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GP > Diabetes > Flashcards

Diabetes Flashcards

1
Q

How often is a diabetic review carried out?

A

annually

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2
Q

What are the 5 main components of the diabetic review history?

A
  • lifestyle assessment (diet, activity, alcohol, smoking)
  • current health
  • history of hypo-/hyper-glycaemic episodes
  • medication review and compliance
  • patient concerns
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3
Q

What 9 examinations/investigations should be carried out at the annual diabetic review?

A
  • BP
  • Weight/BMI
  • HbA1c
  • lipids
  • U&Es
  • Urinalysis
  • Fundoscopy
  • cardiovascular examination
  • foot examination
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4
Q

What are the diagnostic criteria for diabetes?

A

Random blood glucose >11.1
Fasting blood glucose >7.0
OGTT >11.1
HbA1c >48mmol/L

Symptoms + 1 positive blood test
Asymptomatic + 2 positive blood tests

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5
Q

What are the criteria of pre-diabetes?

A

Fasting blood glucose 6.1 - 6.9
OGTT 7.8 - 11
HbA1c 42-47

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6
Q

What is the most appropriate initial management of an asymptomatic patient with newly diagnosed diabetes and HbA1c of 49mmol/L?

A
  • Lifestyle changes alone
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7
Q

What is the most appropriate initial management of symptomatic patients with newly diagnosed diabetes?

A
  • Metformin
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8
Q

What is the mechanism of action of Metformin?

A
  • Biguanide

- reduces hepatic glucose output

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9
Q

What are the benefits of metformin?

A
  • weight neutral
  • oral, once-a-day
  • low risk of hypoglycaemia
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10
Q

What are the major side-effects of metformin?

A
  • lactic acidosis
  • GI disturbance
  • B12 deficiency
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11
Q

When is metformin contraindicated?

A
  • AKI

- eGFR<30

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12
Q

What are the two most common drugs used in combination with Metformin for dual therapy of diabetes?

A
  • Gliclazide (sulfonylureas)

- Sitagliptin (DPP4 Inhibitor)

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13
Q

What are the criteria for stepping up diabetes therapy?

A

HbA1c >48mmol/L on lifestyle or Metformin monotherapy

HbA1c >58mmol/L on 2 or more drugs

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14
Q

What are the HbA1c targets for T2DM?

A

<48mmol/L if controlled with lifestyle or metformin monotherapy

<53mmol/L if on 2 or more drugs or 1 drug associated with hypoglycaemia

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15
Q

What is the mechanism of action of Gliclazide?

A

Sulfonulurea

Increases insulin secretion

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16
Q

What are the benefits of Gliclazide?

A

Very effective
Cheap
Well tolerated

17
Q

What is the main side-effects of Gliclazide?

A

Hypoglycaemia risk

18
Q

What is the mechanism of action of Sitagliptin?

A

DPP4 inhibitor

Incretin effect - increases GLP-1 mediated insulin secretion

19
Q

What are the benefits of Sitagliptin?

A

Weight neutral

Low risk of hypoglycaemia

20
Q

What are the major side-effects of Sitagliptin?

A

Pancreatitis

Limited evidence of efficacy

21
Q

What drug may be considered for additional drug treatment in obese patients?

A

Exanetide - GLP-1 agonist

22
Q

What is the mechanism of action of Exanetide?

A
  • GLP-1 agonist
  • Increases glucose-dependent insulin secretion \
  • Slows gastric emptying
  • Increases satiety
23
Q

What are the benefits of Exanetide?

A
  • weight loss
  • low risk of hypoglycaemia
  • can be taken once weeky
24
Q

What are the limitations of Exanetide?

A
  • given by injection
  • expensive
  • GI side-effects
25
Q

What is the mechanism of action of Canaglifozin?

A

SGLT2 inhibitor

Reduces glucose resorption in the kidney therefore increases urinary glucose excretion

26
Q

What are the benefits of Canaglifozin?

A
  • wight loss
  • low risk of hypoglycaemia
  • lowers cardiovascular risk
27
Q

What are the side-effects of Canaglifozin?

A
  • frequent UTI
  • polyuria
  • thirst
  • requires eGFR >60
28
Q

What is the mechanism of action of Pioglitazone?

A
  • Thiazolidinedione

- increase insulin sensitivity

29
Q

Why aren’t thiazolidinediones used much anymore?

A
  • can precipitate MI, CCF and oedema
  • weight gain
  • increased risk of fracture
30
Q

When is insulin therapy indicated in the management of T2DM

A

If HbA1c remains >58mmol/L despite triple therapy

GP (6 decks)

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