DIABETES Flashcards
What is type 2 diabetes?
Type 2 diabetes is a chronic metabolic condition characterised by insulin resistance and insufficient pancreatic insulin production, resulting in high blood-glucose levels.
What are the aims of treatment for type 2 diabetes?
The aims of treatment for type 2 diabetes are to minimise the risk of long-term microvascular and macrovascular complications by effective blood-glucose control and maintenance of glycated haemoglobin (HbA1c) at or below the target value set for each individual patient.
What lifestyle modifications can help manage type 2 diabetes?
Lifestyle modifications such as weight loss, eating a healthy diet, smoking cessation, and regular exercise can help manage type 2 diabetes.
How should drug treatment for type 2 diabetes be chosen?
Drug treatment for type 2 diabetes should be chosen based on the patient’s preference and clinical circumstances, and the effectiveness, safety, tolerability, and monitoring requirements of the treatment.
What factors should be considered when reviewing or changing treatment for type 2 diabetes?
When reviewing or changing treatment for type 2 diabetes, factors such as managing side-effects, supporting adherence, and reinforcing lifestyle advice should be considered, as well as discussing stopping treatment that has had no impact on glycaemic control or weight, unless there is an additional clinical benefit from continued treatment.
What are the 1st targets for controlling blood-glucose in type 2 diabetes?
The targets for controlling blood-glucose in type 2 diabetes depend on the patient’s clinical circumstances, but generally, a target HbA1c level of 48 mmol/mol (6.5%) is recommended when type 2 diabetes is managed by diet and lifestyle alone, or when combined with a single antidiabetic drug not associated with hypoglycaemia. (such as metformin hydrochloride)
What is the recommended HbA1c level for patients managed by diet and lifestyle alone?
The recommended HbA1c level for patients managed by diet and lifestyle alone is 48 mmol/mol (6.5%).
What HbA1c level is recommended for patients prescribed a single drug associated with hypoglycaemia ?
what drugs are associated with hypoglycaemia in the bnf example
Patients prescribed a single drug associated with hypoglycaemia should usually aim for an HbA1c level of 53 mmol/mol (7.0%).
(sulfonylureas i.e. gliclazide, Tolbutamide)
Should the target HbA1c level be relaxed on a case-by-case basis in type 2 diabetes?
Yes, the target HbA1c level should be relaxed on a case-by-case basis in type 2 diabetes, with particular consideration for patients who are older or frail, those unlikely to achieve longer-term risk-reduction benefits, or where tight blood-glucose control is not appropriate or poses a high risk of the consequences of hypoglycaemia.
What is metformin hydrochloride and what is its effect on blood-glucose levels?
Metformin hydrochloride is an antidiabetic drug that has an anti-hyperglycaemic effect, lowering both basal and postprandial blood-glucose concentrations.
Which antidiabetic drug class is associated with hypoglycaemia?
Sulfonylureas, such as gliclazide, glimepiride, glipizide, and tolbutamide, are associated with hypoglycaemia.
What is acarbose and how does its anti-hyperglycaemic effect compare to other antidiabetic drugs?
Acarbose is an antidiabetic drug with a poorer anti-hyperglycaemic effect than many other antidiabetic drugs.
What is the advantage of meglitinides over sulfonylureas?
The advantage of meglitinides, such as repaglinide, over sulfonylureas is their rapid onset of action and short duration of activity, which allows for flexibility around mealtimes and can be adjusted to fit individual eating habits.
What is the risk associated with thiazolidinedione, pioglitazone?
Thiazolidinedione, pioglitazone, is associated with weight gain and several long-term risks, and its ongoing benefit to the patient should be reviewed regularly and treatment stopped if response is insufficient.
What are dipeptidylpeptidase-4 (DPP-4) inhibitors and how do they compare to sulfonylureas in terms of weight gain and hypoglycaemia?
Dipeptidylpeptidase-4 (DPP-4) inhibitors, such as alogliptin, linagliptin, sitagliptin, saxagliptin, and vildagliptin, do not appear to be associated with weight gain and have less incidence of hypoglycaemia than sulfonylureas.
What is the advantage of sodium glucose co-transporter 2 (SGLT2) inhibitors over other antidiabetic drugs?
Sodium glucose co-transporter 2 (SGLT2) inhibitors, such as canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin, can lower blood-glucose levels, promote weight loss, and improve cardiovascular outcomes in certain patients.
Also Chronic kidney disease (incase of exams not really relevant).
What is the risk associated with SGLT2 inhibitors?
SGLT2 inhibitors are associated with a risk of diabetic ketoacidosis.
symptoms are:
High blood glucose levels (hyperglycemia)
Frequent urination (polyuria)
Excessive thirst (polydipsia)
Nausea and vomiting
Abdominal pain
Rapid breathing (Kussmaul respirations)
Fruity-smelling breath (due to the presence of acetone, a byproduct of ketone breakdown)
Dry mouth and dry skin
Confusion, difficulty concentrating, or altered mental state
Fatigue and weakness
Rapid heartbeat (tachycardia) and low blood pressure (hypotension)
When should glucagon-like peptide-1 (GLP-1) receptor agonists be prescribed?
GLP-1 receptor agonists, such as dulaglutide, exenatide, liraglutide, lixisenatide, and semaglutide, should be prescribed for combination therapy when other treatment options have failed.
What is the advantage of GLP-1 receptor agonists over other antidiabetic drugs?
GLP-1 receptor agonists promote weight loss and may improve cardiovascular outcomes for some patients.
What is recommended as the first choice for initial drug treatment for all patients with type 2 diabetes?
Standard-release metformin hydrochloride is recommended as the first choice for initial drug treatment for all patients with type 2 diabetes.
Why is standard-release metformin hydrochloride recommended as the first choice for initial drug treatment?
Standard-release metformin hydrochloride has a positive effect on weight loss, reduced risk of hypoglycaemic events, and additional long-term cardiovascular benefits (just benefits!!!!!!!) associated with its use.
How should the dose of standard-release metformin be increased?
The dose of standard-release metformin should be increased gradually to minimise the risk of gastro-intestinal side-effects. in steps of 500mg
What should be offered in addition to metformin for patients with chronic heart failure or established atherosclerotic cardiovascular disease?
Patients with chronic heart failure or established atherosclerotic cardiovascular disease should also be offered a sodium glucose co-transporter 2 (SGLT2) inhibitor with proven cardiovascular benefit as initial drug treatment.
When should an SGLT2 inhibitor be considered for patients with type 2 diabetes?
An SGLT2 inhibitor should be considered for patients who are at high risk of developing cardiovascular disease. Metformin should be initiated first, with the SGLT2 inhibitor started as soon as tolerability to metformin is confirmed.