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1. Weight neutrality: Alogliptin does not cause weight gain, making it suitable for overweight/obese T2DM patients who cannot tolerate SGLT2 inhibitor...
1. Obsolete in modern practice: Chlorpropamide is largely replaced by safer alternatives (gliclazide, glimepiride, glipizide) and should be considered...
1. Firstline addon in highrisk T2DM: Prefer dapagliflozin in patients with established ASCVD, HFrEF, or CKD with albuminuria โ irrespective of HbA1c a...
1. Managing GI adverse effects: Initiate at 0.75 mg to minimise nausea; advise patients that nausea typically improves after 2โ4 weeks; recommend smal...
Cardiorenal dose is 10 mg: For HFrEF and CKD indications, use 10 mg only โ higher dose (25 mg) does not provide additional cardiorenal benefit. Peri...
1. Renal safety profile: Evogliptin can be used across all stages of CKD including ESRD without dose adjustment โ useful in Indian diabetic population...
1. Nausea management is key to adherence โ counsel patients that nausea typically diminishes over 4โ8 weeks; advise smaller meals and slower eating; d...
1. Not preferred sulfonylurea: Glibenclamide has the highest hypoglycaemia risk among sulfonylureas due to its long halflife and active metabolites. G...
1. Safest sulfonylurea in CKD: Gliclazide is hepatically metabolised to inactive metabolites, making it the preferred sulfonylurea in mildtomoderate r...
1. Patient selection matters: Best suited for lean, nonobese T2DM patients with preserved betacell function; avoid in overweight patients where metfor...
1. Patient selection: Best suited for T2DM patients with preserved ฮฒcell function and consistent meal patterns; less effective in advanced diabetes wi...
Insulin aspart has faster onset (10โ20 minutes) and shorter duration (3โ5 hours) compared to regular insulin (30โ60 minutes onset, 5โ8 hours duration)...
Duration comparison: Insulin detemir has a flatter pharmacokinetic profile than NPH but shorter duration of action than insulin glargine U100; twiceda...
Insulin lispro has faster onset (15โ30 minutes) and shorter duration (3โ5 hours) compared to regular insulin (30โ60 minutes onset, 5โ8 hours duration)...
Regular insulin must be administered 30 minutes before meals; failure to do so results in postprandial hyperglycaemia followed by late hypoglycaemia ...
1. Unique renal advantage: Linagliptin is the only DPP4 inhibitor that requires no dose adjustment in any degree of renal impairment, including ESRD o...
1. Initiation strategy: Start at 10 mcg for 14 days to minimise GI intolerance; only then titrate to 20 mcg maintenance dose 2. Timing matters: Prebr...
1. Patient selection: Best suited for patients with insulin resistance phenotype โ central obesity, features of metabolic syndrome, NAFLD, or PCOS. Av...
Consider alternative DPP4 inhibitors (sitagliptin, linagliptin) in patients with established heart failure or high cardiovascular risk, given SAVORTIM...
1. GI tolerability improves with slow titration โ do not skip the doseescalation phase; extending titration intervals (6โ8 weeks instead of 4 weeks) s...
Renal dosing is critical: Always check eGFR before initiating and adjust dose accordingly โ one of the few oral antidiabetics usable in CKD stages 4โ5...
1. Renal safety advantage: Teneligliptin is a preferred DPP4 inhibitor in CKD patients (including those on dialysis) as no dose adjustment is required...
1. Not available in India: Tolazamide is essentially unavailable in the Indian market. This monograph is provided for academic completeness; prescribe...