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Glucagon-Like Peptide-1 Receptor Agonists The newest class of antidiabeteic medications to be approved for use in the United States is the glucagon-like- peptide-1 agonists (GLP-1). There are two drugs in this class that are currently available, exenatide (Byetta, Bydurian) and liraglutide (Victoza) (LexiComp, 2014). These medications mimic the actions of endogenous GLP-1. Endogenous GLP-1 is secreted from the L-cells in the colon and ileum in response to the ingestion of nutrients (Ryan, Foster, & Jobe, 2011, p. 794). GLP-1 has a half-life of 2 minutes due to the action of the DPP-4 enzymes. GLP-1 agonists overcome this issue by having an altered structure that renders them less susceptible to DPP-4 enzymatic degradation thus prolonging the effects of GLP-1 (ADA, 2014, p. 621). The first glucagon-like peptide 1 agonist to be developed was exenatide. Exenatide was approved for use in the United States in 2005. It is a synthetic form of a molecule exendin-4. Interestingly, this compound was discovered in the saliva of the Gila monster, a reptile found in the desert southwest of North America. This compound was found to be 53% identical to human GLP-1 and mimics GLP-1 on human receptors with a greater stability than native human GLP-1 hormone. (Furman, 2012, p. 464) In January of 2010, the Food and Drug Administration approved liraglutide for use in the treatment of type 2 diabetes in the United States. Liraglutide is a synthetic form of the human GLP-1 hormone that has been altered in its molecular structure. The alterations increase aggregation of the drug, decreases the binding to albumin, and is more resistant to degradation by DPP-4 enzymes (Ryan et al., 2011, p. 795). These properties increase the bioava... ... middle of paper ... ... 2 Diabetes Mellitus. Case Reports in Pediatrics, 2013. Retrieved from http://www.hindawi.com/journals/cripe/2013/703925/ Novo Nordisk Inc. (2013). Victoza liraglutide (rDNA origin) injection. Retrieved from http://www.novo-pi.com/victoza.pdf Robinson, M., & Wynne, A. L. (2012). Drugs affecting the endocrine system. In Pharmacotherapeutics for nurse practitioner prescribers (3rd ed., pp. 587-644). Philadelphia, Pa: F.A. Davis. Ryan, G. J., Foster, K. T., & Jobe, L. J. (2011). Review of the therapeutic uses of liraglutide. Clinical Therapeutics, 33(7), 793-811. Tierney, K. (2012). Therapeutic choices, and the nurse practitioner’s role, in type 2 diabetes when metformin is no longer enough. Journal of the American Academy of Nurse Practitioners, 24, 234-248. VictozaPro.com. (2014). http://www.victozapro.com/practical-resources/access-and-affordability.html
Scheen AJ. Antidiabetic agents in subjects with mild dysglycaemia: Prevention or early treatment of type 2 diabetes. Diabetes and Metabolism. 2007;33:3-12.
Spikoff, Martin. Controversy Continues to Surround Generic Insulin. 16 April 2008. 9 October 2009 .
For this evaluation of a clinical practice guideline I chose to evaluate a guideline that was published in 2012 and that addressed the use of oral medication in the treatment of Type 2 Diabetes (Appendix B). People who have received a diagnosis of Type 2 Diabetes Mellitus (T2DM) are facing a long term treatment plan. Diabetes mellitus is a chronic metabolic disorder that results from a problem with insulin in the body. T2DM is growing in prevalence and is a cause for concern. There are several co-morbidities that can be linked to poorly controlled blood sugar levels such as cardiovascular disease, peripheral vascular disease, renal failure, and a decrease in eyesight. If blood sugar levels can be maintained at a normal to near normal limits the patient has a decreased risk of experiencing these comorbidities. Because of this it is important for the healthcare practitioner to evaluate all treatment methods available and the evidence that supports the efficacy of recommending this treatment to our patients. I used the AGREE II tool in evaluation of this guideline (Appendix A).
“High levels of hormones can cause problems in the human body, but can hormones we ingest really alter our hormone level...
Wyness, L. (2009). Understanding the role of diet in type 2 diabetes prevention. British Journal of Community Nursing, 14(9), 374.
Journal of Continuing Education in Nursing, 44(9), 406. doi:10.3928/00220124-20130617-38. Torpy, J. M. (2011). The 'Standard' Diabetes. Jama, 305(24), 2592 pp.
