Non insulin therapy Flashcards
Understand the progressive nature of type 2 diabetes and the need for treatment
intensificaAon over Ame
The need for treatment intensification over time in diabetes arises due to the progressive nature of the disease. Type 2 diabetes is characterized by insulin resistance, which means that the body becomes less responsive to the effects of insulin over time. This results in an increased demand for insulin to maintain normal blood glucose levels.
Initially, lifestyle changes such as dietary modifications, exercise, and weight loss may be sufficient to manage blood glucose levels. However, as the disease progresses, these measures may not be sufficient, and medication may be needed to improve insulin sensitivity or stimulate insulin secretion.
Over time, even with medication, many people with diabetes will require additional treatment intensification to maintain adequate glycemic control. This may involve the use of multiple medications in combination or the use of injectable medications such as GLP-1 receptor agonists or insulin.
The need for treatment intensification may also arise due to factors such as weight gain, increased stress, illness, or medication interactions. Blood glucose levels can become more difficult to control in these situations, and additional treatment options may be necessary.
Know the range of non-insulin anA-hyperglycaemic agents currently available and their
place in the treatment pathway
Metformin: Metformin is a biguanide medication that is considered first-line therapy for type 2 diabetes. It works by reducing glucose production in the liver and improving insulin sensitivity in muscle tissue.
Sulfonylureas: Sulfonylureas are oral medications that stimulate insulin secretion from the pancreas. They are often used in combination with metformin in patients with type 2 diabetes who have not achieved adequate glycemic control with metformin alone.
Dipeptidyl peptidase-4 (DPP-4) inhibitors: DPP-4 inhibitors are oral medications that increase insulin secretion and decrease glucagon secretion. They are often used as second-line therapy in patients who are unable to achieve glycemic control with metformin or sulfonylureas.
Glucagon-like peptide-1 (GLP-1) receptor agonists: GLP-1 receptor agonists are injectable medications that increase insulin secretion, decrease glucagon secretion, and slow gastric emptying. They are often used as second- or third-line therapy in patients who are unable to achieve glycemic control with oral medications.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors: SGLT2 inhibitors are oral medications that block glucose reabsorption in the kidneys, leading to increased urinary glucose excretion. They are often used as second- or third-line therapy in patients who are unable to achieve glycemic control with other oral medications.
Thiazolidinediones (TZDs): TZDs are oral medications that improve insulin sensitivity in muscle tissue and adipose tissue. They are often used in combination with other oral medications in patients who are unable to achieve glycemic control with other oral medications.
Alpha-glucosidase inhibitors: Alpha-glucosidase inhibitors are oral medications that slow the absorption of carbohydrates in the intestines. They are often used as second- or third-line therapy in patients who are unable to achieve glycemic control with other oral medications.
The place of these non-insulin antihyperglycemic agents in the treatment pathway of type 2 diabetes depends on various factors such as the patient’s glycemic control, cardiovascular risk factors, comorbidities, and patient preferences. Generally, metformin is considered first-line therapy for most patients with type 2 diabetes, and other medications may be added as needed based on the patient’s individual needs and response to therapy. GLP-1 receptor agonists and SGLT2 inhibitors are often recommended for patients with established cardiovascular disease or high cardiovascular risk, while sulfonylureas are generally avoided in patients at high risk for hypoglycemia. Regular monitoring and adjustment of treatment regimens are necessary to achieve and maintain optimal glycemic control and prevent long-term complications associated with type 2 diabetes.
- IdenAfy how paAent factors may help to idenAfy the next step in treatment
Glycemic control: If a patient’s blood glucose levels are not at the target range despite maximum doses of the current medication, additional therapy may be required.
Patient’s age and life expectancy: For younger patients with a longer life expectancy, long-term glycemic control is important, and more aggressive therapy may be necessary. Older patients with comorbidities may benefit from less intensive treatment to avoid potential side effects.
Comorbidities: Patients with hypertension, dyslipidemia, or cardiovascular disease may require medications that provide additional cardiovascular benefits.
Renal function: Patients with renal impairment may require adjustments in medication doses or medications that are less likely to affect kidney function.
Patient preference: Patient preferences, including the route of administration, frequency of dosing, and potential side effects, should be considered when selecting the next step in treatment.
Cost: The cost of medication and its affordability for the patient should also be considered when selecting the next step in treatment.
