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?
What drug increases excretion of glucose?
What drugs improve insulin action?
Describe the 5 step framework for choosing glucose lowering drugs?
- Set a target HbA1c
- Are there any other risk factors that should be treated first
- Are the current treatments optimised
- Max dose, tolerated, taken
- What are the glucose lowering options
- Remove any that are contraindicated
- Of the remaining what are pros and cons
- Select preferred choice
- 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 reduced life expectancy or high risk of consequences of hypoglycaemia (such as those at 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 organs does metformin act on?
Liver and muscle
What organ does sulphonylureas act on?
Pancreas
What organs does thiazolidinediones act on?
Muscle and adipose tissue
What is the effect of metformin?
Improves insulin action
What is the effect of sulphonylureas?
Increases insulin release
What is the effect of thiazolidinediones?
Improves insulin action
What is the first line for treatment of type 2 diabetes?
Metformin
Why is metformin the first line for treatment of type 2 diabetes?
Improves outcomes
Well tolerated
Cheap
How does metformin improve insulin sensitivity?
Affects glucose production, decreases fatty acid synthesis
Improves receptor function
Inhibits gluconeogenic pathway
What is the half life of metformin?
6 hours
What kind of drug is metformin?
Biguanide (group of drugs that work by preventing the production of glucose by the liver, improving the bodies sensitivity towards insulin)
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 receptors does sulphonylureas bind to?
Sulfonylurea receptors (SUR-1) on functioning pancreatic beta cells
What are some sulphonylureas?
What are some advantages of sulphonylureas?
What are some disadvantages of sulphonylureas?
What drug is the main thiazolidinedione?
Pioglitazone
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 receptors does pioglitazone (thiazolidinedione) act on?
Selectively stimulates the nuclear receptor peroxisome proliferators - activated receptor gamma (PPAR-gamma) and to lesser extent PPAR-alpha
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?
