A 63-year-old Hispanic woman with type 2 diabetes (T2DM) has been under your care for ten years and she was diagnosed with T2DM six years ago. In addition to long-standing hypertension and hypercholesteremia, she has a BMI (body-mass index) of 31 kg/m2 as well as a family history of cardiovascular disease.
However, she has never had a cardiovascular event and does not report any cardiac symptoms.
Zachary T. Bloomgarden, MD
See below for References and Disclosures.
7. Bodmer M, Meier C, Krähenbühl S, Jick SS, Meier CR. Metformin, sulfonylureas, or other antidiabetes drugs and the risk of lactic acidosis or hypoglycemia: a nested case-control analysis. Diabetes Care. 2008;31:2086-2091
8. Bolen S, Feldman L, Vassy J, Wilson L, Yeh HC, Marinopoulos S, Wiley C, Selvin E, Wilson R, Bass EB, Brancati FL. Systematic review: comparative effectiveness and safety of oral medications for type 2 diabetes mellitus. Ann Intern Med. 2007;147:386-399
9. Phung OJ, Scholle JM, Talwar M, Coleman CI. Effect of noninsulin antidiabetic drugs added to metformin therapy on glycemic control, weight gain, and hypoglycemia in type 2 diabetes. JAMA. 2010;303:1410-1418.
10. Gerstein HC, Ratner RE, Cannon CP, Serruys PW, García-García HM, van Es GA, Kolatkar NS, Kravitz BG, Miller DM, Huang C, Fitzgerald PJ, Nesto RW; APPROACH Study Group. Effect of rosiglitazone on progression of coronary atherosclerosis in patients with type 2 diabetes mellitus and coronary artery disease: the assessment on the prevention of progression by rosiglitazone on atherosclerosis in diabetes patients with cardiovascular history trial. Circulation. 2010;121:1176-1187.
11. Nissen SE, Nicholls SJ, Wolski K, Nesto R, Kupfer S, Perez A, Jure H, De Larochellière R, Staniloae CS, Mavromatis K, Saw J, Hu B, Lincoff AM, Tuzcu EM; PERISCOPE Investigators. Comparison of pioglitazone vs glimepiride on progression of coronary atherosclerosis in patients with type 2 diabetes: the PERISCOPE randomized controlled trial. JAMA. 2008;299:1561-1573.
12. Schwartz AV, Sellmeyer DE, Vittinghoff E, Palermo L, Lecka-Czernik B, Feingold KR, Strotmeyer ES, Resnick HE, Carbone L, Beamer BA, Park SW, Lane NE, Harris TB, Cummings SR. Thiazolidinedione use and bone loss in older diabetic adults. J Clin Endocrinol Metab. 2006;91:3349-3354.
Speaker's Bureau: Merck, Novo Nordisk, GSK
Advisory Panel: Merck, BMS, Astra Zeneca, Boehringer Ingelheim, Biodel
Consultant: Merck, Novartis, Dainippon Sumitomo Pharma America, Forest Laboratories
Stock/Shareholder: Covidien, Bard, Novartis, Roche, Stryker
Carol H. Wysham, MD
See below for References and Disclosures.
2. Buse J, Rosenstock J, Sesti G et al. Liraglutide once a day vs exenatide BID for type 2 diabetes: a 26 week randomized, parallel group, multinational, open-label trial (LEAD-6). The Lancet 2009;374:39-47.
4. Bunck M, Corner A, Elizasson B et al. Three-year exenatide therapy, followed by a 4 week off-drug period, had sustainable effect on B-call disposition index in metformin treated patients with type 2 diabetes. Abstract 728-P. Presented at the 70th Annual Sessions of the American Diabetes Association. 2010.
7. Phung OJ, Scholle JM, Talwar M et al. Effect of Noninsulin Antidiabetic Drugs Added to Metformin Therapy on Glycemic Control, Weight Gain, and Hypoglycemia in Type 2 Diabetes. .JAMA 2010; 303: 1410-1418.
9. Kendall DM, Riddle MC, Rosenstock J, et al. Effects of exenatide (exendin-4) on glycemic control over 30 weeks in patients with type 2 diabetes treated with metformin and a sulfonylurea. Diabetes Care 2005;28:1083-1091.
10. Russell-Jones D, Vaag A, Schmitz O et al. Liraglutide vs insulin glargine and placebo in combination with metormin and sulfonylurea therapy in type 2 diabetes mellitus (LEAD-5): randomized controlled trial. Diabetologia 2009;52:2046-2055.
11. Heine RJ, Van Gaal LF, Johns D, Mihm MJ, Widel MH, Brodows RG. Exenatide versus insulin glargine in patients with suboptimally controlled type 2 diabetes: a randomized trial. Ann Intern Med 2005;143:559-569.
15. Knudsen LB, Madsen LW, Andersen S et al. Glucagon-like peptide-1 receptor agonists activate thyroid c-cells causing calcitonin release and c-cell proliferation. Endocrinology 2010;151:1473-1486.
