Clinical Approach to Medical Management of Type 2 Diabetes

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Colesevelam • Bile acid sequestrant with antidiabetic properties – A1c reduction ~ 0.5% – Dose: 3.75 g daily or 1.875 g PO BID – Used in combination with diet, oral agents or insulin • Lipid Effects: – Positive: reduction of the LDL levels ~ 15% – Negative: increase TG levels ~ 20% in combination with SU and insulin • Interfere with absorption of several drugs: OCPs, levothyroxine, cyclosporine, glyburide, warfarin, phenytoin
Colesevelam vs. Placebo in combination with metformin, sulfonylurea and insulin Study Characteristics Colesevelam A1c Effect Colesevelam A1c Effect Placebo N=461, 26 weeks, baseline A1c 8.2-8.3% N=316, 26 weeks, baseline A1c 8.1-8.2% N=287, 16 weeks, baseline A1c 8.3% vs. Placebo (add-on to SU) vs. Placebo (add-on to MF) vs. Placebo (add-on to Insulin) -0.3% +0.2% -0.39% +0.15% -0.4% +0.1% 1. Fonseca et al, Diabetes Care, 2008 2. Bays et al, Arch Intern Med, 2008 3. Goldberg et al, Arch Intern Med, 2008
Page 1 and 2: Clinical Approach to Medical Manage
Page 3 and 4: Outline: 1. Glycemic Targets in Typ
Page 5 and 6: Glycemic Goals of Therapy in Outpat
Page 7 and 8: Adjusted Hazard Ratio for Clinical
Page 9 and 10: Benefit assessment of long-term blo
Page 11 and 12: Outline: 1. Glycemic Targets in Typ
Page 13 and 14: Type 2 DM Treatment - Practical Tip
Page 15 and 16: The Biguanides: Basic Characteristi
Page 17 and 18: 10-Year Follow-up of Intensive cont
Page 19 and 20: Metformin: Old Drug, New Targets Li
Page 21 and 22: Secretagogues: Sulfonylureas and th
Page 23 and 24: Secretagogues: Sulfonylureas and th
Page 25 and 26: Sulfonylurea Versus Newer Agents: G
Page 27 and 28: Basic Characteristics of Glitazones
Page 29 and 30: Pioglitazone • Is not associated
Page 31 and 32: The α-Glucosidase Inhibitors: Basi
Page 33 and 34: Types of Insulins • Basal insulin
Page 35 and 36: Prandial Versus Basal Insulin: The
Page 37: Insulin Initiation and Titration
Page 41 and 42: Cycloset Safety Trial HR Bromocript
Page 43 and 44: • N=656 • DM2 for ~12 yrs • B
Page 45 and 46: So, we have 11 different classes of
Page 47 and 48: Comparative Effectiveness and Safet
Page 49 and 50: Pooled between-group differences in
Page 51 and 52: Effect of Antihyperglycemic Agents
Page 53 and 54: Yearly Cost for Different Antihyper
Page 55 and 56: 2012 Position Statement of the ADA
Page 57: Thank You !

Clinical Approach to Medical Management of Type 2 Diabetes

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