Management of Type 2 Diabetes - 2

Question 1

Give an example of sulfonylurea

Answer 1

Glimepiride or gliclazide

Question 2

Give an example of a thiazolidinedione

Answer 2

Pioglitazone

Question 3

Give an example of a DPP-IV inhibitor

Answer 3

Sitagliptin

Question 4

Give an example of a SGLT-2 inhibitor

Answer 4

Empagliflozin

Question 5

Give an example of GLP-1 agonist

Answer 5

Lixisenatide

Question 6

When would you use sulfonylurea as a first line?

Answer 6

If weight loss/osmotic symptoms

Question 7

What is another name for DPP-IV inhibitors?

Answer 7

Glipins

Question 8

What is the action of glipins (DPP-IV inhibitors)?

Answer 8

Block the action of DPP-4, an enzyme which destroys the hormone incretin

Question 9

What is the action of the hormone incretin?

Answer 9

Increases insulin and decreases glucagon (decreasing BG levels)

Question 10

What are the advantages of DPP-IV inhibitors?

Answer 10

• Used as 2nd or 3rd line agents
• Can be used in renal impairment
• No risk of hypoglycaemia

Question 11

What are the disadvantages of DPP-IV inhibitors?

Answer 11

Possible increased risk of pancreatitis and pancreatic cancer

Question 12

What are the actions of GLP-1 analogues?

Answer 12

GLP-1 agonists mimic GLP-1 hormone by binding to GLP-1 receptors and stimulating insulin release, which reduces blood sugar.

Injectable analogues of GLP-1 which are resistant to enzymatic degradation thus with greatly prolonged biological half-life

Question 13

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

Answer 13

• Weight loss
• No hypoglycaemia
• 3rd line agents
• Injection
• Very expensive
• Risk of pancreatitis and pan. cancer
• SE: nausea, vomiting

Question 14

What is the action of SGLT2 inhibitors?

Answer 14

SGLT2 is a protein in humans that facilitates glucose reabsorption in the kidney.

SGLT2 inhibitors block the reabsorption of glucose in the kidney, increase glucose excretion, and lower blood glucose levels

Question 15

What types of drugs act to increase insulin release?

Answer 15

• Sulphonylureas
• Incretin mimetics (DPL-1 analogues)
• DPP-IV inhibitors

Question 16

What type of drugs acts to increase excretion of Glc?

Answer 16

SGLT2 inhibitors

Question 17

What are the advantages and disadvantages of SGLT2 inhibitors?

Answer 17

• Weight loss
• No hypoglycaemia
• Beneficial effect on CVS morbidity and mortality
• 2nd or 3rd line agent
• Expensive
• SE: UTI, fungal infections
• Risk of DKA, digital amputation

Question 18

What is the regimen for isoprene insulin?

Answer 18

• Once daily injection

* Usually at bedtime

Question 19

What is the HbA1c target?

Answer 19

• On drug with no associated hypoglycaemia -> 48mmol/mol
• On drugs with associated hypoglycaemia -> 53mmol/mol
• HbA1c not adequately controlled by drug –> 58mmol/mol

Question 20

With what type of people should the target Hb1Ac level by relaxed?

Answer 20

• Old or frail

Adults with NIDDM:
• Reduced life expectancy
• High risk of consequences of hypoglycaemia
• Multiple comorbidities

Question 21

What is the 5 step framework for choosing a Glc lowering drug?

Answer 21

1. Set a target HbA1c
2. “Take 5” Are there other risk factors that should be treated first?
3. Are the current treatments optimised. Max dose? Tolerated? Taken?
4. What are the glucose lowering options?
   • Remove any that are contraindicated
   • Of the remaining what are the pros and cons
5. Agree a review date and the target HbA1c with the patient