do not use if patient is ≥80 years of age unless measurement of creatinine clearance demonstrates that renal function is not reduced; do not titrate to maximum dose. • In general, avoid metformin in patients with clinical or laboratory evidence of hepatic disease • Patients should be warned against excessive acute or chronic alcohol use. • Discontinue metformin in the presence of cardiovascular collapse • Patients with unstable or acute congestive heart failure who are at risk of hypoperfusion and hypoxemia are at increased risk of lactic acidosis • Inexpensive • Potential for lactic acidosis when used in patients for whom the drug is contraindicated • Transient doserelated GI symptoms (nausea, vomiting, bloating, flatulence, anorexia) • Decrease in vitamin B12 levels Module G: Glycemic Control: Appendices Page 82
Page 2 and 3:
VA/DoD CLINICAL PRACTICE GUIDELINE
Page 4 and 5:
Version 4.0 VA/DoD Clinical Practic
Page 6 and 7:
Page 8 and 9:
Page 10 and 11:
Page 12 and 13:
Version 4.0 ALGORITHM VA/DoD Clinic
Page 14 and 15:
Version 4.0 MODULE D - CORE ANNOTAT
Page 16 and 17:
Version 4.0 B. Refer To Pediatric D
Page 18 and 19:
Version 4.0 E. Is the Patient Medic
Page 20 and 21:
Version 4.0 Evaluation Component VA
Page 22 and 23:
Version 4.0 H. Consider Aspirin The
Page 24 and 25:
Page 26 and 27:
Version 4.0 Table D5. Target Level
Page 28 and 29:
Page 30 and 31:
Page 32 and 33: Version 4.0 VA/DoD Clinical Practic
Page 34 and 35: Version 4.0 ALGORITHM VA/DoD Clinic
Page 36 and 37: Version 4.0 Table S-1. Risk Factors
Page 38 and 39: Version 4.0 EVIDENCE VA/DoD Clinica
Page 44 and 45: Version 4.0 7. A combination of pre
Page 56 and 57: Version 4.0 J-1. MONOTHERAPY (Initi
Page 58 and 59: Version 4.0 EVIDENCE TABLE VA/DoD C
Page 64 and 65: Version 4.0 Insulin Dosing Examples
Page 70 and 71: Version 4.0 RATIONALE VA/DoD Clinic
Page 78 and 79: Version 4.0 RECOMMENDATIONS VA/DoD
Page 88 and 89: Version 4.0 Comparison of Insulin P
Page 98 and 99: Version 4.0 ANNOTATIONS VA/DoD Clin
Page 104 and 105: Version 4.0 EVIDENCE - Take Charge
Page 110 and 111: Version 4.0 o Evaluation of the pat
Page 120 and 121: Version 4.0 General principles to b
Page 126 and 127: Version 4.0 Algorithm Format VA/DoD
Page 128 and 129: Version 4.0 President Healthcare Qu
Page 132 and 133:
Version 4.0 SMBG SME SUD TC TDD TDI
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 146 and 147:
show all

DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Create successful ePaper yourself

Delete template?

Save as template?