Management of Type 2 Diabetes Mellitus Part 2 Flashcards
What are incretins?
Group of metabolic hormones that stimulate a decrease in blood glucose levels, they are released after eating from pancreatic beta cells
How is the incretin effect altered in T2 diabetes?
It is diminished
What are the 2 types of incretins?
…gliptins
…tides
What are the …gliptins?
DPPIV-inhibitors
What are examples of …gliptins?
Saxagliptin
Sitagliptin
Vildagliptin
What effect do …gliptins have?
Increase insulin release
What is the mode of action of gliptins?
Delay breakdonw of incretins and thereby increase active incretin levels, causing
What are advantages of gliptins?
What are disadvantages of gliptins?
What are examples of …tides?
Exenatide
Liraglutide
Lixsenatide
What are …tides?
GLP-1 analogues
What effect do GLP-1 analogues (…tides) have?
Increase insulin release
What is the mode of action of GLP1?
What is a common side effect of incretin-mimetics?
Nausea
What GLP1 analogue can be given in a pen device?
Exenatide
What are advantages of GLP1 analogues?
What are disadvantages of GLP-1 analogues?
What are the …gliflozins?
SGLT2-inhibitors
What are examples of SGLT2-inhibitors?
Canagliflozin
Dapagliflozin
Empagliflozin
What is the effect of SGLT2-inhibitors?
Increase excretion of glucose
Explain how gliflozins work?
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
What are some SGLT2-inhibitor effects?
- 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
What are some advantages of SGLT2-inhibitors?
What are some disadvantages of SGLT2-inhibitors?
When should insulin be used as a treatment for type 2 diabetes?
After non-insulin options have been tried
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?
48mmol/L
What is the HbA1c target for adults with T2 diabetes on drug associated with hypoglycaemia?
53mmol/L
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?
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
You should consider relaxing HbA1c levels on a case by case basis, who are some people this should be considered for?
- 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
Describe the 5 step framework for choosing a glucose lowering drug?
- Set target HbA1c
- Are there any other risk factors that should be treated first
- Such as smoking, blood pressure, energy drinks, lack of exercise, diet
- Are current treatments optimised (max dose, tolerated, taken)
- What are glucose lowering options
- Remove any that are contraindicated
- Of the remaining what are pros and cons
- Select preferred choice
- Agree a review date and target HbA1c with patient
- Review at 3 to 6 months
- Target is usually 5mmol/L reduction in HbA1c
