PRACTICE QUESTIONS!
Scroll to the bottom for the answers!
- What is the only oral diabetes medication that has been shown to reduce cardiovascular disease events including CHF exacerbations?
- Liraglutide / Victoza (GLP1-RA)
- Glyburide (SU)
- Empagliflozin / Jardiance (SGLT2i)
- Sitagliptin / Januvia (DPP4i)
- Pioglitazone / Actos (TZD)
- Glargine / Lantus (long-acting insulin)
- Which medication has been shown to reduce CKD progression?
- Liraglutide / Victoza (GLP1-RA)
- Glyburide (SU)
- Empagliflozin / Jardiance (SGLT2i)
- Sitagliptin / Januvia (DPP4i)
- Pioglitazone / Actos (TZD)
- Glargine / Lantus (long-acting insulin)
- Which oral medication has the side effect of induced hypoglycemia?
- Liraglutide / Victoza (GLP1-RA)
- Glyburide (SU)
- Empagliflozin / Jardiance (SGLT2i)
- Sitagliptin / Januvia (DPP4i)
- Pioglitazone / Actos (TZD)
- Which medication reduces major adverse cardiac events and is a weekly injection?
- Dulaglutide / Trulicity (GLP1-RA)
- Glyburide (SU)
- Empagliflozin / Jardiance (SGLT2i)
- Sitagliptin / Januvia (DPP4i)
- Pioglitazone / Actos (TZD)
- Glargine / Lantus (long-acting insulin)
- Which medication has the side effect of increased risk of UTIs (or balanitis in uncircumcised men) due to associated glucosuria?
- Liraglutide / Victoza (GLP1-RA)
- Glyburide (SU)
- Empagliflozin / Jardiance (SGLT2i)
- Sitagliptin / Januvia (DPP4i)
- Pioglitazone / Actos (TZD)
- Glargine / Lantus (long-acting insulin)
- Pick either of the two medications that can help with weight-loss.
- Liraglutide / Victoza (GLP1-RA)
- Glyburide (SU)
- Empagliflozin / Jardiance (SGLT2i)
- Sitagliptin / Januvia (DPP4i)
- Pioglitazone / Actos (TZD)
- Glargine / Lantus (long-acting insulin)
- GLP1-RAs are an injectable medication that work similarly to which of the following oral medications? (And therefore patients should not be on both medications.)
- Glyburide (SU)
- Empagliflozin / Jardiance (SGLT2i)
- Sitagliptin / Januvia (DPP4i)
- Pioglitazone / Actos (TZD)
- Glargine / Lantus (long-acting insulin)
DIDACTIC REVIEW
Lowering A1c reduces microvascular complications (e.g. retinopathy, nephropathy, neuropathy)
UKPDS Study: Intensive treatment (A1c 7) vs. conventional (A1c 8). Showed 12-year risk reduction of 27% for retinopathy, 33% for microalbuminuria, 74% for creatinine doubling. Similar findings in DCCT Trial.
SGLT2i (Empagliflozin)
- Reduce MACE (EMPA-REG)
- Reduces CHF exacerbations
- Reduces CKD progression (EMPA-REG CKD)
GLP1-RA (Liraglutide)
- Reduce MACE (LEADER)
- Help weight weight loss
DPP4i (saxagliptan) work better than SU and have less side-effects (no hypogylcemia)
- Don’t use them with GLP1-RA (liraglutide)
PEARLS!
- Lowering A1c reduces microvascular complications (e.g. retinopathy, nephropathy, neuropathy).
- Metformin is always first-line.
- SGLT2i and GLP1-RA reduce macrovascular complications (heart attacks / strokes) and can help with weight loss.
- SGLT2i (eg Empagliflozin / Jardiance):
- Reduce CHF exacerbations, CKD progression, and MACE
- Increase glucosuria
- GLP1-RA (eg liraglutide) are injectables.
- Reduce CVD-deaths
- DPP4i (eg saxagliptan) work better than sulfonylureas and have less side-effects
- Don’t use DPP4i with GLP1-RA (e.g. liraglutide)
- Newer diabetes medications are not cheap. Check out these out-of-pocket costs across more than 3300 Medicare Part D plans nationwide in 2019:
- metformin: $63 for metformin
- sulfonylureas: $31-101
- pioglitazone: $136
- SGLT2i and DPP4i: $1,200-1,600 (annual total cash cost = $5,000-6,000)
- GLP1-RA: $2,000-2,500 (annual total cash cost = $9,000-11,225)
RESOURCES!
- Electronic Decision Guide: https://diabetesdecisionaid.mayoclinic.org/index
- Flowsheet and other figures from ADA DM Guidelines for PCP: https://clinical.diabetesjournals.org/content/37/1/11.figures-only
Answers to the practice questions:
- Empagliflozin / Jardiance (SGLT2i)
- Empagliflozin / Jardiance (SGLT2i)
- Glyburide (SU)
- Dulaglutide / Trulicity (GLP1-RA)
- Empagliflozin / Jardiance (SGLT2i)
- Liraglutide / Victoza (GLP1-RA) & Empagliflozin / Jardiance (SGLT2i)
- Sitagliptin / Januvia (DPP4i)