PATIENT CASE PRESENTATION: Type 2 diabetes melitus (T2DM)
Jonny Nguyen 2024 PharmD. Candidate University of Houston College of Pharmacy, P4 Preceptor: Rosemary Onuegbu Patient Care Service Manager Albertsons/Randall/Tom Thumbs (Southern Division)
INDEX
DIABETES
PATIENT CHOICE
PATIENT INFORMATION
STAT
PRESCRIPTION
NON-PHARMALOGICAL
DIAGNOSIS
INTERACTIONS
REFERNCE
MARKET
MECHANISM
DIABETES MELITUS
What puts me more at risk of having T2DM?
Chronic, metabolic disease characterized by elevated levels of blood glucose, which progressively worsen the heart, vasculature, eyes, kidneys, and nerves.
Here are some things that can increase your likelihood of having T2DM:
- Genetic susceptibility
- highest: Japanese, Hispanics, and Native Americans)
- Aging
- Medication
- corticosteroids, antipsychotic, anti-retrovirals, progestin-only oral contraceptives
- Unhealthy lifestyle
- overeating, obesity (BMI>30), inactivity (sedentary)
MAIN FACTORS
- Defective insulin secretion by pancreatic B-cells
- Inability of insulin-sensitive tissue to respond to insulin
Galicia-Garcia U. Pathophysiology of Type 2 Diabetes Mellitus. International Journal of Molecular Sciences. 2020;21(17):1-34.
epidemiology
How has T2DM impacted our everyday families?
Emergency Department Visits: 579,000Physician Office Visits: 38.2 million (14.2%)Morbidity (Age: 20+): 16.2%Mortality:
- Number of deaths: 103,294
- Deaths per 100,000: 31.1
- Ranked 8th in cause of death in the U.S.
CDC. FastStats - Diabetes. Centers for Disease Control and Prevention. Published 2019. https://www.cdc.gov/nchs/fastats/diabetes.html CDC. National diabetes statistics report. CDC. Published November 29, 2023. https://www.cdc.gov/diabetes/data/statistics-report/index.html
THE IMPACT
It's just sugar, whats the big deal?
Diabetes is a disease that can progressively worsen over time, leading to irreversible damages that will impact patients quality of life. Development of T2DM is contributed by the following organs: the pancreas (beta and alpha cells), liver, skeletal muscle, kidneys, brain, small intestines, and adipose tissues.
DIAGNOSIS
What lab values indicates T2DM?
American Diabetes Association (ADA) has set these criterias as diagnosis for T2DM. Patient qualifies if having any of the following:
- A1C >6.5%+
- Fasting Blood Glucose: >126 mg/dL (7 mmol/L)
- 2 hour plasma glucose >200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test, using a glucose load of 75g anhydrous glucose dissolved in water
- In patients with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose >200mg/dL
American Diabetes Association. Diagnosis | ADA. diabetes.org. Published 2023. https://diabetes.org/about-diabetes/diagnosis
MEDICATION CLASS
What medications can I purchase?
These are the medications along with class that can help lower glucose levels:
- Endogenous medications
- Biguanides
- Sodium-Glucose Transporter-2 inhibitor (SGLT2)
- Glucagon-Like Peptide-1 Receptor Agonist (GLP1RA)
- Dipeptidyl Peptidase IV (DDPIV) inhibitors
- Sulfonylureas
- Thiazolidinedione
- Exogenous medications
- Insulin
- Rapid, Short, Intermediate, Long
(Metformin)
(Empagliflozin)
(Liraglutide)
(Linagliptin)
(Glipizide)
(Pioglitazone)
COMORBID CONDITION?
Well, which one do you recommend?
Based on other risk factor, we can help you determine what can be the most appropriate for you! Your first option should be based upon patient-specific factors!
Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm - 2023 Update. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2023;29(5):305-340. doi:https://doi.org/10.1016/j.eprac.2023.02.001
JUST GLUCOSE+WEIGHT GOALS?
Well, which one do you recommend?
