medicines for type 2 diabetes Flashcards
metformin
- a biguanide
- first-line oral glucose-lowering agent for type 2
- no weight gain (unlike insulin/sulfonylureas)
- does not cause hypoglycaemia
- mechanism of action uncertain
metformin mechanism action
- reduces hepatic glucose production
- can affect multiple cellular processes like the inhibition of mitochondrial respiratory-chain complex 1
metformin side effects
- diarrhoea
- nausea/vomiting
- abdominal bloating/gas
- reduced appetite
- vitamin B12 deficiency
- tiredness/tingling hands and feet
- rare: lactic acidosis
sulfonylureas
- stimulate insulin secretion from pancreatic beta cells
- bind to ATP-gated K+ channels causing channel closure and membrane depolarisation leads to insulin secretion
sulfonylureas drugs
- glibenclamide
- gliclazide
- glipizide
- glimepiride
- tolbutamide
sulfonylureas side effects
- hypoglycaemia
- weight gain (more suitable for patients who are not overweight)
meglitinides
- prandial glucose regulators
- similar mechanism of action as sulfonylureas but rapid onset-short duration
- taken before meals
- repaglinide, nateglinide
thiazolidinediones
- pioglitazone
- increase insulin sensitivity by stimulating the expression of insulin-sensitising genes
- thiazolidinediones bind to and activate the nuclear receptor PPARy
- side effects: water retention (oedema) and weight gain
GLP-1 analogues
- incretin mimetics
- release of active GLP-1 and GIP in response to an increased concentration of glucose in the digestive tract lumen
- DPP-4 rapidly degrades incretins
- incretin effect increased insulin release
GLP-1 analogues medicines
- exenatide (twice daily injection)
- exenatide (once weekly injection)
- liraglutide (once daily injection)
- lixisenatide (once daily injection)
- dulaglutide (once weekly injection)
- semaglutide (once weekly injection)
DPP-4 inhibitors
- gliptins
- DPP-4 inhibitor blocks incretin degradation
- incretins stimulate insulin secretion
- potentiates incretin effect increases insulin release
DPP-4 medicines
- sitagliptin
- vildagliptin
- saxagliptin
- alogliptin
- linagliptin
- can all come with metformin
alpha glucosidase inhibitor (acarbose)
slows down absorption of starchy foods by intestine
slow rise in blood glucose after a meal
SGLT2 inhibitors
act by inhibiting the glucose transporter SGLT2 which functions in the kidney to mediate glucose reabsorption
examples: dapagliflozin, canagliflozin, empagliflozin
if HbA1c rises to 48 mmol/mol
consider monotherapy - metformin
if HbA1c rises to 58 mmol/mol
consider dual therapy:
- metformin + DPP-4
- metformin + pioglitazone
- metformin + sulfonylureas
- metformin + SGLT2 inhibitors
if HbA1c rises to >58 mmol/mol
consider triple therapy:
- metformin + DPP-4 + sulfonylureas
- metformin + sulfonylureas - pioglitazone
- metformin + sulfonylureas + SGLT2 inhibitors
- metformin + pioglitazone + SGLT2 inhibitors
if triple therapy fails
consider insulin program or-
metformin + sulfonylureas + GLP-1 mimetic
if patient is hyperglycaemic
sulfonylureas + short acting insulin
- review treatment when blood glucose has been controlled
surgery for type 2 diabetes
NICE recommended that all patients in UK with a BMI >35 with recent onset type 2 should be assessed for surgery
