Management of diabetes - Type 2 DM

Question 1

What % of the population in Scotland IN 2016 had type 2 DM?

Answer 1

5.4%

Question 2

What is the aims of diabetes treatment?

Answer 2

• Relief of primary symptoms
• Prevention of complications
• Preservation of quality of life
• Damage minimisation - avoidance of emergencies.

Question 3

What are the defects seen in the body in diabetes mellitus type 2?

Answer 3

Beta cell dysfunction
Diminished incretin effects
Excess glucagon
Insulin resistance

Question 4

What classes of drugs are used to increase insulin release?

Answer 4

Sulphonylureas
Metiglinides
Incretin mimetics
DPP-IV inhibitors

Question 5

What class of drugs are used to increase glucose excretion?

Answer 5

SGLT2 inhibitors

Question 6

What class of drugs are used to improve insulin action?

Answer 6

Biguanides e.g. metformin
Thiazolidiones

(Weight reduction also helps)

Question 7

What 3 mechanisms are used by anti hyperglycaemic drugs for diabetes?

Answer 7

Increase insulin release
Improves insulin action
Increases glucose secretion

Question 8

What are some symptoms of diabetes?

Answer 8

• Frequent urination
• Increased thirst
• Blurry vision
• Increased hunger
• Feeling drowsy or sleepy
• Slow or improper healing of cuts and bruises
• Tingling, pain or numbness of hands and feet

Question 9

When does pharmaceutical therapy for T2DM begin?

Answer 9

If HbA1c rises to 48mmol/mol - Offer metformin

Always try lifestyle measures first e.g. weight loss, healthier diet and exercise

Question 10

What is used as first line treatment in those who are intolerant of standard release metformin in those with 48mmol as their HbA1c target e.g. poor renal function, upset bowel?

Answer 10

Modified release metformin
OR
DPP-IV inhibitor
OR
Pioglitazone (only thiazolidione)
OR 
Sulphonylurea if target slightly higher (HbA1c 53mmol)

Question 11

When is dual therapy for diabetes suggested?

Answer 11

If HbA1c rises to 58mmol/mol consider dual therapy

Question 12

What dual therapy can be given in 2nd line diabetes treatment?

Answer 12

If metformin tolerant can have MET-DPP/MET-PIO/MET-SU/MET-SGLT.

If not tolerant of metformin, can consider DPP-PIO/DPP-SU/PIO-SU.

Question 13

When do you consider triple therapy for DM?

Answer 13

If HbA1c continues to rise from 58mmol/mol following starting dual therapy or if nothing improves

Question 14

What drugs are usually saved for second line treatment only according to the SIGN guidelines?

Answer 14

Sulfonylureas* e.g. glimepiride, gliclazide

Thiazolidinedione* e.g. pioglitazone – if hypos are a concern, if no congestive heart failure

DPP-IV inhibitor* e.g. sitagliptin – if hypos and weight gain are a concern

SGLT2 inhibitor* e.g. empagliflozin – if hypos and weight gain a concern