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NPS Modules > Glycaemic control in long-established diabetes > Flashcards

Glycaemic control in long-established diabetes Flashcards

1
Q

What are the major modifiable risk factors for macrovascular disease?

A 
Diabetes
Hypertension
Smoking
Dyslipidaemia
Lack of exercise
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2
Q

What is the mechanism of action of the Sulfonylureas?

A

Increase pancreatic insulin secretion.

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3
Q

In which patients would the Sulfonylureas be used as a first-line treatment?

A

Patients with type 2 diabetes in whom hypoinsulinaemia (rather than insulin resistance) is the predominant cause of hyperglycaemia

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4
Q

What are four examples of sulfonylureas?

A

Glibenclamide
Gliclazide
Glipizide
Glimepiride

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5
Q

How are sulfonylureas used in most T2DM patients?

A

as second-line treatment, after metformin

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6
Q

What is the mechanism of action of Thiazolidinediones?

A

Increase peripheral insulin sensitivity.

Decreases hepatic glucose output.

( Agonist of peroxisome proliferator-activated receptor gamma, which regulates genes involved in lipid and glucose metabolism)

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7
Q

How are Thiazolidinediones used in glycaemic control?

A

Reserve for patients unable to take other antidiabetics

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8
Q

Name 2 Thiazolidinediones

A

Rosiglitazone

Pioglitazone

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9
Q

What is the mechanism of action of acarbose?

A

Reduces carbohydrate absorption in gut. Prevents the breakdown of polysaccharides to monosaccharides. (e.g. sucrose to glucose)

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10
Q

To which group of drugs does metformin belong?

A

Biguanides

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11
Q

What is the mechanism of action of metformin?

A

The glucose-lowering, insulin-sensitizing agent metformin works mainly by reducing gluconeogenesis and opposing glucagon-mediated signalling in the liver and, to a lesser extent, by increasing glucose uptake in skeletal muscle

The primary site of metformin action is the mitochondrion

The antihyperglycaemic effect of metformin is probably owing to defective protein kinase A signalling

Metformin affects lipid metabolism primarily via 5′-AMP-activated protein kinase (AMPK) activation

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12
Q

What tests are performed to monitor the microvascular complications of diabetes?

A

neuropathy: clinical examination
nephropathy: urine albumin creatinine ratio
retinopathy: ophthalmological retinal screening

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13
Q

What are the microvascular complications of diabetes?

A

Neuropathy
Nephropathy
Retinopathy

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14
Q

What is a possible complication of using sulfonylureas?

A

Hypoglycaemia

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15
Q

What is the first line treatment for T2DM?

A

Metformin

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16
Q

What is the major side effect of Metformin?

A

Gastrointestinal upset (1/3 of patients)

17
Q

What is the daily dose of Metformin?

A

250-1000mg daily

18
Q

How is metformin cleared from the body?

A

Renally (100%)

19
Q

What is the mechanism of action of GLP-1 Analogues?

A

Analogues of glucagon-like peptide‑1 (an incretin);

  • increase glucose-dependent insulin secretion
  • suppress inappropriate glucagon secretion.
  • delay gastric emptying, which slows glucose absorption,
  • decrease appetite.
20
Q

What is an example of a GLP-1 Analogue?

A

Semaglutide
Exenatide
Dulaglutide
Liraglutide

21
Q

What is the mode of administration of exenatide?

A

Subcutaneous

22
Q

What is the dosing regimen for exenatide?

A

Initially 5mg SC BD

If tolerated, 10mg SC BD

23
Q

What is the mechanism of action of DPP-IV inhibitors?

A

Stimulate insulin secretion and suppress glucagon release by increasing concentrations of GLP-I and related peptides by blocking their metabolism.

24
Q

How are DPP-IV inhibitors used to treat T2DM?

A

In combination with metformin or a sulfonylurea

25
Q

What is the name of a DPP-IV inhibitor?

A 
Sitagliptin
Linagliptin
Saxagliptin
Alogliptin
Vildagliptin
26
Q

How is sitagliptin cleared from the body?

A

Renally (100%)

27
Q

In which patients are Thiazolidinediones contraindicated?

A

In patients with heart failure.

28
Q

How often should one monitor HBA1c levels?

A

HbA1c most accurately reflects the patient’s glycaemic control for the previous eight to 12 weeks. Testing every 3 months is sufficient.

29
Q

How can patients mitigate the gastrointestinal side-effects of metformin?

A

Taking with meals, gradual dose titration or using the extended release preparation.

30
Q

What is one rare but significant risk of metformin usage? And what feature of a patient would make this outcome more likely?

A

Lactic acidosis. Renal impairment.

31
Q

What proportion of patients will not respond to thiazolidinediones?

A

up to 1/3

32
Q

What are the common adverse effects of sulfonylureas?

A

Weight gain and hypoglycaemia

33
Q

What are the benefits of initiating insulin therapy early?

A

Potentially improves or preserves beta-cell function
Prevents loss of glycaemic control
Reduces the risk of microvascular complications.

NPS Modules (15 decks)

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