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Injecting New Ideas into Managing Type 2 Diabetes

Evolving Roles of GLP-1 Receptor Agonists

Guidelines

Standards of Medical Care in Diabetes—2018.

The ADA’s Standards of Care provide clinicians, patients, researchers, payers, and other interested individuals with the components of good diabetes management, general treatment goals, and tools to evaluate the quality of care. Importantly, these recommendations should be adjusted based on individual preferences, comorbidities, and other patient-related factors.

American Diabetes Association. Diabetes Care. 2018;41(suppl 1):S1-S153.

AACE/ACE Comprehensive Diabetes Management Algorithm 2018.

The AACE/ACE algorithm provides recommendations on evaluating the whole patient, outlines potential risks and complications, and highlights evidence-based treatment approaches for diabetes. The document contains sections on lifestyle changes, considerations for obese individuals, prediabetes, glycemic goals, antihyperglycemic therapies, treatment algorithms, modifications for atherosclerotic cardiovascular disease risk factors, and overall principles of diabetes management.

Garber AJ, Abrahamson MJ, Barzilay JI, et al. Endocr Pract. 2018;24(1):91-120.

Patient and Caregiver Resources

Diabetes HealthSense

Created as part of the National Diabetes Education Program, Diabetes HealthSense includes easily accessible resources that can help patients live well and meet their goals—whether they have diabetes or are at risk for the disease. 

Decision Aids for T2DM

To facilitate shared decision making, these examples of medication choice decision aids from the Mayo Clinic are organized into 7 issues that may be of interest to patients with T2DM. A video demonstrating the use of these cards can be found at: www.youtube.com/watch?v=SYTPqceFgSw.

Suggested Readings

Efficacy and safety of once-weekly semaglutide versus exenatide ER in subjects with type 2 diabetes (SUSTAIN 3): a 56-week, open-label, randomized clinical trial.

Ahmann AJ, Capehorn M, Charpentier G, et al. Diabetes Care. 2018;41(2):258-266.

Efficacy and safety of once-weekly semaglutide versus once-daily sitagliptin as an add-on to metformin, thiazolidinediones, or both, in patients with type 2 diabetes (SUSTAIN 2): a 56-week, double-blind, phase 3a, randomised trial.

Ahrén B, Masmiquel L, Kumar H, et al. Lancet Diabetes Endocrinol. 2017;5(5):341-354.

Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial.

Pratley RE, et al. Lancet Diabetes Endocrinol. 2018;6(4):275-286.

Pharmacology, physiology, and mechanisms of incretin hormone action.

Campbell JE, Drucker DJ. Cell Metab. 2013;17(6):819-837.

From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus.

Defronzo RA. Diabetes. 2009;58(4):773-795.

Hypoglycemia, diabetes, and cardiovascular events.

Desouza CV, Bolli GB, Fonseca V. Diabetes Care. 2010;33(6):1389-1394.

Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes.

Holman RR, Bethel MA, Mentz RJ, et al. N Engl J Med. 2017;377(13):1228-1239.

Minimizing hypoglycemia in diabetes.

International Hypoglycaemia Study Group. Diabetes Care. 2015;38(8):1583-1591.

Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes.

Inzucchi SE, Bergenstal RM, Buse JB, et al. Diabetes Care. 2015;38(1):140-149.

Liraglutide and renal outcomes in type 2 diabetes.

Mann JFE, Ørsted DD, Brown-Frandsen K, et al. N Engl J Med. 2017;377(9):839-848.

Liraglutide and cardiovascular outcomes in type 2 diabetes.

Marso SP, Daniels GH, Brown-Frandsen K, et al. N Engl J Med. 2016;375(4): 311-322.

Semaglutide and cardiovascular outcomes in patients with type 2 diabetes.

Marso SP, Bain SC, Consoli A, et al. N Engl J Med. 2016;375(19):1834-1844.

Lixisenatide in patients with type 2 diabetes and acute coronary syndrome.

Pfeffer MA, Claggett B, Diaz R, et al. N Engl J Med. 2015;373(23):2247-2257.

Report from the 2nd Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes and Cardiovascular Disease (D&CVD) EASD Study Group.

Schnell O, Standl E, Catrinoiu D, et al. Cardiovasc Diabetol. 2017;16(1):35.

Activity
Clinical Profiles of Current and Emerging GLP-1 RAs

Module 1 of 4

Activity
Reducing Cardiovascular Risk in Patients with T2DM

Module 2 of 4

Activity
Overcoming Barriers to Injectable Noninsulin Therapies

Module 3 of 4

Activity
Practical Recommendations for Noninsulin Injectable Therapies

Module 4 of 4

Relevant Resources

Incretin-Based Therapies for Type 2 Diabetes

Mechanism-Based Strategies to Achieve Patient-Centered Care

Insulin Replacement Therapy for Type 2 Diabetes

Patient-Centered Management of Hyperglycemia in Primary Care

Improving Outcomes in Type 2 Diabetes

Integrating GLP-1 Receptor Agonists Into Multimodal Treatment Regimens

A Focus on Bipolar Depression

Overcoming Diagnostic Barriers and Optimizing Long-Term Patient Outcomes

Clinical Issues in Type 2 Diabetes

Discussions and Debates Around GLP-1 Receptor Agonists

Clinical Issues in Type 2 Diabetes

Evolving Roles of GLP-1 Receptor Agonists

Improving Outcomes for Women with Type 2 Diabetes

Individualizing Evidence-Based Care

Noninsulin Approaches to Managing Type 2 Diabetes

Best Practices in Combination Therapy

Hitting the Target in Type 2 Diabetes

Evolving Approaches to Insulin Based Therapy

Improving Outcomes in Congenital and Acquired Lipodystrophy

Best Practices in Diagnosis and Management

Clinical Updates in Type 2 Diabetes

New Strategies for Insulin Replacement Therapy

Clinical Issues in Type 2 Diabetes

Consensus and Controversies Around Intensifying Noninsulin Therapy

How Low Do You Go?

