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

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?

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?

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).

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)

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