Management of Type 2 Diabetes Mellitus Part 2

Question 1

What are incretins?

Answer 1

Group of metabolic hormones that stimulate a decrease in blood glucose levels, they are released after eating from pancreatic beta cells

Question 2

How is the incretin effect altered in T2 diabetes?

Answer 2

It is diminished

Question 3

What are the 2 types of incretins?

Answer 3

…gliptins

…tides

Question 4

What are the …gliptins?

Answer 4

DPPIV-inhibitors

Question 5

What are examples of …gliptins?

Answer 5

Saxagliptin

Sitagliptin

Vildagliptin

Question 6

What effect do …gliptins have?

Answer 6

Increase insulin release

Question 7

What is the mode of action of gliptins?

Answer 7

Delay breakdonw of incretins and thereby increase active incretin levels, causing

Question 8

What are advantages of gliptins?

Answer 8

Question 9

What are disadvantages of gliptins?

Answer 9

Question 10

What are examples of …tides?

Answer 10

Exenatide

Liraglutide

Lixsenatide

Question 11

What are …tides?

Answer 11

GLP-1 analogues

Question 12

What effect do GLP-1 analogues (…tides) have?

Answer 12

Increase insulin release

Question 13

What is the mode of action of GLP1?

Answer 13

Question 14

What is a common side effect of incretin-mimetics?

Answer 14

Nausea

Question 15

What GLP1 analogue can be given in a pen device?

Answer 15

Exenatide

Question 16

What are advantages of GLP1 analogues?

Answer 16

Question 17

What are disadvantages of GLP-1 analogues?

Answer 17

Question 18

What are the …gliflozins?

Answer 18

SGLT2-inhibitors

Question 19

What are examples of SGLT2-inhibitors?

Answer 19

Canagliflozin

Dapagliflozin

Empagliflozin

Question 20

What is the effect of SGLT2-inhibitors?

Answer 20

Increase excretion of glucose

Question 21

Explain how gliflozins work?

Answer 21

In normal renal handling of glucose majority of glucose is reabsorbed by SGLT2, remaining glucose is absorbed by SGLT1 and minimal to no glucose is excreted

Gliflozins selectively inhibit SGLT2 in the renal proximal tubule

Question 22

What are some SGLT2-inhibitor effects?

Answer 22

• Gets rid of glucose/more glycosuria
  
  • Lowers HbA1c
• Gets rid of water/osmotic diuresis
  
  • Postural hypotension, dehydration
• Gets rid of calories/wastes glucose
  
  • Lost weight with same intake
• Gets rid of sodium/less reuptake
  
  • Lowers systolic blood pressure
• Greater risk of urogenital infection
  
  • Cystitis and candidiasis

Question 23

What are some advantages of SGLT2-inhibitors?

Answer 23

Question 24

What are some disadvantages of SGLT2-inhibitors?

Answer 24

Question 25

When should insulin be used as a treatment for type 2 diabetes?

Answer 25

After non-insulin options have been tried

Question 26

What is the HbA1c target for adults with T2 diabetes managed by lifestyle and diet or lifestyle and diet with single drug not associated with hypoglycaemia?

Answer 26

48mmol/L

Question 27

What is the HbA1c target for adults with T2 diabetes on drug associated with hypoglycaemia?

Answer 27

53mmol/L

Question 28

What should be done for people with T2 diabetes when HbA1c levels are not adequately controlled by single drug and rise to 58mmol/L or higher?

Answer 28

Reinforce advice about diet, lifestyle and adherence to drug treatment Support the person to aim for HbA1c level of 53mmol/L and intensify drug treatment

Question 29

You should consider relaxing HbA1c levels on a case by case basis, who are some people this should be considered for?

Answer 29

* People who are older or frail * For adults * With reduced life expectancy * High risk of consequences of hypoglycaemia (those at risk of falling, impaired awareness of hypoglycaemia or who drive machinery) * Intensive management not appropriate, such as multiple comorbidities

Question 30

Describe the 5 step framework for choosing a glucose lowering drug?

Answer 30

1. Set target HbA1c 2. Are there any other risk factors that should be treated first 1. Such as smoking, blood pressure, energy drinks, lack of exercise, diet 3. Are current treatments optimised (max dose, tolerated, taken) 4. What are glucose lowering options 1. Remove any that are contraindicated 2. Of the remaining what are pros and cons 3. Select preferred choice 5. Agree a review date and target HbA1c with patient 1. Review at 3 to 6 months 2. Target is usually 5mmol/L reduction in HbA1c