Therapies:

Type 2 Diabetes Crash Course

Lifestyle Metformin DPP-4s
Modifications
Basics: oHigh efficacy oNO
•≥ ____% weight
Monitoring oNO hypoglycemia
loss for those with
hypoglycemia risk
•A1C T2DM +
overweight/obese risk oPotential HF risk
•Diagnosis: ≥ 6.5% with saxagliptin
•Target changes in oPotential ASCVD
•Goals: ≤ _____% (AACE), < _____% (ADA) benefit oRisk of
diet and exercise
•FBG oLow cost _____________
•Diagnosis: ≥ 126 mg/dL oGI side effects
•Goal: ______ mg/dL
•PPBG
GLP-1s SGLT-2s
•Goal: < 180 mg/dL
•Random BG oHigh efficacy oNO hypoglycemia risk
•Diagnosis: ≥ 200 mg/dL oWeight loss oWeight loss
•Hypoglycemia: < ____ mg/dL
oASCVD benefit and oASCVD benefit:
Complications/Comorbidities potential DKD benefit: empagliflozin, canagliflozin
dulaglutide, liraglutide, oHF benefit: empagliflozin,
•HTN
semaglutide canagliflozin, dapagliflozin,
•HLD
oHigh cost ertugliflozin
•Statin therapy in DM:
oFDA Black Box Warning: oDKD benefit: canagliflozin,
•High intensity if DM + ASCVD event
_____________________ empagliflozin, dapagliflozin
•High intensity if DM + ASCVD risk factors OR 50-70
yo o↑ LDL, DKA risk, bone
fracture risk, hypotension
•Moderate intensity if DM + age 40-75 yo
•Statin may be reasonable if DM + 20-39 yo +
ASCVD risk factors Sulfonylureas
•IF 10yr ASCVD risk is ≥ 20%, may be reasonable to
TZDs
add ezetimibe oWeight gain oWeight gain
•CKD oNO hypoglycemia risk oRisk of hypoglycemia
•Diabetic retinopathy oPotential ASCVD benefit oFDA Special Warning on
•Diabetic neuropathy with pioglitazone increased risk of
•Foot care oBlack box warning: ___________________
Management in the Hospital: __________________
 Perform an A1C on all patients with DM or BG > 140 if not
performed in last 3 months Treatment Algorithm Tid Bits:
 Insulin therapy should be initiated for treatment of
persistent BG ≥ 180 mg/dL  First line: metformin and lifestyle changes
o Goal: BG ______________ mg/dL  Insulin if A1C > _____% or BG ≥ _____ mg/dL
 Preferred treatment:  Metformin should be continued if/when insulin therapy
o Poor oral intake/NPO: basal insulin OR basal + basal added
correction  GLP-1 preferred to insulin usually
o Good oral intake: basal, prandial, and correction parts  High ASCVD risk, HF, and CKD: GLP-1, SGLT2 are
 Metformin and SGLT-2s appropriate initial therapy

Pen Packaging: Practice:

Drug Concentration Package A pt has a prescription for Humalog
Liraglutide (Victoza) 6 mg/mL 3 mL x 2 or 3 pens Kwikpen 15 units subQ TID. What is
Dulaglutide (Trulicity) 0.75, 1.5, 3, and 4.5 mg/mL 0.5 mL x 4 pens the day supply for a box of
Semaglutide (Ozempic) 2 mg/1.5 mL 1.5 mL x 1 pen Kwikpens? ___________________
Insulin aspart (Novolog), lispro 100 U/mL 3 mL x 5 pens
How many Victoza pens are needed
(Humalog)
Insulin glargine (Lantus), (Toujeo) 100 U/mL 3 mL x 5 pens to fill a prescription for 1.2 mg subQ
Insulin degludec (Tresiba) 100 U/mL, 200 U/mL 3 mL x 1, 3, 5 pens daily, 30 days supply? ___________

American Diabetes Association; Standards of Medical Care in Diabetes—2022 Abridged for Primary Care Providers. Clin Diabetes 1 January 2022; 40 (1): 10–38.
IBM Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Accessed August 15, 2022. http://www.micromedexsolutions.com