Clinical Updates in LDL-C Management

Incretin-Based Therapies For Type 2 Diabetes

Improving Comprehensive Patient Care

Clinical Updates in Type 2 Diabetes

An Evolving Role for Combinations of Injectable Antihyperglycemic Therapies

Raising the Bar by Lowering the Target

Integrating PCSK9 Inhibitors Into Hypercholesterolemia Management

Multidimensional Issues in Type 2 Diabetes

Looking Beyond Hemoglobin A1c

GLP-1 Receptors Agonists in Type 2 Diabetes

Mechanistic Insights and Evolving Treatment Options

Pharmaceutical Economics and LDL-C Management

Implications for PCSK9 Inhibitors in Clinical Practice

Assimilating the Evidence in T2DM

Cardiovascular and Renal Outcomes With SGLT2 Inhibitors

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1 0.001869 0.001869 0.001869 0.001869
SELECT * FROM `resources` `t` WHERE `t`.`id` IN (143, 132, 129, 122, 118, 109, 81, 73, 51, 50, 49, 48, 45, 42, 38, 33, 30, 29, 20, 18, 16, 14, 13, 9, 11, 4)
1 0.001608 0.001608 0.001608 0.001608
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
2 0.001456 0.000728 0.000590 0.000866
SHOW COLUMNS FROM `resources`
1 0.001421 0.001421 0.001421 0.001421
SHOW COLUMNS FROM `users`
1 0.001338 0.001338 0.001338 0.001338
SHOW COLUMNS FROM `activities`
1 0.001267 0.001267 0.001267 0.001267
SHOW COLUMNS FROM `resource_videos`
1 0.001099 0.001099 0.001099 0.001099
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
2 0.000910 0.000455 0.000454 0.000456
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
2 0.000867 0.000434 0.000263 0.000604
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
1 0.000488 0.000488 0.000488 0.000488
SELECT * FROM `resources` `t` WHERE `t`.`id`=89 LIMIT 1
1 0.000473 0.000473 0.000473 0.000473
SHOW CREATE TABLE `resources`
1 0.000361 0.000361 0.000361 0.000361
SHOW CREATE TABLE `users`
1 0.000346 0.000346 0.000346 0.000346
SHOW CREATE TABLE `activities`
1 0.000323 0.000323 0.000323 0.000323
SHOW CREATE TABLE `resource_videos`
1 0.000307 0.000307 0.000307 0.000307
# Query Time (s)
0
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000866
1
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
0.000604
2
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000590
3
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
0.000263
4
SHOW COLUMNS FROM `resources`
0.001421
5
SHOW CREATE TABLE `resources`
0.000361
6
SELECT * FROM `resources` `t` WHERE `t`.`id`=89 LIMIT 1
0.000473
7
SHOW COLUMNS FROM `resource_videos`
0.001099
8
SHOW CREATE TABLE `resource_videos`
0.000307
9
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
0.000488
10
SHOW COLUMNS FROM `activities`
0.001267
11
SHOW CREATE TABLE `activities`
0.000323
12
SHOW COLUMNS FROM `users`
0.001338
13
SHOW CREATE TABLE `users`
0.000346
14
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000456
15
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
0.003883
16
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000454
17
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2539986
0.003023
18
SELECT `activities`.`id` AS `t1_c0`, `activities`.`group_id` AS `t1_c1`, `activities`.`resource_id` AS `t1_c2`, `activities`.`title` AS `t1_c3`, `activities`.`type` AS `t1_c4`, `activities`.`facultyNames` AS `t1_c5`, `activities`.`shortDescription` AS `t1_c6`, `activities`.`fullDescription` AS `t1_c7`, `activities`.`creditAmount` AS `t1_c8`, `activities`.`shortAddress` AS `t1_c9`, `activities`.`creditType` AS `t1_c10`, `activities`.`startDate` AS `t1_c11`, `activities`.`finishDate` AS `t1_c12`, `activities`.`sponsors` AS `t1_c13`, `activities`.`status` AS `t1_c14`, `activities`.`createDate` AS `t1_c15`, `activities`.`image` AS `t1_c16`, `activities`.`image_featured` AS `t1_c17`, `activities`.`archived` AS `t1_c18`, `activities`.`managers_list` AS `t1_c19`, `activities`.`is_send_pp_email` AS `t1_c20`, `activities`.`muvi_sync_date` AS `t1_c21`, `activities`.`expert_questions` AS `t1_c22` FROM `activities` `activities` WHERE (`activities`.`resource_id`=:ypl0)
0.001869
19
SELECT r.id, COUNT(r.id) relevance FROM resources r join `resource_topics` rtj on rtj.`resource_id`=r.id WHERE rtj.`topic_id` in (SELECT topic_id from `resource_topics` rt where rt.`resource_id`=:rid AND rt.topic_id>0) AND r.id <> :rid AND r.status = 'active' Group by r.id order by relevance DESC, r.`createDate` DESC
0.003626
20
SELECT * FROM `resources` `t` WHERE `t`.`id` IN (143, 132, 129, 122, 118, 109, 81, 73, 51, 50, 49, 48, 45, 42, 38, 33, 30, 29, 20, 18, 16, 14, 13, 9, 11, 4)
0.001608
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