Diabetes Mellitus: GLP-1 & The New Drugs Flashcards

1
Q

How does GLP-1 (Incretin) works in normal physiology?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In T2DM patients, what has happened to their Incretin (GLP-1)?

A

They don’t produce as much and thus lose regulation over their sugar & insulin levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe 2 new drugs that affect Incretin (GLP-1).

A
  1. GLP-1 mimetics - GLP-1 is produced by an oral carbohydrate bolus. It increase the levels of GLP-1 in the body and thus the body is able to better regulate insulin and sugar. (e.g. Exenatide)
  2. DPP-4 Inhibitors - GLP-1 does not last for long because it is broken down by DPP-4 enzyme. These DPP-4 inhibitors stop the degradation of GLP-1. (e.g. Gliptins)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is one of the major advantages of GLP-1 mimetics (Exenatide) over other treatments?

A

It typically results in weight loss whilst medciations like insulin, sulfonylureas(e.g. gliclazide) and thiazolidinediones (e.g. glitazones) can result in weight gain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How must exenatide be given?

A

It must be given by subcutaneous injection within 60 minutes before the morning and evening meals and should not be given after meals.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Exenatide is the name of one GLP-1 mimetic. What is a name for another?

A

Liraglutide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is an advantage of liraglutide over exenatide?

A

It only needs to be given once daily whilst exenatide is given twice daily.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When does NICE suggest that we add exenatide to metformin and a sulfonylurea?

A
  1. BMI >= 35 kg/m2 in people of European descent and there are problems associated with high weight
  2. BMI < 35 kg/m2 and insulin is unacceptable because of occupational implications or weight loss would benefit other comorbidities.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In order to justify the use of GLP-1 mimetics, what does NICE expect to see after 6 months of use?

A

A 1% reduction in HbA1C and a 3% weight loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the main side effects of exanetide?

A
  • N&V (main one)
  • Severe Pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How are DPP-4 inhibitors taken?

A

Orally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Do DPP-4 inhibitors cause weight gain/

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name some DPP-4 inhibitors.

A

Vildagliptin

Sitagliptin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Do DPP-4 (Vidagliptin, sitagliptin) inhibitors cause hypoglycaemia?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are NICE’s guidelines regarding DPP-4 inhibitors?

A
  • Continue DPP-4 inhibitor only if there is a reduction of > 0.5 percentage points in HBA1c in 6 months
  • NICE suggest that a DPP-4 inhibitor might be preferable to a thiazolidinedione if:
    • Further weight gain would cause significant problems
    • A thiazolidinedione is contraindicated
    • The person has had a poor response to a thiazolidinedione
How well did you know this?
1
Not at all
2
3
4
5
Perfectly