Diabetes 5

Question 1

What are the aims of therapy for type 2 diabetes?

Answer 1

• Alleviate hyperglycaemic symptoms
• Improve glucose, lipids and BP
• Avoid excessive weight gain
• Improve quality of life
• Reduce risk of hypoglycaemia

Question 2

What non-drug treatment is available for type 2 diabetes?

Answer 2

• Healthy eating
• Regular exercise
• Weight loss
• Smoking cessation
• Safe and sensible alcohol intake

Question 3

What drug treatments are available for type 2 diabetes?

Answer 3

Oral (anti-diabetics) and injectable (insulin)

Question 4

What are the two target levels for type 2 diabetes?

Answer 4

• Managed by non-drug treatment and single drug NOT associated with hypoglycaemia: HbA1c: 48 mmol/mol (6.5%)
• Drug associated with hypoglycaemia: HbA1c: 53 mmol/mol (7.0%)

Question 5

What classes of oral anti-diabetics works by sensitising the body to insulin and or/decreasing glucose production?

Answer 5

Biguanides (Metformin), thiazolidinediones (glitazones)

Question 6

What class of oral anti-diabetics works by blocking glucose reabsorption in the kidneys?

Answer 6

Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors, -flozin)

Question 7

What class of oral anti-diabetics works by stimulating insulin production?

Answer 7

Sulfonylureas

Question 8

What classes of oral anti-diabetics works by targeting the incretin system?

Answer 8

DPP-4 inhibitors (-gliptins), GLP-1 agonists (incretin mimetics)

Question 9

What is the mechanism of action of metformin?

Answer 9

• Decrease hepatic glucose production
• Decrease intestinal absorption of glucose
• Anti-oxidative properties of merformin on endothelial cells

Question 10

What are the advantages of metformin?

Answer 10

Enhances weight loss (Drug of choice in overweight), improves lipid profile

Question 11

What are the disadvantages of metformin?

Answer 11

Gastric intolerance (nausea, diarrhoea, abdominal pain), C/I’d in impaired renal function, lactic acidosis

Question 12

What is the dosage for metformin?

Answer 12

500mg OD after main meal, inc to 500mg TID after 2-3 weeks.
Normal dose: 500mg TID / 850mg BD, maximum dose usually 2g daily
MR prep available if having GI symptoms (intolerance)

Question 13

What is the dosage for SGLT2 inhibitors and what are two examples?

Answer 13

OD dosing, Dapagliflozin and Canagliflozin

Question 14

What are two side effects of SGLT2 inhibitors?

Answer 14

• Urine will test positive for glucose
• Increased incidence of genital and urinary tract infections (due to above)

Question 15

What are the advantages of SGLT2 inhibitors?

Answer 15

• May promote weight loss
• Improve cardiovascular outcomes in certain patients
• Reduce CKD progression, mortality and CVS events in adults with type 2 diabetes and CKD

Question 16

The risk of what is assessed before starting a SGLT2 inhibitor and why?

Answer 16

Diabetic ketoacidosis
- Inc risk of previous episode
- caution if patient on very-low carb / keto diet

Question 17

What is the mechanism of action of sulfonylureas and how long until max effect is reached?

Answer 17

Stimulate beta cell insulin secretion, require residual beta-cell activity.
6 months.

Question 18

What is an example of a sulfonylurea?

Answer 18

gliclazide

Question 19

What are the side effects of sulfonylureas?

Answer 19

• Hypoglycaemia
• Weight gain (caution in overweight patients)
• GI disturbances