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Management
of Type 2 Diabetes
Abdullah M. Kharbosh, B.Sc. Pharm
Type 2
What… ? Introduction
0
W est co u n tries E ast co u n tries
Diabetes
Hyperlipidemia
Tuberculosis
Epilepsy
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pe 2What…
High?Prevalence in KSA
Normal
Obesity in KSA
Over-weight
Obese
24%
32% 44%
pe 2What…
High?Prevalence in KSA
40 Retinopathy Neuropathy
30
Nephropathy
20
10
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Diabetes is a reversible
pathological condition
that can be done with:
Exercise
Diet
Drugs
Lifestyle Modification
Lifestyle modification is a cornerstone of DM management &
comprises the following:
Medical Nutrition Therapy
Physical activity and exercise
Avoidance of smoking and alcoholic beverages
Diet should include foods from each of the basic food groups
Thiaz Biguanides id es
olidi G lin
Rosig nediones Metformin
e pa
de
glini
litazo R inide
Piogl ne t egl
itazon Na
e
Sulfonylureas
Glibenclamide
osi dase Gliclazide Amy
uc lin
α-Gl ibitors Glipizide Pram Analo
Inh se Glimepiride lintid g
bo e
Acar itol
Migl
DPP
im etics -4
tin M Sita Inhib
Incre enatide glip it
tin or
Ex
diabetics Sites of Action
INTESTINE PANCREAS
↓ GLUCOSE ABSORPTION
↑INSULIN SECRETION
Alpha-glucosidase inhibitors
SU, Repaglinide, Nateglinide
*
Liver Enzyme Monitoring Recommended In Product Monographs
Consider Avoid
Renal Function Glipizide, Glimepiride, Insulin, TZD’s, Acarbose, Metformin
Repaglinides
+ +
At diagnosis: Basal insulin Intensive insulin
Lifestyle
+
Metformin Lifestyle + Metformin
+
Sulfonylurea
Lifestyle + Metformin
+ Lifestyle + Metformin
Pioglitazone + Pioglitazone
No hypoglycemia + Sulfonylurea
Oedema/CHF/Bone loss
Lifestyle + Metformin
+ Lifestyle + Metformin
GLP-1 Agonist + Basal insulin
GLP-1: Glucagon-like No hypoglycemia
peptide-1 (Exenatide) Wt loss/Nausea/Vomiting
1 Begin with low dose (500 mg) OD or BID with meals or 850 mg OD
After 5-7 days, if no GI SEs, ↑ dose to 850 mg, or two 500 mg tablet, BID
2 )(before breakfast &/or dinner
Check FG (usually daily) and ↑ dose, typically by 2 U Q3D until FG levels are consistently in target
range (3.9-7.2 mmol/l [70-130 mg/dl]). Can ↑ dose in larger increments, e.g., by 4 U Q3D, if FG is >
10 mmol/l (180 mg/dl)
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