Diabetes Programs: The Scripps Whittier Diabetes Institute Experience. Curr Diab Rep Current Diabetes Reports, 14(2). Doi:10.1007/s11892-013-0462-0
By the 1920s, diabetes was considered a global epidemic, affecting people across the globe. Scientists unanimously agreed that diabetes was “the failure of the pancreas to secrete enough of a certain mysterious substance necessary for the proper utilization of carbohydrates as a body fuel.”2 This had stumped scientists for years, and no sufficient cure or treatment had been found. However, in 1921, Toronto doctor Frederick Banting, assisted by J. Macleod, Charles Best, and Dr. J.B Collip successfully created insulin, which was subsequently tested on dogs with diabetes before experimenting on the first human, Leonard Thompson in
People with Type 1 diabetes do nor produce enough insulin. So insulin needs to be injected into their bodies to control the level of g...
P ICOT? Individuals with type II diabetes as well as their families and their healthcare professionals are impacted by this problem. The intervention identified as best practice focus on direct nursing support as the most effective management in diabetes patients. Interventions focused on management strategies prescribed by nurse practioners and medical doctors. The study results indicate that the use of direct patient support provided by nurse practioners were most effective for compliance and increasing management in diabetes
In recent years, diabetes education has become an integral part of diabetes treatment (Piccinino et al, 2015). The 2012 National Standards for Diabetes Self-Management Education (DSME) defines education as an exchange of knowledge, tools and practices that will address client needs. Patients need information about their illness, side effects, complications and how to care for it. Diabetes education must be effective and accurate in quality, content, and method (Atak & Arslan, 2005). Diabetes education should happen concurrently with diagnosis and throughout treatment for a patient and should involve a structured program.
Diabetes Mellitus is a chronic condition which afflicts millions of people around the world. It is related to the insulin hormone, which is secreted by cells in the pancreas, regulates the level of glucose in the bloodstream and supports the body with breaking down the glucose to be used as energy. In someone who has diabetes, the body doesn’t produce enough insulin or cells don’t respond to the insulin that is produced. There are three main types of diabetes, type 1, type 2, and gestational. I will be discussing type 1 and type 2.
Diabetes Mellitus is a chronic health condition in which the level of glucose in the blood is higher than usual. Type 1 diabetes occurs when the pancreas does not create enough insulin and type 2 diabetes occurs when insulin is produced, but is not adequate in lowering blood glucose levels or there is resistance to the insulin (Edwards, 2007, p. 9). Diabetes mellitus is the leading cause of end-stage kidney disease, foot and leg amputations, and new cases of blindness in the United States (Ignatavicius & Workman, 2010, p. 1465-66). People with type 1 diabetes are required to take insulin to manage their glucose levels. People with type 2 diabetes are usually prescribed oral medications such as sulfonylurea agents, meglitinide analogues, or biguanides to help control their glucose levels. Twenty to 30% of people with type 2 diabetes require insulin therapy as well (Ignatavicius & Workman, 2010, p. 1471). In addition to medication therapy, diet and weight control can help manage both type 1 and type 2 diabetes. Because diabetes mellitus can cause such severe complications, it is important that people with diabetes understand the importance of certain health and lifestyle choices, such as their diet and weight to manage their disease. Patients with diabetes mellitus should pay special attention to the amount of carbohydrates, protein, fat, and minerals that are included in their diet. Monitoring these components of their diet, along with weight management, can help control their diabetes mellitus.
According to Krisha McCoy on her article: The history of Diabetes; “In 150 AD, the Greek physician Arateus described what we now call diabetes as "the melting down of flesh and limbs into urine." From then on, physicians began to gain a better understanding about diabetes. Centuries later, people known as "water tasters" diagnosed diabetes by tasting the urine of people suspected to have it. If urine tasted sweet, diabetes was diagnosed. To acknowledge this feature, in 1675 the word "mellitus," meaning honey, was added to the name "diabetes," meaning siphon. It wasn't until the 1800s that scientists developed chemical tests to detect the presence of sugar in the urine”.
“To manage diabetes, patients must take treatment for diabetes. There are two major treatments. They are diet treatment and tablet treatment. Oral anti diabetes drugs sulphonamide (sulphonylureas) and guanidine derivaties (biguanides) are used by 30% of all diabetes.” (6)