Diabetes Medications – Summary

00:01 So, in summary, when we're looking at all of our drugs in diabetes - not just the SGLT2s - the first line agent right now is still metformin. Part of the reason is because of cost.

00:13 It’s a cheap drug, it really works well, it increases insulin sensitivity, and the side effect profile is quite acceptable.

00:20 The TZDs and the secretagogues like sulfonylureas are really falling out of favor.

00:27 We've seen a lot of side effects with them and we've also seen that they don’t really reduce mortality like some of the other agents.

00:37 Alpha glucosidase inhibitors have essentially disappeared from the therapeutic landscape because of the multiple side effects that patients have but I don’t want you to get the idea that we don’t use them at all.

00:47 It’s just that we have other better choices out there but if you're in a pickle and you really need to treat your patients you can use an AGI.

00:57 The DPP4s are very safe.

00:59 They're often combined with metformin and from a practical point of view they are often second line agents at this point in time but I think that’ll change with the new SGLT2s because they're the exciting new drug class.

01:11 They have evidence of heart failure reduction, they may have evidence of renal improvement and I think they’re the most exciting thing that’s happened to diabetes probably in 20 - 30 years.

01:24 They should not be used in volume depleted patients.

01:28 And, finally, insulin is the mainstay of type 1 diabetics and diabetic ketoacidosis; and of course insulin is not a bad drug, it’s a very good drug when used appropriately.