With lifestyle modification, phentermine/topiramate appears most effective in terms of weight loss. Lorcaserin demonstrates moderate efficacy. Long-term cardiovascular outcomes studies are needed to confirm the safety and benefit of these new obesity agents.
There was no financial contribution to this study. Riche reports participation in the Speaker's Bureau for Merck and the Speaker's Bureau and Advisory Board for Novo Nordisk. The authors have no other conflicts of interest to report pertinent to this research. This data has not been previously published in any other location. Richie, Sewell, Malinowski, Jackson, and Fleming were involved in study design and manuscript preparation/approval. Jackson was involved in data collection, and Richie and Sewell were involved in data collection and data analysis. Sewell and Richie had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
The improvement in this patient's biochemical and ultrasonographic markers of resistant, severe NAFLD was rapid and sustained with combination therapy. This case represents a potential solution for initiating or maintaining statin therapy in patients with NAFLD who are at high cardiovascular risk.
Purpose
The purpose of this article is to educate nurse practitioners about the role of Toujeo®, insulin glargine U‐300 (Gla‐300), which is a new option for the treatment of diabetes mellitus.
Data sources
A comprehensive literature search was conducted using MEDLINE with the key terms: insulin glargine 300, Toujeo, Gla‐300, and EDITION for clinical trial data. Other resources included package inserts, drug information websites, and the World Health Organization (WHO).
Conclusions
Gla‐300 appears to be a safe and effective option for basal insulin therapy. In clinical trials, it was shown to be equally efficacious as Gla‐100 with fewer episodes of hypoglycemia and slightly less weight gain, and subjects receiving Gla‐300 required approximately 10 units more basal insulin to obtain the same hemoglobin A1c (HbA1c) as subjects receiving Gla‐100.
Implications for practice
This new basal therapy option represents a potential advantage for patients who require higher doses of insulin because of the higher concentration of Gla‐300. The lower incidence of hypoglycemia and more predictable pharmacokinetics could offer a significant therapeutic benefit in difficult‐to‐control patients with diabetes mellitus. The biggest disadvantage of this product is the slightly higher insulin dosage that is required to improve and/or maintain patients’ HbA1c.
Purpose
The purpose of this article is to educate nurse practitioners about the newest class of oral medications developed to treat type 2 diabetes mellitus (T2DM). This article will review dapagliflozin and canagliflozin, the two Food and Drug Administration (FDA) approved sodium glucose co‐transporter 2 (SGLT2) inhibitors, and discuss their place in therapy.
Data sources
A comprehensive literature search was conducted using MEDLINE with the key terms: dapagliflozin, canagliflozin, SGLT2 inhibitors, and SGLT2 inhibitors. Other resources included the World Health Organization (WHO), U.S. FDA, Centers for Disease Control and Prevention (CDC), clinical guidelines, FDA labeling, briefings, and press releases.
Conclusions
Dapagliflozin and canagliflozin appear to be safe and moderately effective. SGLT2 inhibitors provide an alternative for dual and triple therapy for T2DM or can be used as monotherapy in patients who cannot tolerate other first‐line options.
Implications for practice
SGLT2 inhibitors have a unique, insulin‐independent mechanism of action, targeting the kidneys. They have a low incidence of hypoglycemia and result in a moderate reduction in HbA1C. Improvements in weight, blood pressure, and lipid parameters have been demonstrated. Dosing considerations are required for the elderly, renally impaired, and patients at risk for hypotension.
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