Naplex Complete Study Outline A Topic-Wise Approach Diabetes

Copyright

Johanna Kristin Ellerup, PharmD

Contributing Editor: Olga Kalugina, PharmD

2019

Johanna Kristin Ellerup PharmD

All rights reserved.

No part of this book may be reproduced, or stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, nor in any language without the express written permission of the author.

Printed in the United States of America

Table of Contents

Diabetes

Epidemiology and Generalized Information:

Recommendations

Patient Counseling points:

Cover terms

Clinical Pearls & Notes:

Signs and symptoms of associated disease states:

Pathophysiology:

Treatment options:

Lifestyle Interventions –

DPP-4

GLP-1

Alpha-Glucosidase

Meglitinides

Sulfonylureas

First Generation

Second Generation

Sodium Glucose Transporter Protein2 – Inhibitors

Thiazolidinediones

Biguanides

Amylin Analog

Insulin

Anti-Hypoglycemic Agent/Glycogenolytic

Clinical Guidelines:

References:

Diabetes

Epidemiology and Generalized Information:

Prevalence 1.25 million Americans. Incidence is 40,000 new diagnoses each year.

2013 – 33-49% of patients not meeting general targets for glucose

33-49% of patients not meeting general targets for glucose, BP or cholesterol & only 14% met goal while not smoking.

2012-17 – cost of diabetes (w/adjustments for inflation) increased 26%

Social determinants of health are economics, environment, political & social conditions in which people live.

14% of Americans suffer from food insecurity & increased risk of T2DM, suboptimal glycemic control, psychosocial conditions and low treatment adherence 79.

Recommendations

A—Clear evidence from well-conducted, generalizable randomized controlled trials that are adequately powered

B—Supportive evidence from well-conducted cohort studies

C—Supportive evidence from poorly controlled or uncontrolled studies

E—Expert consensus or clinical experience

Patient Counseling points:

Cover terms

Fasting Blood Glucose (FPG) – Macrovascular disease – Metformin, Insulin. Fasting – greater than 6 hours between meals – 70-100 (up to 130)

Post-Prandial Glucose (PPG) and A1C – Microvascular disease – GLP-1, DPP4, Insulin & SGTP. Peak postprandial – (peak – 1-2 Hrs after initiation of meal) = <=180mg/dl.

Preprandial – Similar to trough – just prior to eating 70-130

HbA1C – Normal non-diabetic patients 4-6%. Very strict control is <7. Some patients may require <8 to prevent hypoglycemia.

Primary failure – Inability to achieve disease remission/optimal effect with evidence based drug treatment and doses.

Secondary effect – After initial success, the agent loses effectiveness which may be neutralization by pathogen enzyme secretion, alternate pathway or irreversible over-saturation of receptors (down regulation).

75g oral glucose tolerance test (OGGT) – With either fasting plasma glucose (FPG) or 2HR plasma glucose.

The 2Hr plasma glucose