Diabetes oral medications!

PRACTICE QUESTIONS!

Scroll to the bottom for the answers!

  1. 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)
  1. 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)
  1. 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)
  1. 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)
  1. 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)
  1. 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)
  1. 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!


Answers to the practice questions:

  1. Empagliflozin / Jardiance (SGLT2i)
  2. Empagliflozin / Jardiance (SGLT2i)
  3. Glyburide (SU)
  4. Dulaglutide / Trulicity (GLP1-RA)
  5. Empagliflozin / Jardiance (SGLT2i)
  6. Liraglutide / Victoza (GLP1-RA) & Empagliflozin / Jardiance (SGLT2i)
  7. Sitagliptin / Januvia (DPP4i)