String of Pearls

Metformin, a biguanide, has demonstrated favorable effects in controlling blood glucose and body weight. Patients who are overweight with high fasting blood glucose levels may be particularly suited for this medication. With its low risk of hypoglcemia, low cost and demonstrable reduction in the risk of microvascular complications, metformin has been a widely used medication in the management of type 2 diabetes. It is used as a first line agent, and also in combination with other agents when glycemic control is not achieved.

Osteoporosis is a systemic skeletal disease which is characterized by low bone mass, reduced bone strength (which is dependent on bone density and bone quality), increased fracture risk, and the weakening or deterioration of the microarchitecture of the bone. Glucocorticoid treatment is a common cause of secondary osteoporosis.

In August 2011, two trials looked at direct factor Xa inhibitors (rivaroxaban, apixaban) versus warfarin in patients with atrial fibrillation. Dabigatran, a direct competitive inhibitor of thrombin, was approved by Health Canada in 2010, for the prevention of stroke and systemic embolism in patients with atrial fibrillation in whom anticoagulation is appropriate [Primary Clinical Pearl #28: Dabigatran, an alternative to warfarin for stroke prevention in patients with atrial fibrillation?].

August 22, 2011

I hope that everyone is having an awesome summer thus far. My apologies for producing a clinical pearl so late in the summer; however, I am very glad to have the opportunity to create a pearl for this topic as it is a topic that I have been focusing on this year especially during medication reviews.

In April 2011, ACCF/AHA published an expert consensus document on hypertension in the elderly. I thought that I would take this opportunity to summarize some of the points that  they presented today.

Summary of key points:

Liraglutide in a nutshell:

Mechanism of Action:

In patients with type 2 diabetes mellitus, the incretin effect of GLP-1 (half-life is 1 to 2 minutes) is greatly diminished (decreased secretion of GLP-1). Incretin effect involves the release of gastrointestinal hormones with the ability to stimulate insulin secretion in response to glucose.