×
Choose Speciality

EXPLORE!

LOGIN

Focusing on T2DM Management in Special Population: Highlighting the Requisites

  1014 Views

Dr Samar Banerjee    27 November 2018

  1. CV complications are common in elderly T2DM patients. Elderly patients are more prone to hypoglycemia, infections, volume depletion, fractures, etc. Vildagliptin has proven efficacy and safety in elderly patients with CV risk. It has a low potential for drug-drug interactions.
  2. Patients with diabetes are at increased risk for CKD and CV events. Frequency of hypoglycemia is more in patients with renal impairment. Dose adjustment of some gliptins is not based on adverse effects or renal toxicity, but is aimed at achieving drug exposure that yields maximum efficacy. Vildagliptin has been shown to reduce albuminuria in early stages of diabetic nephropathy.
  3. Select such an OAD that has salutary effect on CVD and at least should not have any adverse effect on this. Recently, EMPA-REG, CANVAS, SUSTAIN 6, LEADER and IRIS trials have shown a convincing salutary effect of empagliflozin, canagliflozin, semaglutide, liraglutide and pioglitazone on CVD outcomes. Several observational studies have shown that metformin, either as monotherapy or in combination with another agent, is associated with reduced CV events, CV deaths and total mortality.
  4. ADA 2018 recommendations – In patients with T2DM and established ASCVD, after lifestyle management and metformin, canagliflozin may be considered to reduce MACE, based on drug-specific and patient factors.
  5. Liver diseases – OADs should not be used in patients with advanced liver diseases with cirrhosis, ascites or encephalopathy. In NAFLD, the use of incretin-based therapies is the most favorable. No dose adjustment of vildagliptin is necessary in patients with CLD with mild, moderate or severe HI.

To comment on this article,
create a free account.

Sign Up to instantly get access to 10000+ Articles & 1000+ Cases

Already registered?

Login Now

Most Popular Articles

News and Updates

eMediNexus provides latest updates on medical news, medical case studies from India. In-depth medical case studies and research designed for doctors and healthcare professionals.