Diabetes treatment

Question 1

What is the first line treatment for TIIDM?

Answer 1

Metformin + lifestyle advice.

Question 2

What is the second line treatment for TIIDM?

Answer 2

Metformin + sulphonylurea.

Question 3

What is the third line treatment for TIIDM?

Answer 3

Insulin therapy.

Question 4

Give an example of a Biguanide?

Answer 4

Metformin

Question 5

What is the MOA of biguanides?

Answer 5

Increases insulin sensitivity > increased glucose uptake in peripheral tissue.
Decrease glucose absorption from GIT.

Question 6

What are the side effects of biguanides?

Answer 6

Nausea & diarrhoea.

Question 7

Give an example of a sulphonylurea?

Answer 7

Gliclazide.

Question 8

What is the MOA of sulphonylureas?

Answer 8

Increases insulin secretion from beta cells:
> Binds to ATP-dependent K+ channels > depolarisation > opening of voltaged-gated Ca2+ channels > Ca2+ influx > insulin secretion.

Question 9

What are the side effects of sulphonylureas?

Answer 9

Hypoglycaemia.

Weight gain.

Question 10

Give an example of a metiglinide?

Answer 10

Repaglinide.

Question 11

What is the MOA of metiglinides?

Answer 11

Same MOA as sulphonylureas.

Question 12

What are the side effects of metiglinides?

Answer 12

Same as sulphonylureas.

Question 13

Give an example of an alpha-glucosidase inhibitor?

Answer 13

Acarbose.

Question 14

What is the MOA of alpha-glucosidase inhibitors?

Answer 14

Inhibit the breakdown of starch > glucose > decreased glucose absorption.

Question 15

What are the side effects of alpha-glucosidase inhibitors?

Answer 15

GI disturbances:

> cramp, distension & diarrhoea.

Question 16

Give an example of a thiazolidinediones?

Answer 16

Pioglitazone.

Question 17

What is the MOA of thiazolidinediones?

Answer 17

Increases peripheral insulin sensitivity.

Question 18

What are the side effects of thiazolidinediones?

Answer 18

Oedema.
Anaemia.
Increased fracture risk.
Bladder cancer - controversial.

Question 19

Give an example of a DPP-4 inhibitor?

Answer 19

Sitagliptin.

Question 20

What is the MOA of DPP-4 inhibitors?

Answer 20

Inhibit the breakdown of GLP-1.

Question 21

Give an example of a GLP-1 agonist?

Answer 21

Liraglutide.

Question 22

What is the MOA of GLP-1 agonists?

Answer 22

Binds to the GLP-1 receptor which leads to:
> Increased insulin secretion from beta cells.
> Decreased glucagon secretion.
> Decreased gastric emptying.

Question 23

Give an example of an SGLT-2 inhibitor?

Answer 23

Ipgragliflozin.

Question 24

What is the MOA of SGLT-2 inhibitors?

Answer 24

Inhibits the SGLT-2 receptor in the kidneys from absorbing glucose > increased glucose excretion.

Question 25

What conditions are SGLT-2 inhibitors contra-indicated in?

Answer 25

Genital infections.

UTIs.

Question 26

What is familial renal glucosuria?

Answer 26

Genetic disorder > glucosuria with normal blood glucose and no symptoms.

Question 27

What is the legacy effect?

Answer 27

Shown in the UK prospective diabetes study that early control of HbA1c ( < 53mmol/L) results in significantly lower macro-vascular complications in late disease.

Question 28

What should the target BP be for a diabetic patient with hypertension? What would be the order of anti-hypertensive treatment?

Answer 28

< 140/80 or 130/80 with a previous vascular incident.
1st line - ACEi.
2nd line - Ca2+ channel blocker.
3rd line - Diuretic.

Question 29

What should the target cholesterol be for a diabetic patient with dyslipidaemia?

Answer 29

LDL-c < 2mmol/L.

Total cholesterol < 4mmol/L.

Question 30

What TIIDM patients should be on statins?

Answer 30

Any diabetic patient > 40 years (unless at a low risk) or any diabetic between 18-40 years at high risk.

Question 31

Reducing what modifiable risk factor is most important in TIIDM treatment?

Answer 31

1st - cholesterol.
2nd - hypertension.
3rd - glycaemic control.