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SGLT-2 inhibitors are the first class of drugs to target renal glucose reabsorption as a means of reducing hyperglycemia in type 2 diabetes mellitus.
Developed by a faculty of renowned, international diabetes experts led by Julio Rosenstock, MD, this 2-part educational activity will provide clinicians with an interpretation of recent clinical data, and explore the potential role of SGLT-2 inhibitors in diabetes care. This continuing medical education activity is jointly sponsored by Albert Einstein College of Medicine of Yeshiva University and Haymarket Medical Education and supported by an educational grant from Bristol-Myers Squibb. The first component of this 2-part educational activity, the clinical monograph will provide endocrinologists, cardiologists, and general practitioners who manage the care of patients with type 2 diabetes with the latest data on the SGLT-2 inhibitors.
Four international diabetes experts will further elucidate the future role of the SGLT-2 inhibitors in the T2DM treatment arsenal.
In primary and general medical practice, the relevance and importance of metabolic syndrome as a construct and as a risk marker are often debated.
In terms of equipment, practitioners should have a digital scale, blood pressure cuff, and tape measure easily accessible in the office. Emerging data strongly suggest that this novel drug class will, in the very near future, have a role to play in diabetes management. A detailed explanation of the unique mechanisms of action and the safety and tolerability profiles of this drug class will be provided, and the results of key clinical trials will be discussed. Guidelines for the management of hyperlipidemia are grounded on the Framingham assessment, which is based on total and low-density lipoprotein cholesterol levels. Office scales only measure up to 300 or 350 lb; clinics or hospitals should ensure access to a more advanced scale for patients who weigh more. Baseline monitoring is important when an antipsychotic is first prescribed for a new patient; it will be extremely valuable if problems later emerge.
Referrals must be made when there is a new diagnosis of diabetes, hypertension, or significant dyslipidemia or when diabetes is poorly controlled.

Thus, it is important that health care providers who treat patients with diabetes are aware of the most recent data on these agents and the implications for clinical practice. Practitioners may find it useful to designate 1 month of every 6 or 12 months to focus on metabolic monitoring and to ensure that every patient in the caseload is monitored. Some would also include those receiving mood stabilizers or antidepressants because these drugs are associated with weight gain. When a patient’s medication is switched, particularly to a high-liability agent, getting another baseline is again valuable. In our center, we have developed an electronic tool that organizes these tasks, integrates with the laboratory system, analyzes the data, and flags areas of concern.13 Computer systems are well suited to this task and allow for auditing and reports. If there is a need to focus on a smaller target, one might choose the highest-risk groups—patients with early psychosis, those receiving clozapine who are already having routine blood work, forensic patients who are confined for long periods in hospitals or jails, or high-risk ethnic groups (Hispanic, South Asian, Aboriginal, or black). Setting up reminders or a system for annual monitoring is important, as is checking 3 months after the initial baseline. When uncertain, clinicians may find it helpful to fax results to the primary care physician or to consult a colleague.
More frequent monitoring is usually unnecessary and redundant unless there is a specific clinical focus or concern. The task of data collection and data entry can be delegated, but the prescribing clinician should maintain responsibility for ensuring that the monitoring is completed and for reviewing results.
When high-risk patients are identified (prediabetes, metabolic syndrome, severe obesity), referral to a dietitian or metabolic clinic is indicated.
Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices.
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity.

Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Canadian Diabetes Association Position Paper: antipsychotic medications and associated risks of weight gain and diabetes. Drawing up guidelines for attendance of physical health of patients with severe mental illness [in French].
Swedish clinical guidelines—prevention and management of metabolic risk in patients with severe psychiatric disorders.
Monitoring and management of antipsychotic-related metabolic and endocrine adverse events in pediatric patients. Evidence-based recommendations for monitoring safety of second generation antipsychotics in children and youth [published correction appears in J Can Acad Child Adolesc Psychiatry. Course and predictors of weight gain in people with first-episode psychosis treated with olanzapine or haloperidol.
Development and implimentation of the Metabolic Health Monitor at the Centre for Addiction and Mental Health.
Metabolic syndrome in the prevention of cardiovascular diseases and diabetes—still a matter of debate? Characterizing coronary heart disease risk in chronic schizophrenia: high prevalence of the metabolic syndrome. The link between schizophrenia and diabetes: vigilant metabolic monitoring informs treatment decisions.

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