PMID- 24769505
OWN - NLM
STAT- MEDLINE
DCOM- 20150818
LR  - 20221207
IS  - 1945-1997 (Electronic)
IS  - 0098-6151 (Linking)
VI  - 114
IP  - 5 Suppl 2
DP  - 2014 May
TI  - Treating patients with diabetes of long duration: GLP-1 receptor agonists and 
      insulin in combination.
PG  - S22-9
LID - 10.7556/jaoa.2014.086 [doi]
AB  - Patients with long-standing type 2 diabetes mellitus (T2DM) can be clinically 
      challenging for physicians to treat because these patients often lack sufficient 
      beta-cell function to respond to some oral glucose-lowering agents, may have 
      profound comorbidities, and may have renal impairment that limits the use of 
      traditional agents. These complications, in addition to older age, also increase 
      the risk of hypoglycemia, which can be a major barrier to treatment success. 
      Individualizing treatment targets to balance the benefits of glycemic control 
      with risks of hypoglycemia is the first step to successfully treating these 
      patients. Careful selection of combination therapy strategies to address limited 
      beta-cell function, renal function, and cardiovascular status, along with attention 
      to selection of agents associated with lower risk of hypoglycemia, is important. 
      Basal insulin analogs are often used in patients with long-standing diabetes to 
      address insulinopenic states. Incretin-based therapies, particularly GLP-1 
      receptor agonists, provide postprandial control with lower risks of hypoglycemia 
      than prandial insulin. The author discusses the management of patients with 
      long-standing diabetes who may have limited beta-cell function and require 
      transition to insulin therapy with gradual intensification.
FAU - Moghissi, Etie S
AU  - Moghissi ES
AD  - University of California - Los Angeles, 4644 Lincoln Blvd, Marina del Rey, CA 
      90292. emoghissi@gmail.com.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - J Am Osteopath Assoc
JT  - The Journal of the American Osteopathic Association
JID - 7503065
RN  - 0 (Blood Glucose)
RN  - 0 (GLP1R protein, human)
RN  - 0 (Glucagon-Like Peptide-1 Receptor)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (Receptors, Glucagon)
SB  - IM
MH  - Blood Glucose/drug effects/*metabolism
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy
MH  - Drug Therapy, Combination
MH  - Glucagon-Like Peptide-1 Receptor
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Insulin/*therapeutic use
MH  - Receptors, Glucagon/*agonists/blood
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2014/04/29 06:00
MHDA- 2015/08/19 06:00
CRDT- 2014/04/29 06:00
PHST- 2014/04/29 06:00 [entrez]
PHST- 2014/04/29 06:00 [pubmed]
PHST- 2015/08/19 06:00 [medline]
AID - 114/5_suppl_2/S22 [pii]
AID - 10.7556/jaoa.2014.086 [doi]
PST - ppublish
SO  - J Am Osteopath Assoc. 2014 May;114(5 Suppl 2):S22-9. doi: 10.7556/jaoa.2014.086.