Management of T2DM

Question 1

What drug class is Metformin?

Answer 1

Biguanides

Question 2

What is the MOA of Metformin?

Answer 2

Reduces gluconeogenesis by activating AMPK = less glucose release into blood.
Increases insulin receptor expression (GLUT-4)
Increases levels of Glucagon-like peptide 1 (GLP1) = increased insulin absorption by tissues.
Inhibits synthesis of glucose, lipids and protein + stimulation of glucose uptake and fatty acid oxidation.

Question 3

Which side effects are most common with biguanides?

Answer 3

GI - diarrhoea
Headaches
B12 deficiency - due to reduced absorption. Risk increases with long term therapy.

Question 4

What are some rare side effects of biguanides?

Answer 4

Haemolytic anaemia
Cholestatic jaundice
Allergic pneumonitis
Leucocytoclastic vasculitis

Question 5

What are the contraindications of Biguanides?

Answer 5

Acute metabolic acidosis
eGFR <30
Liver dysfunction

Question 6

What is the MOA of a-glucosidase inhibitors?

Answer 6

Inhibits a-glucosidase enzymes –> reduces amount of carb absorption + reduces postprandial hyperglycaemia.

Question 7

Which drug class is Acarbose?

Answer 7

a-glucosidase inhibitors

Question 8

Which drug class is Repaglinide and Nateglinide?

Answer 8

Glinides (Meglitinides)

Question 9

What is the MOA of meglitinides?

Answer 9

Stimulates insulin release
Mimics postprandial insulin secretion

Question 10

Which drug class is Gliclazide?

Answer 10

Sulphonylureas

Question 11

What is the MOA of Sulphonylureas?

Answer 11

Blocks K+ ATP channels within beta cells –> stimulates insulin secretion

Question 12

what are some common side effects of Sulphonylureas?

Answer 12

Hypoglycaemia
Weight gain
Secondary failure (stops reducing Hba1c)

Question 13

What are the contraindications of Sulphonylureas?

Answer 13

Ketoacidosis
Acute porphyuria

Question 14

What are the cautions for Sulphonylureas?

Answer 14

Elderly
Obesity
G6PD deficiency

Question 15

Which drug class is Rosiglitazone + Pioglitazone?

Answer 15

Thiazolidinediones

Question 16

What is the MOA of Thiazolidinediones?

Answer 16

Insulin sensitisers
Alter glucose metabolism + changes within the lipid pathway.
Reduces insulin resistance

Question 17

Which drug class is Sitagliptin and Linagliptin?

Answer 17

DPP4 inhibitors (Gliptins)

Question 18

What is the MOA of DPP4 inhibitors (Gliptins)?

Answer 18

Retains insulin excretion
Promotes postprandial insulin release
Reduces insulin resistance

Question 19

What is the drug class of Dapagliflozin?

Answer 19

SGLT2 inhibitors

Question 20

What is the MOA of SGLT2 inhibitors?

Answer 20

Decrease renal tubular glucose reabsorption, therefore excreted in urine.
Lowers glucose without increasing insulin release.

Question 21

What is the drug class of Dulaglutide?

Answer 21

GLP-1 agonists

Question 22

What is the MOA of GLP-1 agonists?

Answer 22

Stimulates insulin release
Reduced glucose sensitivity
Enhances beta cell replication + prevents their decline
Delayed gastric emptying
Inhibits glucagon secretion

Question 23

Which medication increases the risk of medullary thyroid cancer?

Answer 23

GLP-1 agonists

Question 24

What is the first line treatment for T2DM?

Answer 24

Biguanides (Metformin)

Question 25

If Metformin is contraindicated, what would be the next management?

Answer 25

SGLT2 Inhibitors

Question 26

Aside from Biguanides and SGLT2 inhibitors, which medications would be considered for those with symptomatic hyperglycaemia?

Answer 26

Sulphonylurea or DPP4 inhibitors (Gliptins)

Question 27

When would GLP-1 agonists be prescribed in T2DM?

Answer 27

If triple therapy with Metformin + 2 other oral drugs are not effective or tolerated.

Question 28

What are the leading trials in diabetes management?

Answer 28

UK Prospective diabetes study (UKPDS)
Diabetes Prevention Programme Trial

Question 29

If Metformin Immediate Release is not tolerated, which medication would be next to try?

Answer 29

Metformin MR