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Pt ada heart failure, EF 35% and DM, hba1c 7.2%
Sekarang on metformin. Target hba1c untuk pt DM is <7.0*
*kalau utk diagnose, >6.3 is DM
So nak add on apa untuk glycemic control?
#tweetorial
Sekarang on metformin. Target hba1c untuk pt DM is <7.0*
*kalau utk diagnose, >6.3 is DM
So nak add on apa untuk glycemic control?
#tweetorial
Sblm tu, basic pasal OHA, ingat 5 jenis yg paling biasa kita guna di klinik/wad dgn contoh-
Biguanide: Metformin
Sulphonylurea: Gliclazide
TZD: Pioglitazone
DPP4: Sitagliptin
SGLT-2i: dapaglifozin
Siapa boleh bg mechanism action ubat2 ni?
Biguanide: MetforminSulphonylurea: Gliclazide TZD: Pioglitazone DPP4: Sitagliptin SGLT-2i: dapaglifozinSiapa boleh bg mechanism action ubat2 ni?
Metformin ialah 1st line OHA utk DM sebab excellent profile, dan boleh 
HbA1c upto 15%
initiation of medication utk newly diagnosed DM
Okay so pt kita tadi, dah on treatment, tapi kita nak optimize lagi glycemic control dia. Lifestyle mod pun dah. So nak tambah apa lagi?
HbA1c upto 15% initiation of medication utk newly diagnosed DMOkay so pt kita tadi, dah on treatment, tapi kita nak optimize lagi glycemic control dia. Lifestyle mod pun dah. So nak tambah apa lagi?
Sebab pt ada heart failure, yg paling sesuai ialah SGLT2-i, eg dapaglifozin, empaglifozin.
Dia inhbit glucose reabsorption in proximal tubule
glucose urinary excretion, jd diuresis.
SGLT2-i
risk heart failure admission & CV death by 25% (DAPA-HF, EMEPEROR-reduced trial).
Dia inhbit glucose reabsorption in proximal tubule
glucose urinary excretion, jd diuresis.SGLT2-i
risk heart failure admission & CV death by 25% (DAPA-HF, EMEPEROR-reduced trial).
Kenapa yg lain tak guna dlm pt ni?
Insulin ni last option utk glycemic control, pt ni okay lagi. Another thing is insulin can cause Na retention hence worsen heart failure dia (Brands, 2018).
Gliclazide will
insulin.
Sitagliptin also worsen HF (Scirica, 2013)
Insulin ni last option utk glycemic control, pt ni okay lagi. Another thing is insulin can cause Na retention hence worsen heart failure dia (Brands, 2018).
Gliclazide will
insulin.Sitagliptin also worsen HF (Scirica, 2013)
So ingat ya, kalu pt heart failure, ada Diabetes, OHA yg selamat untuk dual therapy is SGLT2-i
Pembetulan untuk tweet ni, hbA1c reduction for metformin is 1.5%, highest among OHA, bukan 15% ya. Tertinggal titik perpuluhan. 15% kiok patient. https://twitter.com/kfgibran/status/1362076513076539393
