DM2 - Indications/Use

Question 1

HbA1c targets

Answer 1

diet alone: <48 (6%)
diet and metformin: <48
add new drug if >58 (7%)
risk of hypoglycaemia: <53 (6.5%)

Question 2

Metformin

Answer 2

benefits: no hypos, no weight gain

first-line medication

Question 3

Sulphonyureas

Answer 3

benefits: rapid decrease in HbA1c, well-tolerated

first-line option if metformin CI/not tolerated
second-line option: add to metformin
first-line option for MODY (good response)

Question 4

DPP4 inhibitors (Gliptins)

Answer 4

benefits: can use in renal failure, no hypos

first-line option if metformin CI/not tolerated
second-line option: add to metformin

Question 5

GLP-1 analogues

Answer 5

benefits: effective, weight loss

failed triple therapy
BMI >35 + issues relating to obesity
BMI <35 and insulin contraindication
*criteria for continuation: >1% (11mmol) drop in HbA1c, >3% weight loss after 6/12

Question 6

SGLT2 inhibitors (Gliflozins)

Answer 6

benefits: additional weight loss

second-line option: add to metformin

Question 7

Glitazones/TZDs

Answer 7

benefits: excellent response in some patients

first-line option if metformin CI/not tolerated
second-line option: add to metformin
*usually only used in young men due to SEs

Question 8

Insulin

Answer 8

consider after failed double or triple therapy