DM and Metabolic Syndrome Flashcards
Know BP goals for diabetics.
<130/80 mmHg
Biguanides
Metformin (Gluocphage®, Glucophage XR®, Fortamet®, Glumetza®)
Mechanism of Action of Biguanides:
-> FBG, 1-2% A1c reduction • ↓ hepatic glucose production (major) • ↑ peripheral uptake by muscle (minor) • ↓ GI glucose absorption (minor) • Requires insulin for efficacy, but does not stimulate insulin release
What is Considered first-line therapy for DM II?
Metformin
v
Based on cost, beneficial effects on lipid profile, weight “neutral,” and may reduce CV events
• ↓ TGs, TC and LDL, and ↑ HDL (slightly)
Sulfonylureas
Glipizide (Glucotrol®, Glutrol XL®), glyburide (Diabeta®, Micronase®), glimepiride (Amaryl®)
Mechanism of Action of Sulfonylureas:
-> FBG, 1-2% A1c reduction
• ↑ insulin secretion from functioning β-cells and enhance β-cell sensitivity (major)
• ↓ hepatic glucose production (minor)
• ↑ insulin receptor sensitivity &/or number (minor)
Meglitinides:
Repaglinide (Prandin®), nateglinide (Starlix®)
Mechanism of Action of Meglitinides:
Stimulate release of insulin from functioning β-cells
Glucose-dependent (effect diminished at low serum glucose concentrations)
v
Short duration of action leads to more effects on PPBG vs. FBG
A1c reduction 0.5-1.9% (repag > nate)
α-Glucosidase Inhibitors
Acarbose (Precose), miglitol (Glyset)
Mechanism of action of α-Glucosidase Inhibitors:
Delays carbohydrate absorption (starches and sucrose)
Reduces the postprandial spike in glucose
Does not affect absorption of lactose, fructose or glucose
v
Patient should be consuming a diet high in complex carbohydrates (50% or more)
Does not ↑ insulin levels or cause hypoglycemia when used alone
Neutral or slight benefit in LDL, HDL, and TG
Thiazolidinediones (TZDs)
Rosiglitazone (Avandia), pioglitazone (Actos)
Mechanism of Action:
Stimulate the peroxisome proliferator-activated receptor-gamma (PPAR-γ)
• ↑ insulin sensitivity (major)
• ↓ hepatic glucose production (minor)
• ↓ plasma insulin levels (minor)