L 27 Therapy of T2DM Flashcards
Diabetes is most common among these 4 ethnicities?
South Asian/Indian, Māori, Pasifika, Middle Eastern
There is a high correlation between T2DM and … and ….
between T2DM and hypertension and hyperlipidaemia
Risk factors for T2DM
Obesity or Over-wight pre-diabetes, family history, Māori/Asian/Middle Eastern/Pacific Islander 30yr+, High BP
How will we identify prediabetes and diabetes?
Prediabetic: HbA1c of 41-49mmol/mol or fastet glucose concentration 6.1-6.9 mmol/L
+ CV risk if >35y/o
+ lifestyle modifications suggested
Diabetec: HbA1c >50mmol/mol or fasting blood glucose 7.0 mmol/L
+ Recommended for full diabetes management
Rate the Diabetes according to HbA1c levels:
64-86 mmol/mol means moderate
Above 86 mmol/mol is severe
What is HbA1c is?
HbA1c is what’s known as glycated haemoglobin. Haemoglobin (Hb) is the protein in your blood that carries oxygen around your body.
Glucose (a type of sugar) in your blood can stick to the haemoglobin protein. When this happens the haemoglobin is called HbA1c. The higher the glucose (sugar) levels are in your blood, the more of it gets stuck to your haemoglobin and the higher your HbA1c is.
It represents the BG over the past 2-3 months.
its measuring unit is mmol/mol
What are the Signs and symptoms of T2DM?
Usually none!
Fatigue, polyuria, polydipsia (thirst), recurrent urogenital infections
What is the Treatment steps for T2DM management
Lifestyle changes
Drugs to increase insulin
Drugs to treat HTN(hypertension) and High cholesterol
Assess 5 year CV risk and try to reduce CV risk.
5 components of metabolic syndrome
- Low HDL
- Visceral obesity
- Insulin resistance
- Hypertension
- High TGs
What are the Goals of T2DM treatment?
- Reducing complications
- Preserving Beta cell function as they get influenced by high blood glucose.
- Preventing acute complications from high blood glucose
- Minimising hypoglycaemic episodes
- Maintaining patient QoL
What are the Non Pharmacological treatment options for T2DM?
Diet advice Weight reduction Exercise Alcohol moderation Smoking cessation Regular physical activity
What would be an example of Long-acting insulin?
Glargine
What is an example of sulphonylureas?
Glipizide, gliclazide and glibenclamide
Treatment steps for T2DM !!!!!
Classes not examples
- Metformin
- Sulphonylurea or DPP-4 inhibitor
- Acarbose if can’t do 1 or 2
- GLP-1 agonist or SGLT2
- PPARy activator
- Insulin
- ACE inhibitor if diabetic/hypertensive.
- ARB if ACE is not tolerated.
Treatment steps for T2DM (examples w classes) !!!!
- Metformin (biguanide) in addition to lifestyle modification (first line)
- Add Glicazide or Vildagliptin (Sulph or DPP-4)
- Acarbose (x-glucosidase inhibitor)
- Dulaglutide +/- empagliflozin (GLP-1 or SGLT2)
- Pioglitazone (PPARy activator)
- Endogenous insulin
- Enalapril
- Losartan
