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Glycemic Control Medications. Sulfonylureas (2 nd generation). Percent of CVD Demonstration programs with unrestricted & restricted use of glycemic control medications:. Pearls: Sulfonylureas. Generally, little benefit beyond 50\% of maximal dose;

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Percent of CVD Demonstration programs with unrestricted & restricted use of glycemic control medications:
pearls sulfonylureas
Pearls: Sulfonylureas
  • Generally, little benefit beyond 50% of maximal dose;
  • Metabolized in the liver: caution with liver disease;
  • Cleared by the kidneys: glyburide has partially active metabolites and should be avoided in renal disease.

* Uncommon side effect: Lactic Acidosis


Percent of CVD Demonstration programs with unrestricted & restricted use of glycemic control medications:
pearls metformin
Pearls: Metformin
  • Renally cleared: do not use if creatinine 1.5 in men,  1.4 in women
    • Very rare: 1/30,000 patient-years
    • Contraindicated in renal insufficiency, dehydration, hemodynamic instability, alcoholism, CHF requiring medication therapy, metabolic acidosis
    • Check AST/ALT and creatinine every 6-12 months
pearls metformin1
Pearls: Metformin
  • Hold for radio-contrast studies the day of procedure and restart 48 hours after procedure
  • Optimal dose 2,000mg/day. No additional benefit at higher dose
  • Does not cause hypoglycemia unless used with sulfonylurea or insulin
pearls tzds
Pearls: TZDs
  • Weight gain and pedal edema can be a problem for patients, especially at higher dose
  • Caution in hepatic dysfunction
  • Check LFT every 6 months
  • Safe in renal dysfunction
  • Delayed onset of action: may take 4 – 12 weeks to achieve peak effect
insulin types
Insulin Types

* Pharmacokinetics of insulins are influences by dose, injection site, and other

factors: as a result, certain patients may experience variable onsets, peaks

and durations of insulins.

pearls insulins
Pearls: Insulins
  • Rapid-Acting Insulin;
    • May be given no more than 15 minutes before meal
    • Can also be given at the end of the meal. May be helpful for patients with delayed gastric emptying
  • Long-Acting Insulin glargine: cannot be mixed with other insulins
jnc 7 algorithm for the treatment of hypertension in patients with diabetes
JNC-7 Algorithm for the treatment of hypertension in patients with diabetes

NOT AT BP GOAL < 130/80

NOT AT BP GOAL < 130/80

selected references
Selected References:
  • Hypertension:

Konzen, S et a. Controlling Hypertension in Patients with Diabetes: American Family Physician 2002; 66: 1209-14

The physician reference card from the JNC 7 (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) is available at the following website:

  • Blood cholesterol and lipids: The appendix of the At-A-Glance: Quick Desk Reference by the NCEP ADP III (National Cholesterol Education Program Adult Treatment Panel III) provides further information on the risk determination and treatment for elevated cholesterol levels. The quick reference guide, as well as the full report, are available at the following website:
  • Blood glucose control:

Luna, B. Fienglas, M: Oral Agent in the Management of Type 2 Diabetes. American Family Physician. 2001; 63:1747-56, 1759-80. Clear presentation on oral agents in DM care with excellent stepped approach to glycemic management.

  • CVD Risk Reduction:

Garvin, J et alReducing Cardiovascular Disease Risk in Patients with Type 2 Diabetes: American Family Physician 2003; 68: 1569-74, 1577-8