1 / 10

GLP-1 Case Histories and Practical Aspects of Prescribing

Workshop Plan (40 mins). Quick revision of NICE When to start and when to stopWhich GLP 1 to use (local guidance)Off licence use with insulinA few quick cases to illustrateHow to get started and other practical issues. NICE guidance. Baseline criteria:2nd / 3rd line agentBMI > 35kg/m2 or oc

cadence
Download Presentation

GLP-1 Case Histories and Practical Aspects of Prescribing

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. GLP-1 Case Histories and Practical Aspects of Prescribing Kate Allen (Diabetes Consultant) Sally Catchpole (Diabetes Specialist Nurse)

    2. Workshop Plan (40 mins) Quick revision of NICE When to start and when to stop Which GLP 1 to use (local guidance) Off licence use with insulin A few quick cases to illustrate How to get started and other practical issues

    3. NICE guidance Baseline criteria: 2nd / 3rd line agent BMI > 35kg/m2 or occupation that precludes insulin HbA1c >7.5% Contraindications: PMH or FMH medullary thyroid cancer, pancreatitis or high risk, eGFR< 30ml/min Side effects: Nausea, vomiting, diarrhoea, ankle swelling, rash, warfarin interaction, renal failure, hypoglycaemia risk Continuation after 6 month trial: Loss of 3% baseline body weight Fall in HbA1c >1%

    4. Which GLP 1 to use (BCAP) 1st line: Exenatide (£68.24 for 30 days) 2nd line: Liraglutide (£78.48 for 30 days) Use liraglutide if lifestyle precludes twice daily injections, or exenatide not tolerated Exenatide once weekly (Bydureon) 2mg (£73.36 for 4 weeks) DURATION trials show similar or slightly superior efficacy compared with liraglutide or exenatide. Less nausea?

    5. Off licence use with insulin What are the goals of dual therapy? Insulin dose reduction or insulin cessation Weight loss Reduction in HbA1c

    6. Wolverhampton Insulin with exenatide study (n=160)

    7. Case (1) 52 year old truck driver, BMI 32 Current meds: Metformin, gliclazide, pioglitazone, simvastatin HbA1c 9.1%, Chol 5.3, TAG 3, eGFR 67 Q: How would you change his medication? A: Exenatide (depending on shifts and eating pattern), see dietitian or enrol in group start session, stop pioglitazone, change statin

    8. Case (2) 47 year old woman, BMI 42 Has completed 6 month trial of exenatide and tolerated well Other meds: metformin, gliclazide Baseline HbA1c was 8.9% now 8.1%, but has lost 9kg (7% body weight) Will you continue exenatide? Will you change her medication?

    10. Case (3) 62 year old man, BMI 37 Current medication: NovoMix 30 90 units BD, metformin 3g/day HbA1c 9.7 Who would consider exenatide? If yes, what would you do about his insulin?

    11. Case (4) 58 year old lady, BMI 41 Basal bolus insulin regimen 300+ units insulin per day HbA1c 10.2% After 6 months with exenatide: HbA1c 9.5%, insulin requirement 150 units per day, has lost 2kg in weight Do you think we should continue her exenatide?

More Related