Lesson 1Pharmacokinetics, formulations, dosing schedules, and routes of administrationThis section details absorption, distribution, metabolism, and elimination of GLP-1 RAs, dual incretins, SGLT2 inhibitors, and fixed-ratio insulin/GLP-1 products, linking pharmacokinetics to dosing schedules, titration, and route selection.
Onset, peak, and duration of GLP-1 receptor agonistsOral versus injectable incretin formulationsRenal handling and half-life of SGLT2 inhibitorsFixed-ratio insulin/GLP-1 titration strategiesAdjusting doses in organ dysfunction and frailtyLesson 2Common therapeutic effects: glycaemic control, weight change, blood pressure and cardiorenal effectsThis section reviews expected effects of newer agents on HbA1c, fasting and postprandial glucose, body weight, blood pressure, and cardiorenal outcomes. It highlights class differences, dose–response patterns, and realistic targets for shared decisions.
HbA1c and time-in-range improvements by classWeight loss profiles of GLP-1 and dual incretinsBlood pressure and volume effects of SGLT2 inhibitorsCardiovascular outcome benefits and neutral findingsRenal protection and albuminuria reduction patternsLesson 3Contraindications, cautions and special populations: renal impairment thresholds, hepatic impairment, personal/family medullary thyroid carcinoma/MEN2, pregnancy and lactationThis section covers contraindications and cautions for newer agents, including renal and hepatic impairment thresholds, thyroid C-cell disease, MEN2, pregnancy, lactation, frailty, and elderly patients, with emphasis on risk–benefit assessment.
eGFR thresholds for SGLT2 and incretin therapiesHepatic impairment and dose adjustment needsMedullary thyroid carcinoma and MEN2 precautionsUse in pregnancy, lactation, and preconceptionElderly, frail, and multimorbid patient considerationsLesson 4Mechanisms of action: GLP-1 receptor agonists, dual/triple incretin agonists, SGLT2 inhibitors, fixed-ratio insulin/GLP-1 combosThis section explains mechanisms of GLP-1 receptor agonists, dual and triple incretin agonists, SGLT2 inhibitors, and fixed-ratio insulin/GLP-1 combinations, linking molecular actions to clinical benefits, risks, and rational drug selection.
GLP-1 receptor signaling and beta-cell effectsDual and triple incretin agonists: rationale and dataRenal glucose transport and SGLT2 inhibitionSynergy in fixed-ratio insulin/GLP-1 productsMechanistic basis for cardiorenal protectionLesson 5Reading and applying guideline statements: how to extract recommendations from ADA, EASD, ESC, KDIGO, and national guidelines for therapy choice and sequencingThis section explains how to navigate ADA, EASD, ESC, KDIGO, and national guidelines. Emphasis is on extracting graded recommendations, reconciling differences, and translating algorithms into individualised therapy choices and sequencing.
Structure of ADA, EASD, ESC, KDIGO documentsStrength of recommendation and evidence gradingPrioritizing cardiorenal risk in treatment algorithmsReconciling conflicting guidance across societiesAdapting global guidance to national formulariesLesson 6Drug interactions with commonly used medications in diabetes, CV disease, and lipid-lowering therapyThis section analyses pharmacodynamic and pharmacokinetic interactions between newer glucose-lowering drugs and common agents for hypertension, heart failure, dyslipidaemia, and antiplatelet therapy, focusing on safety and efficacy in polypharmacy.
Interactions with ACE inhibitors and ARBsLoop and thiazide diuretics with SGLT2 inhibitorsStatins, fibrates, and newer glucose-lowering drugsAntiplatelet and anticoagulant co-therapy issuesManaging complex polypharmacy in older adultsLesson 7Interpreting clinical trial endpoints: HbA1c reduction, body weight, MACE, heart-failure hospitalisation, renal composite outcomesThis section teaches interpretation of clinical trial endpoints, including HbA1c change, weight loss, MACE, heart-failure hospitalisation, renal composites, and safety outcomes, emphasising absolute risk, NNT, and patient-centred relevance.
Glycemic endpoints: HbA1c, TIR, and durabilityWeight and metabolic syndrome outcomesMACE and expanded cardiovascular endpointsHeart-failure hospitalization and diuretic sparingRenal composite endpoints and slope analysesLesson 8Major adverse effects and safety signals: GI effects, pancreatitis concerns, euglycaemic DKA, genital infections, hypoglycaemia risk with combosThis section reviews major adverse effects of newer agents, including gastrointestinal intolerance, pancreatitis concerns, euglycaemic DKA, genital and urinary infections, volume depletion, and hypoglycaemia when combined with insulin or sulphonylureas.
Gastrointestinal effects and mitigation strategiesPancreatitis and gallbladder disease signalsEuglycemic DKA: recognition and preventionGenital and urinary infections with SGLT2 drugsHypoglycemia risk in combination regimens
