Additional Diabetes Treatment Options

DPP-4 inhibitors (~0.5–1%)

• Block degrad. GLP-1 & GIP → ↑ insulin.
• ↑ risk of HF w/ saxagliptin (NEJM 2013;369:1317), not w/ others.

• 參考➡️ Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus

Sulfonylureas (SU) (~1.5%)

• ↑ insulin secretion. Hypoglycemia; wt gain.
• Thiazolidinediones (TZD) (~1%)
• ↑ insulin sens. in adipose & muscle. Wt ↑, fluid retention & CHF. Hepatox. ↑ MI w/ rosiglitazone? Contraindic. in HF & liver dysfxn.

Glinides (~1%)

↑ insulin secretion; hypoglycemia; wt gain

α-gluc. inhib (~0.5%)

↓ intestinal CHO absorption. Abd pain, flatulence.

Pramlintide (~0.5%)

• Delays gastric emptying & ↓ glucagon. N/V
• Insulin
• (variable)
• ↓↓ glc; wt gain. Mandatory in T1D; consider in T2D if oral Rx inadeq. Weekly vs. daily w/ similar glycemic ctrl (NEJM 2020;383:2107).

Tirzepatide (~2–2.5%)

• Dual glucose-dependent insulinotropic polypeptide-GLP-1 receptor agonist.
• Greater ↓ in A1C & wt vs. semaglutide (NEJM 2021;385:503).

參考➡️ Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes

• Not yet FDA approved.

Gastric bypass

Wt ↓↓↓; can cause remission DM (NEJM 2014;370:2002)

參考➡️ Comment on: trends in utilization of bariatric surgery, 2010-2014: sleeve gastrectomy dominates

Lifestyle changes including weight management are foundational. Diabetes Care 2022;45:S256; NEJM 2021; 385:896. NEJM 2019;381:1995; Lancet 2019;393:31; Circ 2019;139:2022; NEJM 2019;380:2295. 詳見Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. 參考➡️ Canagliflozin and renal outcomes in type 2 diabetes and nephropathy 參考➡️ Cardiovascular and renal outcomes with efpeglenatide in type 2 diabetes

Explain by ChatGPT

• DPP-4 inhibitors block the degradation of GLP-1 and GIP, which leads to an increase in insulin.
• There is an increased risk of HF with saxagliptin, but not with other DPP-4 inhibitors.
• Sulfonylureas increase insulin secretion. They can cause hypoglycemia and weight gain.
• Thiazolidinediones increase insulin sensitivity in adipose tissue and muscle. They can cause weight gain, fluid retention, and CHF. Hepatotoxicity is a concern with rosiglitazone. Thiazolidinediones are contraindicated in HF and liver dysfunction.
• Glinides increase insulin secretion and can cause hypoglycemia and weight gain.
• Alpha-glucosidase inhibitors decrease intestinal CHO absorption. They can cause abdominal pain and flatulence.
• Pramlintide delays gastric emptying and decreases glucagon. It can cause nausea and vomiting.
• Insulin can cause weight gain. It is mandatory in T1D; consider in T2D if oral Rx is inadequate.
• Tirzepatide is a dual glucose-dependent insulinotropic polypeptide-GLP-1 receptor agonist. It can cause a greater decrease in A1C and weight vs. semaglutide. It is not yet FDA approved.
• Gastric bypass surgery can cause a significant weight loss and can lead to remission of DM.

窩的英文不太好

• DPP-4 抑製劑阻斷 GLP-1 和 GIP 的降解，從而導致胰島素增加。
• 沙格列汀會增加心衰風險，但其他 DPP-4 抑製劑不會增加。
• 磺脲類藥物增加胰島素分泌。它們會導致低血糖和體重增加。
• 噻唑烷二酮增加脂肪組織和肌肉中的胰島素敏感性。它們會導致體重增加、體液瀦留和充血性心力衰竭。肝毒性是羅格列酮的一個問題。噻唑烷二酮類禁用於 HF 和肝功能障礙。
• 格列奈類藥物可增加胰島素分泌，可引起低血糖和體重增加。
• α-葡萄糖苷酶抑製劑會降低腸道對 CHO 的吸收。它們會引起腹痛和脹氣。
• 普蘭林肽延遲胃排空並降低胰高血糖素。它會引起噁心和嘔吐。
• 胰島素會導致體重增加。在 T1D 中是強制性的；如果口服 Rx 不充分，請考慮 T2D。
• Tirzepatide 是一種雙重葡萄糖依賴性促胰島素多肽-GLP-1 受體激動劑。與 semaglutide 相比，它可以導致 A1C 和體重的更大降低。它尚未獲得 FDA 批准。
• 胃繞道手術可導致體重顯著減輕，並可緩解 DM。