Management of Type 2 Diabetes Mellitus Part 1 Flashcards
What is the prevalence of type 2 diabetes, is this increasing or decreasing?
5.4% (increasing)
Does diabetes affect more men or woman?
Men (55% men, 45% woman)
Who is in the diabetes team?
Patient
Specialist nurse
GPs
Clinical psychologists
Dietitians
Podiatrists
Diabetes doctors
Other specialties
Where can advice about diabetes be found?
Practice nurse/GP
Online education (DUK, mydiabetesmyway)
Group education sessions
Dietetic advice
What should patients expect from their diabetic care?
Give an example of what would typically occur in a consultation for type 2 diabetes?
How is diabetic information shared between healthcare professionals?
Using SCI diabetes
What are some of the aims of diabetic treatment?
Relief of primary symptoms
Prevention of complications
Preservation of quality of life
Damage minimalisation (avoidance of emergencies)
What are some examples of the primary symptoms due to type 2 diabetes?
- polyuria
- polydipsia
- myopia
- fatigue
- weight loss
- paraesthesia
- slow or improper healing of bruises or cuts
What kinds of things need to be considered to prevent complications due to type 2 diabetes?
- mood
- dietary changes
- physical activity
- blood pressure
- statins
- smoking
What drugs increase insulin release?
- sulphonylureas
- metiglinides
- incretin mimetics
- DPPIV inhibitors
What drug increases excretion of glucose?
SGLT2 inhibitors
What drugs improve insulin action?
- biguanides
- thiazolidiones
- weight reduction
- physical activity
Describe the 5 step framework for choosing glucose lowering drugs?
- set a target HbA1c
- other risk factors that should be treated first
- current treatments should be optimised
- what are the glucose-lowering options
- agree a review date and the target HbA1c with patient
What are some ways of optimising current treatment drug for type 2 diabetes?
Max dose
Tolerated
Is it taken correctly
Target HbA1c should be set on a case by case basis, what kinds of things impact this HbA1c target level?
- people who are older or frail
- for adults with type 2 diabetes with
- reduced life expectancy
- high risk of consequences of hypoglycaemia (eg increased risk of falling, or who drive)
- intenstive management not appropriate, multiple co-morbidities
What are the first 3 lines of drugs for type 2 diabetes?
- Metformin (improves insulin action, acts on liver and muscle)
- Sulphonylureas (increases insulin release, acts on pancreas)
- Thiazolidinediones (improves insulin action, acts on liver, muscle and adipose tissue)
What are some advantages of metformin?
What are some disadvantages of metformin?
Explain the mechanism of action of sulphonylureas?
- Binds to sulfonylurea receptors (SUR-1) on functioning pancreatic beta cells
- Binding closes linked ATP sensitive potassium channels
- Decreased potassium influx depolarises beta cell
- Voltage dependent calcium channel opens and cause influx of calcium
- Translocation and exocytosis of secretory granules of insulin to the cell surface
What are some sulphonylureas?
What are some advantages of sulphonylureas?
What are some disadvantages of sulphonylureas?
Explain the mechanism of action of pioglitazone (thiazolidinedione)?
- selectively stimulates the nuclear receptor peroxisome proliferator – activated receptor gamma (PPAR-gamma) and to lesser extent PPAR-alpha
- modulates transcription of insulin sensitive genes involved in control of glucose and lipid metabolism in muscle, adipose tissue and liver
- reduces insulin resistance in liver and peripheral tissues
- increases expense of insulin dependent glucose
- decreases withdrawal of glucose form liver
- reduces quantity of glucose, insulin and glycated haemoglobin in bloodstream
What are some advantages of pioglitazone?
What are some disadvantages of pioglitazone?
Out of metforming, sulphonyleus and glitazone, which has the better CV outcomes?
Out of metforming, sulphonyleus and glitazone, which impacts the patients weight?
Out of metforming, sulphonyleus and glitazone, what are contraindications?
Out of metforming, sulphonyleus and glitazone, what are potential adverse effects for each?
