Management of Diabetes D - Type 2 Diabetes Mellitus - Part 2 Flashcards
SUMMARY of the diabetes drugs:
What class of drug is metformin?
- Biguanide
What does incretin do?
- Stimulates a decrease in blood glucose levels (wiki)
How do DPPIV inhibitors (gliptans) work?
- 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
DPPIV inhibitors list:
State the advantages and disadvantages of DPPIV inhibitors
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
How do GLP-1 analogues work? (LATER)
GLP-1 analogue list:
What is exenatide?
Injectable pen (with glucagon-like peptide-1 receptor agonist (GLP-1 receptor agonist))
What are the advantages and disadvantages of GLP-1 analogues?
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
How do SGLT2 inhibitors (…gliflozins) work?
- 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
List some effects of SGLT2 inhibitors.
- Excretes/gets rid of glucose/glycosuria
- Lowers HbA1c
- Gets ride of water/osmotic diuresis
- Lose weight with same uptake
SGLT-2 inhibitors list:
State the advantages and disadvantages of SGLT2 inhibitors
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
Insulin is the main treatment for Type I diabetes mellitus but can it be used in Type II?
- YES
Give the name of an insulin injection
- Humalin I
(Once daily injection usually at bedtimw)
What are the HbA1c targets in those with Type II diabetes?
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
