KINE 2475 Chapter Notes - Chapter 5.5: Pioglitazone, Ketosis, Biguanide

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Treatment of newly diagnosed people w/dm2: if glycemic targets not achieved using healthy behavior interventions alone in 3 months, antihyperglycemic therapy should be added to reduce risk of microvascular complications. If lower risk of hypoglycemic & weight gain are priorities: patients treated w/basal insulin, if lower risk of hypoglycemic is priority, long-acting insulin (glargine u-100, glargine u-300, detemir, degludec) should be considered over nph insulin to reduce nocturnal. Key messages: dm2 w/a1c <1. 5% above individualized target, antihyperglycemic therapy should be added if glycemic targets are not achieved in 3 months of initiating healthy behavior, dm2 w/a1c >1. 5% above target should be initiated w/healthy behavior. I to other agents --> low risk of hypoglycemia & weight gain: patients receiving insulin, addition of glp-1, dpp-4i or sglt2i may be considered before adding or intensifying prandial insulin --> less weight gain. First-line: metformin (biguanide): safe, low cost, possible cv benefits. Makes body respond better to insulin to use it more effectively.

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