DULAGLUTIDE OK FOR PRIMARY AND SECONDARY CV RISK REDUCTION

Good morning dear friends and fellow colleagues, There is a latest update on GLP-1 receptor agonist DULAGLUTIDE which was approved for treatment of Type 2 DM by USFDA in 2014. The USFDA recently approved DULAGLUTIDE for reducing the 3 point MACE ( Nonfatal MI, Nonfatal stroke,CV death ) in patients with Type 2 DM with or without established cardiovascular disease or multiple CV risk factors. It is now the first and only TYPE 2 Diabetes medicine approved to reduce CV events for primary and secondary prevention populations. This new indication is based on the results of CV outcomes for DULAGLUTIDE known as REWIND Trial. The REWIND Trial included primary people with Type 2DM with out established CVD. All three components of MACE showed significant reduction in REWIND Trial. REWIND trial showed significant reduction in risk of MACE with DULAGLUTIDE compared with placebo including Cv death, Nonfatal MI with strongest effect seen in Nonfatal stroke. Regards and thanks Dr Sepuri Tirumala Devi.

(Edited)

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Nice post Dr s tirumala Would u plse explain my quary Is dulaglutide safer n more effective than sulphanourea and biguinide what your clinical says. Your reply will improve curofians skiil in managing DM 2
Dr Godara Sir, Thanks for your kind interaction. 1) DULAGLUTIDE is a GLP-1 receptor agonist and it is not a first line of drug in treating Type 2 DM except in specific exception like where in the patient suffering from T2DM with established ASCVD, where in the first drug of Choice would be either SGLT2 Inhibitors OR GLP1 Analogues with or without Metformin. 2) It acts by increasing insulin secretion in response to elevated blood glucose after food intake Decreases glucagon secretion Reduces post prandial glucose Delays gastric emptying Reduces appetite. Incretin mimetic. 3) DULAGLUTIDE is injection available in 0.75mg/0.5 ml and 1.5 mg/0.5 ml in prefilled syringes . It should be given subcutaneously once in a week with 0.75 mg and increase the dose to 1.5 mg to control blood sugars. 4) Sulfonylureas and biguanides are time tested and time trusted drugs compared to DULAGLUTIDE, but SU has some side effects like Weight gain Hypoglycemia CV Neutral. 5) Metformin is the first drug of choice in the management of Patients suffering from T2DM unless otherwise it's contraindicated. 6) Nothing is a substitute for Metformin, it's a gold standard time tested and time trusted molecule. 7) DULAGLUTIDE reduces weight on contrary to sulfonylureas which increase weight whereas metformin is either weight neutral or reduces the weight. 8) It is costly compared to sulfonylureas and bigianides especially a country like India. 9) DULAGLUTIDE is an injectable form whereas sulfonylureas and Metformin are oral drugs. 10) Sulfonylureas are secretogogue group of drugs more potent, cheaper and patient friendly compared to DULAGLUTIDE in our country like India where cost is a big barrier to purchase medicines from patient's pocket where we don't have Insurance System unlike USA, UK or other foreign countries. 11) Please try to avoid Glibenclamide in patients above 60 years of age keeping Hypoglycemia in view which is very fatal as age increases. 12) It also blunts the IPC, Ischemia Pre Conditioning of the heart thereby the patient doesn't get the natural symptoms of Heart Attack which proves lethal. 13) Metformin belongs to biguanide group,insulin sensitiser, the first drug of choice in Type 2 DM otherwise it is contraindicated in conditions like GI intolerance Hypersensitivity Lactic acidosis Severe renal dysfunction if eGFR is less than 30 ml/ min/ 1.73 m2 DKA Acute MI, Chronic heart failure, Septicemia and shock Surgery ,etc. 14) DULAGLUTIDE has got its own barriers like Injectable form Costly GI intolerance Not to be used in pancreatitis and Thyroid medullary carcinoma s and MEN 2. Not truly proven CV safety when compared to Liraglutide Semaglutide Albiglutide. 15) In my opinion i always prefer gold standard sulfonylureas and Metformin compared to DULAGLUTIDE in view of patients economic status 16) If blood sugars are not controlled with the combination of Metformin plus SU like Glipizide Gliclazide Glimepiride I would try AGIs or Low Dose Pioglitazone 7.5 mg daily, F/B Insulin Therapy. 17) Insulin Therapy may be Biphasic Premixed Insulin Badal Plus Insulin along with existing OHAs OR Basal Bolus Insulin Therapy stopping all OHAs. I think I have enlightened your query with my eloborate explanation sir. Regards and thanks, Dr Sepuri Tirumala Devi.
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Is it cost effective? & Freely available in India, the 1st drug in this catagory Liraglutide is very expressive.
It is not cost effective in country like India. Latest drug belongs to GLP1 receptor agonist DULAGLUTIDE which has primary and secondary CV risk reduction in Type 2 DM approved by USFDA. Liraglutide has only secondary cv reduction in Type 2 DM . Not freely available in India.
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.very valuable opnion and with latest updates.
Thank you doctor
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A really informative update , ma'm
Thank you doctor
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Informative updates... Thnx sir
Thank you doctor
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Nice, continue updates , ma’am
Thank you doctor
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Informative post Madam.
Thank you doctor
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Nice to learn Madam.
Informative
Thank you doctor
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