Improving the Guidelines for Combination Therapy for Type...

I have chosen the above topic because the guidelines are very vague in recommending this combination therapy even though we have clear cut guidelines recommending the use of individual agents in the treatment in Type II Diabetes patients. American diabetes association (1) guidelines recommend advising lifestyle modifications like healthy eating, increased physical activity and weight control, and if the patient fails to meet the target HbA1C levels on lifestyle changes, Metformin is added and over a period of three months, if the patient does not reach the target A1C levels, patient can be started on two drug combinations and we have several options to do this, from sulfonylureas, TZDs ,GLP-1 Analogues, DPP-4 inhibitors and insulin. A search of literature for this combination (2) shows that there are very few clinical studies conducted with the combination of GLP 1 analogues and Insulin and in these studies it was more common to find short-acting GLP-1 RA (exenatide twice daily , liraglutide once daily, lixesanatide once daily) treatment added to an existing insulin regimen (with or without concomitant OAMs) rather than insulin added to existing GLP-1 RA therapy. I will limit the discussion here to only combination treatment of T2D with GLP-1 RA and basal insulin and would like to discuss the above topic under two headings- 1. Adding basal insulin to a patient who is already receiving OHAs + GLP-1 Analogues and discuss the results. What I do in my practice isShow MoreRelatedPharmacokinetic and Pharmacodynamic Interaction of aqueous extract of Cassia auriculata L. leaves and Metformin in rats.1533 Words   |  7 Pagestreatment of diabetes to control the blood sugar level (Berman et al., 2001). Cassia species, are rich sources of polyphenols, anthraquinone derviatives, flavanoids, polysaccrides, saponins, tannins and steroids (Singh et al., 1980; Yen et al., 1998; Ayo et al., 2004), flavanoids, sterols/terpenoids and phenolic acids are known to be antidiabetic bioactive principles. Flavanoids are known to regenerate the damaged ÃŽ ² cells in alloxan induced diabetic rats (Yasir M et al., 2012). Diabetes mellitus, causedRead MoreHow Many Licks Of A Lollipop Does It Take For Get Diabetes?3162 Words   |  13 PagesTake To Get Diabetes? Abstract/Introduction: When people think of causes of death, the big names that come up are usually cancer, heart disease, stroke, Alzheimer’s, and suicide. These are all huge killers, but the underestimated, unthought-of, underdog of them all might just be diabetes. Diabetes is the 7th leading cause of death, with an estimated 29 million suffering from the disease and a prediction that 1 in 3 born in 2000 will develop it. In 2005, 233, 619 deaths were due to diabetes and the rateRead MoreBenefits Of Physical Training Patients With Diabetes And Chronic Kidney Disease2469 Words   |  10 PagesBENEFIT OF PHYSICAL TRAINING IN PATIENTS WITH DIABETES AND CHRONIC KIDNEY DISEASE. Yetunde M. Fajulugbe Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University Dayton OH. Keywords: Diabetes, Chronic Kidney Disease, Physical Training, Abstract: Introduction Diabetes occur when there is a combination of inadequate secretion of insulin by the pancreatic beta cells and the peripheral insulin resistance. Insulin resistance leads to a reducedRead MoreRisk Factor For Global Disease Burden3283 Words   |  14 PagesSecond, many patients appropriately diagnosed with hypertension fail to achieve the treatment targets recommended by guidelines. This highlights the considerable challenges in implementing risk factor modification and appropriate adherence to antihypertensive therapies long term. Third, uncertainty remains as to the appropriate BP treatment target for high-risk patients. While a target BP 140/90 mm Hg is generally recommended, a lower threshold of 130/80 mm Hg is recommended for patients at high riskRead MoreIn The United States, Approximately Six Million People3312 Words   |  14 PagesIn the United States, approximately six million people are living with some degree and type of heart failure; it is also the number one cause of death in the United States (CDC, 2016). The following research paper details the medical-surgical treatment and nursing care of patients with heart failure, and includes information specific to left-sided heart failure. Left-sided or left ventricular heart failure (LSHF) is most often referred to as congestive heart failure (CHF) in the clinical settingRead MoreCommunity Acquired Pneumonia18251 Words   |  74 Pagesone of the most common infectious diseases prevalent nowadays and affects all ages. It is an acute or chronic infection of one or both lungs caused by microorganisms, such as viruses, bacteria or chemical irritants. (Schmitt, 2011) It has different types, and one of them is Community Acquired Pneumonia (CAP). CAP is a disease in which individuals who have not recently been hospitalized develop an infection of the lungs. It occurs because the areas of the lung which absorbs oxygen (alveoli) from theRead MoreEssay on Liquid Diets4195 Words   |  17 Pagesedu/school/DGIM/Teaching/Modules/obesity.html#RTFToC12). Obesity has been related to high blood pressure, heart disease, respiratory problems, gallstones, insomnia, and some cancers (http://www.fdu.gov/bbs/topics/CONSUMER/CON0007Q.html). Some doctors prescribe liquid diets to patients unable to digest solid foods; however, the majority of liquid diets are used for the purpose of losing weight. HOW DOES IT WORK? Since a reduction of 3,500 calories is needed to lose a pound, most of the liquid diets consist of a very lowRead MoreOsteoporosis: bone Mass7865 Words   |  32 PagesLifestyle change includes preventing falls and exercise; medication includes calcium, vitamin D, bisphosphonates and several others. Fall-prevention advice includes exercise to tone deambulatory muscles, proprioception-improvement exercises; equilibrium therapies may be included. Exercise with its anabolic effect, may at the same time stop or reverse osteoporosis. Signs and symptoms Osteoporosis itself has no specific symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fracturesRead MoreUse Of Traditional Chinese Medicine During The Treatment Of Schizophrenia Essay7976 Words   |  32 Pageswith severe alterations in mood. Schizophrenia tends to more continuous with illogical thinking, hallucinations and delusions controlling an individual’s actions and thoughts. The causes of schizophrenia are unknown, but research suggests that a combination of physical, genetic, psychological and environmental factors can make people more likely to develop the condition. Genetics play a major role in schizophrenia, but there is no one gene responsible. The greatest risk for developing schizophreniaRead MoreGlaxosmithkline18561 Words   |  75 Pagesdivision, which generates 85% of GSK’s sales. The five largest selling GSK products are Seretide/Advair for asthma and Chronic Obstructive Pulmonary Disease (COPD); Paxil/Seroxat and Wellbutrin, both antidepression drugs; Avandia/Avadamet for type 2 diabetes; and the antibiotic Augmentin. Each of these drugs generated above  £800 million of sales in 2003. GSK produces a broad range of products of special importance to developing countries, including: Anti-malaria drugs Zentel (albendazole), for de-worming