Furthermore, these are some other things to consider when choosing your medication!Glucose lowering efficacy:
- Very High: Dulaglutide (high-dose), Semaglutide, Tirzepatide, Combination Thearpy
- High: GLP-1RA (not listed above), Metformin, SGLT2i, Sulfonylurea, TZD
- Intermediate: DPP-4i
Weight loss effect:
- Very High: Semaglutide, Tirzepatide
- High: Dulaglutide, Liraglutide
- Intermediate: GLP-1RA (not listed above), SGLT2i
- Intermediate: DPP-4i, Metformin
Patient is allowed to add additional agents based on patient-specific factors including: comorbidities, risk, glycemic management needs, convience, cost and access
Do not combine DPP-4i, GLP-1RA, and/or Tirzepatide (GLP-1/GIP RA)
Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm - 2023 Update. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2023;29(5):305-340. doi:https://doi.org/10.1016/j.eprac.2023.02.001
Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm - 2023 Update. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2023;29(5):305-340. doi:https://doi.org/10.1016/j.eprac.2023.02.001
PATIENT INFORMATION
PATIENT PROFILE
Name: T.C. Age: 90 Gender: F Allergies: No Known Allergy
COMORBID CONDITIONS:
- Cardiovascular disease
- Diabetes
- High Blood Pressure
- High Cholesterol
- High Potassium
- Irritable Bowel Syndrome (IBS)
- Nerve Pain
- Stroke
PRESCRIPTION
DRUG-DRUG INTERACTION
MyEndoConsult. Mechanism Of Action Of GLP-1 Agonists - My Endo Consult. MyEndoConsult. Published June 1, 2023. https://myendoconsult.com/learn/mechanism-of-action-of-glp-1-agonists/
What's the problem? Shouldn't it be doing double the work?
THE JUSTIFICATION
ADA recommends against combining DPP-4 inhibitors and GLP-1 receptor agonists in patients with diabetes.
- Studies have shown that it is unlikely to provide clinical beneift
- It is not cost effective
- Taking both product simultaneously may increase risk of side effect
The next slide should help you pick which one is best for you!
ONCE WEEKLY INJECTION
MACE: Major adverse cardiovascular event **: Benefit for renal endpoints in cardiovascular outcomes trial, driven by albuminuria outcomes
NON-PHARMALOGICAL CARE
Besides medication, what else can I do?
Here are some options you can look at!
- Medication Nutrition Thearpy
- Weight management
- Physical activity
- Smoking cessation
- Diabetes for self-management education and support
- Psychosocial care
White E. Treatments for Diabetes (Nonpharmacologic). Endocrinology Advisor. Published June 28, 2023. https://www.endocrinologyadvisor.com/ddi/treatments-for-diabetes-nonpharmacologic/#:~:text=4-
THE ACTION PLAN
- DISCONTINUE:
- Linagliptin (Tradjenta) 5mg tablet by mouth daily
- CONTINUE:
- Dulaglutide 3mg/0.5ml; inject 3mg under the skin weekly
- CONSIDERATION:
- MOST LIKELY NOT START: Metformin 500mg tablet by mouth daily - patient can have poor renal function
- START: Empagliflozin (Jardiance) 10mg by mouth daily
- INCREASE: Dulaglutide, inject 4.5mg under the skin weekly
REFERENCE
- Galicia-Garcia U. Pathophysiology of Type 2 Diabetes Mellitus. International Journal of Molecular Sciences. 2020;21(17):1-34.
- CDC. FastStats - Diabetes. Centers for Disease Control and Prevention. Published 2019. https://www.cdc.gov/nchs/fastats/diabetes.htmlCDC. National diabetes statistics report.
- CDC. Published November 29, 2023. https://www.cdc.gov/diabetes/data/statistics-report/index.html
- American Diabetes Association. Diagnosis | ADA. diabetes.org. Published 2023. https://diabetes.org/about-diabetes/diagnosis
- Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm - 2023 Update. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2023;29(5):305-340. doi:https://doi.org/10.1016/j.eprac.2023.02.001
- MyEndoConsult. Mechanism Of Action Of GLP-1 Agonists - My Endo Consult. MyEndoConsult. Published June 1, 2023. https://myendoconsult.com/learn/mechanism-of-action-of-glp-1-agonists/
- White E. Treatments for Diabetes (Nonpharmacologic). Endocrinology Advisor. Published June 28, 2023. https://www.endocrinologyadvisor.com/ddi/treatments-for-diabetes-nonpharmacologic/#:~:text=4-
t2dm patientcase
Jonny Nguyen
Created on February 12, 2024
Start designing with a free template
Discover more than 1500 professional designs like these:
View
Visual Presentation
View
Vintage Photo Album
View
Animated Chalkboard Presentation
View
Genial Storytale Presentation
View
Higher Education Presentation
View
Blackboard Presentation
View
Psychedelic Presentation
Explore all templates
Transcript
PATIENT CASE PRESENTATION: Type 2 diabetes melitus (T2DM)
Jonny Nguyen 2024 PharmD. Candidate University of Houston College of Pharmacy, P4 Preceptor: Rosemary Onuegbu Patient Care Service Manager Albertsons/Randall/Tom Thumbs (Southern Division)
INDEX
DIABETES
PATIENT CHOICE
PATIENT INFORMATION
STAT
PRESCRIPTION
NON-PHARMALOGICAL
DIAGNOSIS
INTERACTIONS
REFERNCE
MARKET
MECHANISM
DIABETES MELITUS
What puts me more at risk of having T2DM?
