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At this point, weight loss typically plateaus or slows naturally as your body reaches a new equilibrium

Drugs/ Drug Classes Metformin TZDs, alogliptin SGLT2 inhibitors Canagliflozin (hyperkalemia), insulin (hypokalemia) DPP4-inhibitors, GLP-1 agonists (not studied in GLP-1/GIP RA) DPP4 inhibitors, SUs SGLT2-inhibitors Pioglitazone, dapagliflozin (bladder cancer) GLP-1 agonists (thyroid cancer) Major Risks Lactic acidosis Hepatotoxicity hypotension/dehydration, UTI/genital infections K abnormalities Pancreatitis Hypersensitivity reactions Ketoacidosis Cancer Intervention %A1C Advantages Insulin No limit dose, low $, Sulfonylureas Disadvantages microvascular Injections, stigma, monitoring, hypoglycemia, weight gain, analogs high $ Low $, experience, microvascular Weight gain, hypoglycemia, limited efficacy TZDs No lows, improves lipid profile, maybe lower MI risk Fluid retention, CHF, weight gain, bone fractures, bladder CA GLP-1 RA, GLP-1/GIP RA Weight loss, no lows, DPP-4 Inhibitors Weight neutral, no lows, well tolerated Less experience, urticaria, angioedema, pancreatitis, high $ Meglitinides Dosing flexibility, post prandial glucose TID, hypoglycemia, weight gain, high $ Weight neutral, post prandial glucose GI SE, TID, moderate $ may B- cell function -glucosidase inhibitors Injections, GI SE, high $, less experience, thyroid tumors question Combination Products Metformin + SU Metformin/glipizide Meformin + Meglitinide Metformin/repaglinide (PrandiMet) Metformin +TZD Metformin/pioglitazone (Actoplus Met, Actoplus Met XR) Metformin/rosiglitazone SU+TZD Glimepiride/pioglitazone (Duetact) Glimepiride/rosiglitazone Metformin+ DPP4 Inhibitor Metfromin/alogluiptin (Kazano) Metformin/linagliptin (Jentadueto, (JentaduetoXR) Metformin/sitagliptin (Janumet, Janumet XR) Metfromin/saxagliptin (Kombiglyze XR) DPP4 Inhibitor + TZD Alogliptin/pioglitazone (Oseni) Metformin + SGLT2 Inhibitor Metformin/canagliflozin (Invokament, Invokamet XR) Metformin/dapagliflozin (Xigduo XR) Metformin/empagliflozin (Synjardy, Synjardy XR) DPP4 Inhibitor + SGLT 2 Inhibitor Linagliptin/empagliflozin (Glyxambi) Saxagliptin/dapagliflozin (Qtern) GLP1 Agonist + Long Acting Insulin * Liraglutide/insulin degludec ( Xultophy) Lixisenatide/insluin glragine (Soliqua) * Newest combinatuion produts engine hype 2Gt kidney Day 3 Mini Review FDA approved CVD benefit FDA approved HF benefit FDA approved CKD benefit Glucose-Lowering Effect- Very High, High, Intermediate Weight-loss Efficacy- Very High, High, Intermediate What new drug(s) did ADA 2023/2024 add for DM

Daousi C, Casson IF, Gill GV, IA MF, Wilding JP, Pinkney JH

Total fat mass (baseline 33.2 kg) was reduced by 3.4 kg and 2.6 kg with semaglutide and canagliflozin, respectively (estimated treatment difference: 0.79 [95% CI 2.10, 0.51])