Carol Wysham has received honoraria for acting as a speaker for Amilyn Pharmaceuticals, Eli Lilly and Novo Nordisk.
Charles F. Shaefer, MD, FACP, FCCP
See below for References and Disclosures.
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5. UKPDS Group. Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837-853.
6. Riddle MC, Ambrosius WT, Brillon DJ, Buse JB, Byington RB, Cohen RM, Goff, Jr. DC, Malozowski S, Margolis KL, Probstfield JL, Schnall A, Seaquist ER, and for the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Investigators. Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial. Diabetes Care 201;33:983-990.
7. Monnier L, Lapinski Hand Colette C. Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA1c.Diabetes Care 2003;26:881-885.
8. Yale JF, Valiquett TR, Ghazzi MN, Owens-Grillo JK, Whitcomb RW, Foyt HL, and for the Troglitazone Triple-Therapy Study Group. The effect of a thiazolidinedione drug, troglitazone, on glycemia in patients with type 2 diabetes mellitus poorly controlled with sulfonylurea and metformin: a multicenter, randomized, double-blind, placebo-controlled trial. Ann Intern Med 2001;134:737-745.
9. Scott R, Loeys T, Davies MJ, Engel SS, for the Sitagliptin Study 801 Group. Efficacy and safety of sitagliptin when added to ongoing metformin therapy in patients with type 2 diabetes. Diabetes Obes Metab 2008;10:959-969.
10. DeFronzo RA, Hissa MN, Garber AJ, Gross JL, Duan RY, Ravichandran S, Chen RS, and for the Saxagliptin 014 Study Group. The efficacy and safety of saxagliptin when added to metformin therapy in patients with inadequately controlled type 2 diabetes with metformin alone. Diabetes Care 2009 ;32:1649-1655.
11. Package insert for sitagliptin and saxagliptin, September 2010.
12. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, Zinman B. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009;32:193–203.
13. Rodbard HW, Jellinger PS, Davidson JA, Einhorn D, Garber AJ, Grunberger G, Handelman Y, Horton ES, Lebovitz H, Levy P, Moghissi E, and Schwartz SS. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract 2009;15:540-559.
14. Buse JB, Rosenstock J, Sesti G, Schmidt WE, Montanya E, Brett JH, Zychma M, Blonde L. LEAD-6 Study Group. Liraglutide once a day versus exenatide twice a day for type 2 diabetes: a 26-week randomised, parallel-group, multinational, open-label trial (LEAD-6). Lancet 2009;374:39– 47.
15. Drucker DJ, Sherman SI, Gorelick FS, Bergenstal RM, Sherwin RS, and Buse JB. Incretin-based therapies for the treatment of type 2 diabetes: evaluation of the risks and benefits. Diabetes Care 2010;33:428-433.
16. Riddle MC, Rosenstock J, and Gerich J. The. Treat-to-Target Trial: Randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care 2003;26:3080-3086.
17. Hermansen K, Davies M, Derezinski T, Ravn GM, Clauson P, and Home P. A 26-week, randomized, parallel, treat-to-target trial comparing insulin detemir With NPH insulin as add_on therapy to oral glucose-lowering drugs in insulin-naive people With type 2 diabetes. Diabetes Care 2006;291269-1274.
18. Gerstein HC, Yale JF, Harris SB, Issa M, Stewart JA, Dempsey E. A randomized trial of adding insulin glargine vs. avoidance of insulin in people with Type 2 diabetes on either no oral glucose-lowering agents or submaximal doses of metformin and/or sulphonylureas. The Canadian INSIGHT (Implementing New Strategies with Insulin Glargine for Hyperglycaemia Treatment) Study. Diabet Med 2006; 23:736-742.
19. Holman RR, Farmer AJ, Davies MJ, Levy JC, Darbyshire JL, M.A., Keenan JF, B.A., and Paul SK, for the 4-T Study Group. Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med 2009; 361:1736-1747.
20. King, AB. Once-daily insulin detemir is comparable to once-daily insulin glargine in providing glycaemic control over 24 h in patients with type 2 diabetes: a double-blind, randomized, crossover study. Diabetes, Obesity and Metabolism 2009;11:69–71.
21. Shaefer, CF. Unpublished data. Cost Analysis of 90 day diabetes therapy. June 2010.
22. Hirsch, IB. Oral communication. ADA 68th Scientific Sessions, Chicago, IL, 2007.
Charles Shaefer has received honoraria as a speaker for Sanofi-Aventis, Novo Nordisk, Amylin, Eli Lilly, Bristol Myers Squibb, AstraZeneca, Novartis, Abbott Labs, Forest Pharmaceuticals, Daiichi Sankyo, and Pfizer. He has acted as a consultant for Sanofi-Aventis, Amylin, and Eli Lilly.
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