Management of Diabetes D - Type 2 Diabetes Mellitus - Part 2

Question 1

SUMMARY of the diabetes drugs:

Answer 1

Question 2

What class of drug is metformin?

Answer 2

• Biguanide

Question 3

What does incretin do?

Answer 3

• Stimulates a decrease in blood glucose levels (wiki)

Question 4

How do DPPIV inhibitors (gliptans) work?

Answer 4

• Delays the breakdown of incretins
• Therefore ↑ active incretin levels
• This ↓ blood glucose becuase incretin augments/promotes the secretion of insulin from pancreatic β cells and lowers the secretion of glucagon from pancreatic α cells

Question 5

DPPIV inhibitors list:

Answer 5

Question 6

State the advantages and disadvantages of DPPIV inhibitors

Answer 6

Advantages:

• Usually well tolerated
• Can be used as a 2nd or 3rd line agent
• Can be used in renal impairment
• No risk of hypoglycaemia
• Weight neutral

Disadvantages:

• Trial data shows relatively small effects on glycaemic control
• CI in pregnancy and breastfeeding
• Possible increased risk of pancreatitis and pancreatic cancer
• SE: nausea

Question 7

How do GLP-1 analogues work? (LATER)

Question 8

GLP-1 analogue list:

Answer 8

Question 9

What is exenatide?

Answer 9

Injectable pen (with glucagon-like peptide-1 receptor agonist (GLP-1 receptor agonist))

Question 10

What are the advantages and disadvantages of GLP-1 analogues?

Answer 10

Advantages:

• Weight loss
• No risk of hypoglycaemia
• 3rd line agent
• Can be used with basal insulin

Disadvantages:

• Injection
• Very expensive
• Possible increased risk of pancreatitis and pancreatic cancer
• CI in pregnancy and breastfeeding
• SE: Nausea and vomiting

Question 11

How do SGLT2 inhibitors (…gliflozins) work?

Answer 11

• Normally, most glucose is reabsorbed by SGLT2 in the renal proximal tubule of the kidney
• Gliflozins selectively inhibit SGLT2 in the renal proximal tubule
• This leads to ↓ glucose absorption into the blood and ↑ urinary glucose excretion

Question 12

List some effects of SGLT2 inhibitors.

Answer 12

• Excretes/gets rid of glucose/glycosuria
• Lowers HbA1c
• Gets ride of water/osmotic diuresis
• Lose weight with same uptake

Question 13

SGLT-2 inhibitors list:

Answer 13

Question 14

State the advantages and disadvantages of SGLT2 inhibitors

Answer 14

Advantages:

• Weight loss
• No risk of hypoglycaemia
• Good effects on glycaemic control
• May have beneficial effect on cardiovascular morbidity and morality
• 2nd or 3rd line agent
• Can add to insulin regimens in Type II Diabetes Mellitus

Disadvantages:

• Expensive
• Side effects: UTI, fungal infections, osmotic symptoms

↑ Risk of digital amputaiton

↑ DKA

• CI in pregnanct and breastfeeding
• Cannot use in renal impairment

Question 15

Insulin is the main treatment for Type I diabetes mellitus but can it be used in Type II?

Answer 15

• YES

Question 16

Give the name of an insulin injection

Answer 16

• Humalin I

(Once daily injection usually at bedtimw)

Question 17

What are the HbA1c targets in those with Type II diabetes?

Answer 17

HbA1c targets:

• Adults with Type II diabetes managed by lifestyle/ diet changes + single drug NOT associated with hypoglycaemia: Aim for HbA1c ≤48 mmol/mol
• For adults on drugs associated with hyperglycaemia: Aim for HbA1c ≤53 mmol/mol
• If HbA1c rises to ≥58 mmol/mol and is not adequately controlled by a single drug: Reinforce diet/ lifestyle changes, reinforce adherence to drug treatment and intensify this drug treatment and support the person to aim for HbA1c ≤53 mmol/mol