Diabetes Medication Decision Tool

Endocrine, Nutrition & Obesity
No Comments
Loading Add to Favorites
Share
Tweet
Diabetes medication decision tool[html]
This decision tool is intended to help select medications for diabetes on the basis of liver and renal function/impairment.[/html]
Step 1: Select serum creatinine level
[select name="Q1" value="less than 1.4 mg/dL for women OR less than 1.5 mg/dL for men=1|1.4-2.0 mg/dL for women OR 1.5-2.0 mg/dL for men=2|greater than 2.0 mg/dL=3"]

Step 2: Select ALT or Child-Pugh score [html]<a href="../../digestive-system/child-pugh-score/" target="_blank">http://www.soapnote.org/digestive-system/child-pugh-score/</a>[/html]
[select name="Q2" value="ALT less than 2.5 times ULN or Child Pugh 5-6=10|ALT greater than or equal to 2.5 times ULN or Child Pugh 7-9=100|Child-Pugh greater than 9=1000"]

RESULT --> [calc memo="recommendation" value="score=(Q1)*(Q2);score>999?'severe liver impairment and any level of renal function. insulin only. ':score>299?'moderate liver impairment and serum creatinine more than 2. DPP-4 inhibitor at renal dose, meglinitide with caution, consider insulin. ':score>199?'moderate liver and renal impairment. DPP-4 inhibitor at renal dose, meglinitide and alpha-glucosidase inhibitor with caution. ':score>99?'moderate liver and mild or no renal impairment. DPP-4 inhibitor, meglinitide and alpha-glucosidase inhibitor with caution. ':score>29?'mild or no liver impairment and serum creatinine more than 2. DPP-4 inhibitor at renal dose, meglinitide, or thiazolidinedione. ':score>19?'mild or no liver and moderate renal impairment. DPP-4 inhibitor at renal dose, sulfonylurea, meglinitide, thiazolidinedione, or alpha-glucosidase inhibitor. ':'mild or no liver or renal impairment. metformin, sulfonylurea, DPP-4 inhibitor, meglinitide, thiazolidinedione, or alpha-glucosidase inhibitor.'"]

[html]<strong>Medication Notes</strong>
<strong><em>Metformin</em></strong>
expected HbA1c reduction: 1-2%; cost: $55/month
May help weight loss
May improve dyslipidemia
Allows flexible meal schedule
Low cost (approximately < $75/month)
Less hypoglycemic episodes
Contraindicated for congestive heart failure
Contraindicated for age > 80

<strong><em>Sulfonylurea</em></strong>
Glyburide, Glipizide, Glimepiride
expected HbA1c reduction: 1-2%; cost: $18/month (glyburide), $15.90/month (glipizide), $10.20/month (glimeperide)
Low cost (approximately < $75/month)

<strong><em>Thiazolidinedione</em></strong>
Pioglitazone
expected HbA1c reduction: 1-2%; cost: $132.30/month
May improve dyslipidemia
Contraindicated for congestive heart failure
May exacerbate peripheral edema

<strong><em>DPP-4 Inhibitor</em></strong>
Sitagliptan
expected HbA1c reduction: ~1%, cost: $180.60/month
Allows flexible meal schedule
Less hypoglycemic episodes

<strong><em>Alpha-glucosidase Inhibitor</em></strong>
Acarbose, Miglitol
expected HbA1c reduction: 0.5-1%, cost: $92.70/month (acarbose), $89.10/month (miglitol)

<strong><em>Meglitinide</em></strong>
Repaglinide, Nateglinide
expected HbA1c reduction: 1-2%, cost: $143.10/month (repaglinide), $138.60/month (nateglinide)
Allows flexible meal schedule

<strong><em>Insulin</em></strong>
expected HbA1c reduction: to less than 7%, cost: ~$90/month (rapid acting), ~$46/month (regular), $47/month (intermediate acting), ~$91/month (long acting)[/html]
[html]<hr>[/html][checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"][html]
reference: From the International Diabetes Center's Staged Diabetes Management Recommendations, 4th Edition. Cost information: Treatment Guidelines from The Medical Letter • Vol. 6 (Issue 71) • July 2008.
HbA1c reduction information: Staged Diabetes Management • 4th Edition • 2007.[/conditional]



Diabetes medication decision tool
This decision tool is intended to help select medications for diabetes on the basis of liver and renal function/impairment.

Step 1: Select serum creatinine level


Step 2: Select ALT or Child-Pugh score http://www.soapnote.org/digestive-system/child-pugh-score/


RESULT --> recommendationscore=(Q1)*(Q2);score>999?'severe liver impairment and any level of renal function. insulin only. ':score>299?'moderate liver impairment and serum creatinine more than 2. DPP-4 inhibitor at renal dose, meglinitide with caution, consider insulin. ':score>199?'moderate liver and renal impairment. DPP-4 inhibitor at renal dose, meglinitide and alpha-glucosidase inhibitor with caution. ':score>99?'moderate liver and mild or no renal impairment. DPP-4 inhibitor, meglinitide and alpha-glucosidase inhibitor with caution. ':score>29?'mild or no liver impairment and serum creatinine more than 2. DPP-4 inhibitor at renal dose, meglinitide, or thiazolidinedione. ':score>19?'mild or no liver and moderate renal impairment. DPP-4 inhibitor at renal dose, sulfonylurea, meglinitide, thiazolidinedione, or alpha-glucosidase inhibitor. ':'mild or no liver or renal impairment. metformin, sulfonylurea, DPP-4 inhibitor, meglinitide, thiazolidinedione, or alpha-glucosidase inhibitor.'

Medication Notes
Metformin
expected HbA1c reduction: 1-2%; cost: $55/month
May help weight loss
May improve dyslipidemia
Allows flexible meal schedule
Low cost (approximately < $75/month)
Less hypoglycemic episodes
Contraindicated for congestive heart failure
Contraindicated for age > 80

Sulfonylurea
Glyburide, Glipizide, Glimepiride
expected HbA1c reduction: 1-2%; cost: $18/month (glyburide), $15.90/month (glipizide), $10.20/month (glimeperide)
Low cost (approximately < $75/month)

Thiazolidinedione
Pioglitazone
expected HbA1c reduction: 1-2%; cost: $132.30/month
May improve dyslipidemia
Contraindicated for congestive heart failure
May exacerbate peripheral edema

DPP-4 Inhibitor
Sitagliptan
expected HbA1c reduction: ~1%, cost: $180.60/month
Allows flexible meal schedule
Less hypoglycemic episodes

Alpha-glucosidase Inhibitor
Acarbose, Miglitol
expected HbA1c reduction: 0.5-1%, cost: $92.70/month (acarbose), $89.10/month (miglitol)

Meglitinide
Repaglinide, Nateglinide
expected HbA1c reduction: 1-2%, cost: $143.10/month (repaglinide), $138.60/month (nateglinide)
Allows flexible meal schedule

Insulin
expected HbA1c reduction: to less than 7%, cost: ~$90/month (rapid acting), ~$46/month (regular), $47/month (intermediate acting), ~$91/month (long acting)


display/hide references



Result - Copy and paste this output:

Leave a Reply