Management of T2DM Flashcards
What drug class is Metformin?
Biguanides
What is the MOA of Metformin?
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.
Which side effects are most common with biguanides?
GI - diarrhoea
Headaches
B12 deficiency - due to reduced absorption. Risk increases with long term therapy.
What are some rare side effects of biguanides?
Haemolytic anaemia
Cholestatic jaundice
Allergic pneumonitis
Leucocytoclastic vasculitis
What are the contraindications of Biguanides?
Acute metabolic acidosis
eGFR <30
Liver dysfunction
What is the MOA of a-glucosidase inhibitors?
Inhibits a-glucosidase enzymes –> reduces amount of carb absorption + reduces postprandial hyperglycaemia.
Which drug class is Acarbose?
a-glucosidase inhibitors
Which drug class is Repaglinide and Nateglinide?
Glinides (Meglitinides)
What is the MOA of meglitinides?
Stimulates insulin release
Mimics postprandial insulin secretion
Which drug class is Gliclazide?
Sulphonylureas
What is the MOA of Sulphonylureas?
Blocks K+ ATP channels within beta cells –> stimulates insulin secretion
what are some common side effects of Sulphonylureas?
Hypoglycaemia
Weight gain
Secondary failure (stops reducing Hba1c)
What are the contraindications of Sulphonylureas?
Ketoacidosis
Acute porphyuria
What are the cautions for Sulphonylureas?
Elderly
Obesity
G6PD deficiency
Which drug class is Rosiglitazone + Pioglitazone?
Thiazolidinediones
What is the MOA of Thiazolidinediones?
Insulin sensitisers
Alter glucose metabolism + changes within the lipid pathway.
Reduces insulin resistance
Which drug class is Sitagliptin and Linagliptin?
DPP4 inhibitors (Gliptins)
What is the MOA of DPP4 inhibitors (Gliptins)?
Retains insulin excretion
Promotes postprandial insulin release
Reduces insulin resistance
What is the drug class of Dapagliflozin?
SGLT2 inhibitors
What is the MOA of SGLT2 inhibitors?
Decrease renal tubular glucose reabsorption, therefore excreted in urine.
Lowers glucose without increasing insulin release.
What is the drug class of Dulaglutide?
GLP-1 agonists
What is the MOA of GLP-1 agonists?
Stimulates insulin release
Reduced glucose sensitivity
Enhances beta cell replication + prevents their decline
Delayed gastric emptying
Inhibits glucagon secretion
Which medication increases the risk of medullary thyroid cancer?
GLP-1 agonists
What is the first line treatment for T2DM?
Biguanides (Metformin)
If Metformin is contraindicated, what would be the next management?
SGLT2 Inhibitors
Aside from Biguanides and SGLT2 inhibitors, which medications would be considered for those with symptomatic hyperglycaemia?
Sulphonylurea or DPP4 inhibitors (Gliptins)
When would GLP-1 agonists be prescribed in T2DM?
If triple therapy with Metformin + 2 other oral drugs are not effective or tolerated.
What are the leading trials in diabetes management?
UK Prospective diabetes study (UKPDS)
Diabetes Prevention Programme Trial
If Metformin Immediate Release is not tolerated, which medication would be next to try?
Metformin MR
