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Increased abdominal obesity
Faster progression from Pre-Diabetes to Diabetes
Decreased adiponectin and increased inflammatory markers
Faster onset of beta cell dysfunction
Possible increase of DPP4 activity
Increased susceptibility for cardio-renal complications
Yes
No
Can’t Say
Similar
Greater CKD risk
Greater heart failure risk
Very Important
Somewhat Important
Less important
Not important at all
<50
60 %
70 %
80 %
>90 %
High Carbohydrate containing foods in the diet
Lifestyle
Both
Lifestyle modification
Lifestyle modification with AGI, Metformin and SU
Greater Heart Failure risk
Drugs In combination should have different mechanism of action
The pharmacokinetics of Drugs must not be too different from each other
The Combination can be chosen based on the recommendations of treatment guidelines
Reduced bill burden
Reduced medication error
Allow drugs with synergistic combination
Low cost to patient
Simplified dosing
Monotherapy
Dual FDC
Triple FDC
Individual Drugs Prescribed Separately
Targeting Multiple pathophysiological factors as never before
Ensuring durable glycemic control with preservation of beta cell mass
Good Possibility of additional Cardio-renal Protection
Dapagliflozin
Empagliflozin
Canagliflozin
Remogliflozin
Sitagliptin
Vildagliptin
Linagliptin
Teneligliptin
DPP4i
SGLT2i
DPP4 Inhibitors
SGLT2 inhibitors
SU+Metformin + DPP4I
SU+Metformin + SGLT2I
DPP4 + SGLT2i + Metformin
GLP -1 RA with proven CVD benefit
SGLt2i with proven CVD benefit
If A1c above target then GLP-1 RA and addition of SGLT2I with proven CVD benefit
GLP-1 RA with proven CVD benefit
If A1c above target, for patients on SGLT2i consider incorporating a GLP-1 RA or vice versa
Metformin
TZD
GLP-1 RA
Sulfonylurea
DPP-4I
Combination of ORAL - combination Injectable (GLP 1-RA /Insulin )
Lifestyle advice
Eating patterns
Medication for weight loss
Medical Nutrition
Physical activity
Metabolic surgery
Intensive evidence based structured weight management program
GLP -1 RA
SGLT2
DPP- 4 i
Diabetes Self-Management Education and Support (DSMES)
Consider technology (Example: diagnostic CGM) to identify therapeutic gaps and tailor therapy
Identify and address social determinants of health (SDOH) that impact achievement of goals
20 %
40 %
90 %
T1DM & high dose on insulin
T2DM & established CV Risk
T2DM & CKD (Stage 4&5)
Newly diagnosed T2DM Patients with no complications
I agree
I disagree
Sitting
Stepping
Sweating (Moderate to intense exercise)
Sleep quality
Strengthening (resistance exercise)
Strongly agree
Agree
Disagree
Strongly Disagree
Age
T2DM from age
years, Risk factors number =
GLP 1RA or GIP /GLP 1RA
Preferred Alternative
DPP4
SU (Please tick the box if you will avoid)
Basal insulin
Prandial Insulin
DPP4 + SGLT2
DPP4 + SGLT2 + Metformin
SU + DPP4 + Metformin
SU + SGLT2 + Metformin
Somewhat agree
Somewhat disagree
Strongly disagree
Savor Timi 53
Examine
Carmelina
Tecos
Carolina
Elixa
Leader
Harmony Outcomes
Sustain 6
Exscel
Rewind