Clinical Approach to Medical Management of Type 2 Diabetes

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Bromocriptine • Ergot-derived dopamine agonist, unknown antidiabetic mechanism (presumably by increasing the hypotalamic dopamine levels and decreasing SNS activity) – A1c reduction ~0.4% – Dose 0.6-4.8 mg PO daily in AM within 2 hrs after waking – SE: nausea, dizziness, HA, syncope Bromocriptine N=80 (1.6-4.8 mg/day) Placebo N=79 HbA1c (%) •Baseline 9.0 8.8 •Change from baseline -0.1 +0.3 •Difference from placebo -0.4 http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020866lbl.pdf, accessed 04/04/2012
Cycloset Safety Trial HR Bromocriptine QR vs. placebo: 0.60 (CI 0.37-0.96) Composite Cardiovascular Endpoint – time <strong>to</strong> first MI, stroke, CABG, hospitalization for unstable angina or CHF Gaziano et al, <strong>Diabetes</strong> Care, 2010
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 and 38: Insulin Initiation and Titration
Page 39: Colesevelam vs. Placebo in combinat
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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