Chronic, metabolic disease characterized by elevated levels of blood glucose, which progressively worsen the heart, vasculature, eyes, kidneys, and nerves.
Here are some things that can increase your likelihood of having T2DM:
MAIN FACTORS
Galicia-Garcia U. Pathophysiology of Type 2 Diabetes Mellitus. International Journal of Molecular Sciences. 2020;21(17):1-34.
epidemiology
How has T2DM impacted our everyday families?
Emergency Department Visits: 579,000Physician Office Visits: 38.2 million (14.2%)Morbidity (Age: 20+): 16.2%Mortality:
CDC. FastStats - Diabetes. Centers for Disease Control and Prevention. Published 2019. https://www.cdc.gov/nchs/fastats/diabetes.html CDC. National diabetes statistics report. CDC. Published November 29, 2023. https://www.cdc.gov/diabetes/data/statistics-report/index.html
THE IMPACT
It's just sugar, whats the big deal?
Diabetes is a disease that can progressively worsen over time, leading to irreversible damages that will impact patients quality of life. Development of T2DM is contributed by the following organs: the pancreas (beta and alpha cells), liver, skeletal muscle, kidneys, brain, small intestines, and adipose tissues.
DIAGNOSIS
What lab values indicates T2DM?
American Diabetes Association (ADA) has set these criterias as diagnosis for T2DM. Patient qualifies if having any of the following:
American Diabetes Association. Diagnosis | ADA. diabetes.org. Published 2023. https://diabetes.org/about-diabetes/diagnosis
MEDICATION CLASS
What medications can I purchase?
These are the medications along with class that can help lower glucose levels:
(Metformin)
(Empagliflozin)
(Liraglutide)
(Linagliptin)
(Glipizide)
(Pioglitazone)
COMORBID CONDITION?
Well, which one do you recommend?
Based on other risk factor, we can help you determine what can be the most appropriate for you! Your first option should be based upon patient-specific factors!
Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm - 2023 Update. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2023;29(5):305-340. doi:https://doi.org/10.1016/j.eprac.2023.02.001
JUST GLUCOSE+WEIGHT GOALS?
Well, which one do you recommend?
Furthermore, these are some other things to consider when choosing your medication!Glucose lowering efficacy:
- Very High: Dulaglutide (high-dose), Semaglutide, Tirzepatide, Combination Thearpy
- High: GLP-1RA (not listed above), Metformin, SGLT2i, Sulfonylurea, TZD
- Intermediate: DPP-4i
Weight loss effect:- Very High: Semaglutide, Tirzepatide
- High: Dulaglutide, Liraglutide
- Intermediate: GLP-1RA (not listed above), SGLT2i
- Intermediate: DPP-4i, Metformin
Patient is allowed to add additional agents based on patient-specific factors including: comorbidities, risk, glycemic management needs, convience, cost and accessDo not combine DPP-4i, GLP-1RA, and/or Tirzepatide (GLP-1/GIP RA)
Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm - 2023 Update. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2023;29(5):305-340. doi:https://doi.org/10.1016/j.eprac.2023.02.001
Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm - 2023 Update. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2023;29(5):305-340. doi:https://doi.org/10.1016/j.eprac.2023.02.001
PATIENT INFORMATION
PATIENT PROFILE
Name: T.C. Age: 90 Gender: F Allergies: No Known Allergy
COMORBID CONDITIONS:
PRESCRIPTION
DRUG-DRUG INTERACTION
MyEndoConsult. Mechanism Of Action Of GLP-1 Agonists - My Endo Consult. MyEndoConsult. Published June 1, 2023. https://myendoconsult.com/learn/mechanism-of-action-of-glp-1-agonists/
What's the problem? Shouldn't it be doing double the work?
THE JUSTIFICATION
ADA recommends against combining DPP-4 inhibitors and GLP-1 receptor agonists in patients with diabetes.
- Studies have shown that it is unlikely to provide clinical beneift
- It is not cost effective
- Taking both product simultaneously may increase risk of side effect
The next slide should help you pick which one is best for you!ONCE WEEKLY INJECTION
MACE: Major adverse cardiovascular event **: Benefit for renal endpoints in cardiovascular outcomes trial, driven by albuminuria outcomes
NON-PHARMALOGICAL CARE
Besides medication, what else can I do?
Here are some options you can look at!
White E. Treatments for Diabetes (Nonpharmacologic). Endocrinology Advisor. Published June 28, 2023. https://www.endocrinologyadvisor.com/ddi/treatments-for-diabetes-nonpharmacologic/#:~:text=4-
THE ACTION PLAN
REFERENCE