Diabetic drugs

Question 1

What is recommended as the first choice initial treatment for all diabetic patients? Why?

Answer 1

Metformin:
Positive effect on weight loss.
Reduced risk of hypoglycaemic events.
Long-term cardiovascular benefits associated with its use.

Question 2

How does metformin work? Does it cause hypoglycaemia?

Answer 2

Metformin is a biguanide, it works be reducing the production of glucose by the liver.

It does not cause hypoglycaemia as it does not stimulate insulin secretion.

Question 3

When should metformin be taken and what are its most common side effects?

Answer 3

During/at meal times.
Most common side effects are diarrhoea, metallic aftertaste and nausea.

GI effects can be reduced by using a MR form.

Question 4

If metformin alone does not control HbA1c, the addition of a drug from the sulphonyurea class is often attempted. How do sulfonylureas work and what are some examples?

Answer 4

Sulfonylureas work by stimulating the pancreas to produce more insulin (thus can cause hypo’s).

Gliclazide, glibenclamide, glimepiride, glipizide and tolbutamide.

Question 5

What are the common side effects of sulphonylureas?

Answer 5

Modest weight gain, hypo due to increased insulin.

Long-acting ones such as glibenclamide are more likely to cause hypo.

Sulfonylureas should be taken 30 minutes or more before meals and NOT at bedtime.

Question 6

When should sulphonylureas be used?

Answer 6

30 minutes or more before mealtimes.

Question 7

How does pioglitazone work in diabetes?

Answer 7

It is a thiazolidinedione that works by increasing insulin sensitivity of glucose by the liver.

Question 8

When should pioglitazone be taken?

Answer 8

With, or without food, at the same time every day.

Question 9

What are the common side effects of pioglitazone?

Answer 9

Swelling due to water retention, weight gain and an increased risk of bladder cancer.

Question 10

How do dipeptidylpeptidase-4 inhibitors work? what are some examples?

Answer 10

Linagliptin, saxagliptin, sitagliptin and vildagliptin.

They appear to work by intensifying the effect of intestinal hormones (incretines) involved in the control of blood sugar.

Question 11

What are the side effects associated with DPP-4-inhibitors such as saxagliptin and sitagliptin?

Answer 11

Headache and pharyngitis but not weight gain and less incidence of hypoglycaemia than sulfonylureas.

Question 12

What type of drug is Jardiance (empaglifozin)?

Answer 12

Sodium glucose co-transporter 2 inhibitor.

See also: canaglifozin and dapaglifozin.

Question 13

How does empaglifozin work?

Answer 13

They inhibit the sodium glucose transporter 2 so result in increased elimination of glucose in the urine.

Question 14

What are the main side effects of SGT2 inhibitors like empaglifozin?

Answer 14

Increased risk of UTI and genital infections, diabetic ketoacidosis.

Question 15

When should saxagliptin (and other DPP-4 inhibitors) be taken?

Answer 15

With or without food at the same time each day.

Question 16

When should SGT2 inhibitors be taken?

Answer 16

Only when sulfonylureas are contra-indicated or not tolerated.

Canaglifozin: before the first meal of the day.
Empaglifozin and dapaglifozin: any time of the day with or without food.

Question 17

Exenatide, liraglutide and lixisenatide are what type of drugs?

Answer 17

Glucagon-like peptide receptor agonists that may be presribed as part of triple therapy regimen with metformin and sulfonylurea.

Question 18

What are the criteria that must be met before a glucagon-like peptide 1 receptor agonist can be prescibed?

Answer 18

If triple therapy is tried and not effective, not tolerated or contra-indicated.

Must be part of triple-therapy with metformin and sulfonylurea.

Should only be prescribed for patients who have a BMI of 35kg/m2 or above and who also have a specific psychological or medical problem associated with obesity.