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Content Update
December 12, 2023
Updates in Weight Management Pharmacotherapy for Diabetes and Cardiovascular Risk Management Type 2 diabetes mellitus prevention recommendations include weight management; however, there have historically been difficulties with pharmacological options for weight loss due to robust adverse event profiles and minimal efficacy. Recent evidence of the incretin mimetics semaglutide and tirzepatide in non-diabetic populations has demonstrated significant outcomes related to secondary cardiovascular risk reduction, sustained body mass reduction, and improvement in glycemic control in populations with HbA1c below the diabetes threshold. The SELECT trial demonstrated reduction in secondary macrovascular complications with use of semaglutide in those without diabetes, the first weight loss medication to do so. The SURMOUNT trial showed significant and sustained weight loss reduction and improvement in cardiovascular risk markers, leading to Food and Drug Administration approval of tirzepatide for obesity in people without diabetes.
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Content Update
July 21, 2023
Tirzepatide: a first-in-class medication to lower blood sugar and treat type 2 diabetes mellitus In 2022, the U.S. Food and Drug Administration (FDA) approved tirzepatide (Mounjaro), a novel glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor co-agonist, as an adjunct treatment with diet and exercise for patients with type 2 diabetes mellitus (T2DM). The SURPASS trials have demonstrated significant improvements with tirzepatide as compared to various antidiabetic treatment regimens for the primary outcome of reduced hemoglobin A1c (HbA1c). Additional studies, as a part of the SURPASS study program, are pending.
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Content Update
May 23, 2022
Inclusion of Finerenone (Kerendia) in the 2022 American Diabetes Association Guidelines for Diabetes and Chronic Kidney Disease In 2021, the U.S. Food and Drug Administration (FDA) approved finerenone (Kerendia), a mineralocorticoid receptor antagonist (MRA), to reduce the risk of kidney disease progression, kidney failure, nonfatal heart attacks, cardiovascular death, and hospitalization for heart failure in adults with diabetic chronic kidney disease (CKD). The Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes (FIDELIO-DKD) clinical trial demonstrated significant differences with finerenone compared to placebo in the primary composite outcome of kidney failure, decrease in estimated glomerular filtration rate (eGFR) and death from renal causes. The 2022 American Diabetes Association (ADA) guidelines now include finerenone as an option for patients with type 2 diabetes and CKD who cannot tolerate a sodium-glucose cotransporter-2 inhibitor (SGLT2i).
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LEARNING OBJECTIVES
Upon completion of the chapter, the reader will be able to:
Discuss the incidence of diabetes mellitus (DM).
Distinguish clinical differences in type 1, Latent Autoimmune Diabetes of Adulthood, type 2, and gestational diabetes.
List screening and diagnostic criteria for DM.
Discuss therapeutic goals for blood glucose (BG) and blood pressure (BP) for a patient with diabetes.
Recommend nonpharmacologic therapies, including meal planning and physical activity, for patients with diabetes.
Compare oral agents used in treating diabetes by their mechanisms of action, time of action, ...