Management of Type 2 Diabetes

Question 1

what increases insulin release?

Answer 1

> sulphonylureas
metaglinides
incretin mimetics
DPPIV inhibitors

Question 2

what in creases the excretion of glucose?

Answer 2

SGLT2 inhibitors

Question 3

what improves insulin action?

Answer 3

> biguanides
thiazolidiones
weight reduction

Question 4

what is the 5 step framework for choosing a glucose lowering drug?

Answer 4

1. set target HbA1c
2. check for other risk factors that should be treated first
3. are current medications optimised
4. what are the options?
5. set review date

Question 5

in what cases can the target HbA1c be relaxed?

Answer 5

> older people (frail)
reduced life expectancy
high risk of consequences of hypoglycaemia
multiple comorbidities

Question 6

what are the first line treatment options?

Answer 6

> METFORMIN

> sulfonylurea

Question 7

what are the second line treatment options?

Answer 7

Add one:
> SULFONYLUREA
> thiazolidinedione
> DPP-IV inhibitor
> SGLT-2-inhibitor

Question 8

what are third line oral agents that can be used?

Answer 8

> thiazolidinedione
DPP-IV inhibitor
SGLT-2 inhibitor

Question 9

what are third line injectable agents that can be used?

Answer 9

> GLP-1 agonist

> Insulin

Question 10

true or false:

Metformin (biguanide) improves insulin action

Answer 10

true

Question 11

how does metformin improve insulin sensitivity?

Answer 11

> affects glucose production
decreases fatty acid synthesis
improves receptor function
inhibits gluconeogenic pathways

Question 12

what are the disadvantages of metformin?

Answer 12

> risk of lactic acidosis by inhibiting lactic acid uptake by liver
risk of vitamin b12 malabsorption

Question 13

what are the advantages of metformin?

Answer 13

> improves cardiac outcomes
cheap
well tolerated
used in pregnancy

Question 14

name 3 sulphonylureas

Answer 14

> glimepiride
gliclazide
glipizide

Question 15

what are the advantages of sulphonylurea?

Answer 15

> used with metformin
generally well tolerated
rapid improvement of symptoms

Question 16

what are the disadvantages of sulphonylurea?

Answer 16

> risk of hypoglycaemia
weight gain
caution in renal and hepatic disease
CI in pregnancy and breast feeding

Question 17

name a thiazolidinediones

Answer 17

pioglitazone

Question 18

what are the advantages of thiazolidinediones?

Answer 18

> good in significant insulin resistance
cheap
cardiovascular safety

Question 19

what are the disadvantages of thiazolidinediones?

Answer 19

> increased bladder cancer risk
fluid retention
weight gain
fractures in females

Question 20

name some DPPIV-inhibitors

Answer 20

> saxagliptin
sitagliptin
vildagliptin

Question 21

what are the advantages of DPPIV inhibitors?

Answer 21

> well tolerated
can be used in renal impairment
no risk hypoglycaemia
weight neutral

Question 22

what are the disadvantages of DPPIV inhibitors?

Answer 22

> CI in pregnancy and breast feeding

Question 23

name some GLP-1 analogues

Answer 23

> exenatide
liraglutide
lixisemide

Question 24

what are the advantages of GLP-1 analogues?

Answer 24

> weight loss
no risk of hypoglycaemia
can be used with basal insulin

Question 25

what are the disadvantages GLP-1 analogues?

Answer 25

> injection
expensive
CI in breast feeding and pregnancy

Question 26

name some SGLT2 inhibitors

Answer 26

> canagliflozin
dapagliflozin
empagliflozin

Question 27

what are the advantages of SGLT2 inhibitors?

Answer 27

> weight loss
no risk of hypoglycaemia
can be added to insulin regimes

Question 28

what are the disadvantages of SGLT2 inhibitors?

Answer 28

> expensive
> risk of digital amputation
> risk of DKA
> CI pregnancy and breast feeding
> cant be used in renal impairement