Slides for questions
Risk Factors for Prediabetes and Type 2 Diabetes
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Family history of diabetes mellitus
Cardiovascular disease
Being overweight or obese
Sedentary lifestyle
Nonwhite ancestry
Previously identified impaired glucose tolerance, impaired fasting glucose, and/or metabolic syndrome
Hypertension
Increased levels of triglycerides, low concentrations of high-density lipoprotein cholesterol, or both
History of gestational diabetes mellitus
Delivery of a baby weighing more than 4 kg (9 lb)
Polycystic ovary syndrome
Antipsychotic therapy for schizophrenia and/or severe bipolar disease
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Handelsman Y, et al. Endocr Pract. 2011;17(suppl 2):1-53.
Glucose Testing and Interpretation: AACE Diagnostic
Criteria
Test
FPG, mg/dL
(measured after 8-hour fast)
PPG, mg/dL
(measured with an OGTT
performed 2 hours after 75-g
oral glucose load taken after
8-hour fast)
Random plasma glucose,
mg/dL
With polyuria, polydipsia,
or polyphagia
Hemoglobin A1C, %
(screening only)
Result
≤99
100-125
≥126
≤139
140-199
Diagnosis
Normal
Impaired fasting glucose
Diabetes
Confirmed by repeat testing on a different day
Normal
Impaired glucose tolerance
≥200
Diabetes
Confirmed by repeat testing on a different day
≥200
Diabetes
≤5.4
5.5-6.4
Normal
High risk/prediabetes
Diabetes
Confirmed by repeat testing of FPG or PPG on a different
day
≥6.5
FPG, fasting plasma glucose; OGTT, oral glucose tolerance test; PPG, postprandial glucose.
Handelsman Y, et al. Endocr Pract. 2011;17(suppl 2):1-53.
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Safety Considerations
with SGLT2 Inhibitors
Genitourinary
infection
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Increased LDL-C
• Small increases in LDL-C have been observed in clinical trials
Increased incidence; patients should be monitored and treated if necessary
• Increased incidence of bladder cancers in patients receiving dapagliflozin
Bladder cancer
Renal impairment
• Dapagliflozin labeling recommends not using in patients with active bladder cancer and
should be used with caution in patients with a history of bladder cancer
• Monitor kidney function during therapy, especially in patients with GFR <60
mL/min/1.73 m2
Garber AJ, et al. Endocr Pract. 2013;19(suppl 2):1-48.
Farxiga (dapagliflozin) prescribing information. Princeton, NJ: Bristol-Meyers Squibb Company. 2014.
Invokana (canagliflozin) prescribing information. Titusville, NJ: Janssen Pharmaceuticals, Inc. 2014.
Weight Change with SGLT2 Inhibitors
Absolute Change from Baseline
(Not Head-to-Head Trials)
Monotherapy
 Weight (kg)
Can1
0
-0.5
-1
-1.5
-2
-2.5
-3
-3.5
-4
-4.5
Dap2
Add-on to Metformin
Can3
Add-on to Insulin +/- OAs
Dap4
Can5
-1.4
-3.4
-3.2
-3.2
-4.0
1. Stenlof K, et al. Diabetes Obes Metab. 2013;15:372-382. 2. Ferrannini E, et al. Diabetes Care. 2010;33:2217-2224.
3. Cefalu WT, et al. Lancet. 2013;382:941-950. 4. Nauck MA, et al. Diabetes Care. 2011;34:2015-2022.
5. Yale J-F, et al. Diabetes Obes Metab. 2013;15:463-473. 6. Wilding JPH, et al. Ann Intern Med. 2012;156:405-415.
Dap6
-1.6