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CONTINUING PROFESSIONAL DEVELOPMENT
Management of diabetes must
be patient-centred, and shared
decision-making with the patient
on treatment targets and treatment
options is essential. Oral antidiabetic
agents play an important role in helping
patients with T2DM reach their target
BGLs. Traditional oral antidiabetic
agents generally either influence insulin
secretion, or increase the sensitivity
of peripheral tissues or liver to insulin.
However, despite the vast array of
medicines available, many patients are
unable to adequately control their BGLs.
SGLT2 inhibitors are a novel group of
oral antidiabetic agents that elicit their
effects at the kidneys and their place
in therapy remains to be established.
As such, cost-effectiveness and risks
versus benefits of the SGLT2 inhibitors
per se, when compared to other
available antidiabetic agents, must be
taken into consideration.
Mr Sweets’ case
You counsel Mr Sweets as you would
someone with a new medicine.
You explain that Forxiga (dapagliflozin)
is an orally administered medicine that
requires once-daily dosing, and that it is
a new medicine that works in a different
way from his metformin. You explain that
aside from the benefits of helping him to
reduce his BGLs, Forxiga (dapagliflozin)
has also been shown to cause slight
reductions in blood pressure, reductions
in abdominal obesity and modest weight
loss. You also take the opportunity to
check his adherence to his other medicines
and stress the importance of continuing
to take his metformin, and maintaining
his exercise regimen and healthy diet.
You also check and confirm that he has
a follow-up appointment with his doctor
to monitor how he is progressing with the
Forxiga (dapagliflozin) tablets, including
his BGLs, blood pressure and weight.
1. Rossi S, ed. Australian medicines handbook. Adelaide:
Australian Medicines Handbook; 2015.
2. Type 2 diabetes in adults. BMJ Best Practice. UK: BMJ
Publishing Group; 2015.
3. Gerich JE, Bastien A. Development of the sodium-glucose
co-transporter 2 inhibitor dapagliflozin for the treatment
of patients with type 2 diabetes mellitus. Expert Rev Clin
4. Australian Government Department of Health.
Pharmaceutical benefits scheme (PBS) - Dapagliflozin,
tablet, 10 mg, Forxiga - July 2013. Canberra: Australian
Government Department of Health. 2013. At: www.pbs.
5. Davis CS, Fleming JW, Warrington LE. Sodium glucose
co-transporter 2 inhibitors: a novel approach to the
management of type 2 diabetes mellitus. J Am Assoc Nurse
Pract 2014;26(7):356–63 .
6. Plosker GL. Dapagliflozin: a review of its use in type 2
diabetes mellitus. Drugs 2012;72(17):2289–312.
7. Endocrinology Expert Group. Therapeutic guidelines:
endocrinology. Version 5. Melbourne: Therapeutic
Guidelines Limited; 2014.
8. Forxiga (product information). eMIMS Cloud. Sydney: MIMS
Australia Pty Ltd; 2015.
9. NPS MedicineWise. Dapagliflozin (Forxiga) and canagliflozin
(Invokana) sodium–glucose co-transporter-2 inhibitors for
add-on therapy in type 2 diabetes mellitus. In: NPS Radar.
2013. At: www.nps.org.au/publications/health-professional/
10. Australian Government Department of Health.
Pharmaceutical benefits scheme (PBS) – Dapagliflozin.
Canberra : Australian Government Department of Health.
2015. At: www.pbs.gov.au/medicine/item/10011X
1. Dapagliflozin acts as an antidiabetic
a) Reducing hepatic glucose production
and increasing peripheral utilisation of
b) Increasing pancreatic insulin secretion.
c) Reducing glucose re-absorption in the
kidneys, leading to increased glucose
excretion in the urine.
d) None of the above.
2. Dapagliflozin is a:
b) Sodium-glucose co-transporter
c) Sodium-glucose co-transporter
d) Alpha-glucosidase inhibitor.
3. Forxiga (dapagliflozin) is indicated
a) As monotherapy in people with
type 2 diabetes who do not tolerate
b) In fixed-dose combinations with
metformin (Xiguo XR), and may be used
when metformin as monotherapy with
diet and exercise is not adequate.
c) In combination with insulin.
d) All of the above.
4. Caution must be exercised when
using Forxiga (dapagliflozin) in the
following patient populations:
a) Pregnant and breastfeeding women.
b) Patients with, or at risk of, volume
c) Patients with moderate-to-severe
renal impairment, or severe hepatic
d) All of the above.
5. Select the ONE correct statement
about Forxiga (dapagliflozin):
a) Forxiga (dapagliflozin) is effective in
providing glycaemic control when used
as add-on therapy in patients who are
unable to attain their target glycaemic
levels with either metformin or a
b) Aside from reducing BGLs, other
benefits reported for Forxiga
(dapagliflozin) include slight reductions
in blood pressure, reductions in
abdominal obesity and modest
c) Forxiga (dapagliflozin) is generally well
tolerated, but may be associated with
an increased risk of genital and urinary
tract infections, and long-term safety
data remains to be seen.
d) All of the above.
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