Oral hypoglycaemics Flashcards
What is first line treatment for raised HbA1C less than 48mmol/mol in previously non-diabetic adult patient?
Lifestyle interventions
What is first line treatment for raised HbA1C 48mmol/mol or above but less than 58mmol/mol in adult patients?
Metformin
or
Dipeptydl Peptidase 4 inhibitors (DPP-4i), Piaglitazone or Sulphonylurea
What is 2nd line treatment for raised HbA1C 58mmol/mol or above in adult patients?
Metformin + Dipeptydl peptidase 4 inhibitors (DPP-4i)
Metformin + pioglitazone
Metformin + Sulphonylurea
Metformin + Sodium Glucose Co-Transporter 2 Inhibitors (SGLT-2i)
What is first line treatment for children with T2DM?
Strict Diet
If strict diet alone fails to control HbA1C in children what is the first line treatment?
Metformin at lower end of adult dose
What is mode of action of sulfphonylurea?
bind to ATP-sensitive potassium channels on the pancreatic cell surface, reducing potassium conductance and causing depolarization of the membrane. Depolarization stimulates calcium ion influx through voltage-sensitive calcium channels, raising intracellular concentrations of calcium ions, which induces the secretion, or exocytosis, of insulin.
What is mode of action of DPP4?
inhibits dipeptidyl peptidase 4 (DPP-4), which normally degrades the incretins glucose-dependent insulinotropic polypeptide (GIP) and glucagon like peptide 1 ( GLP-1). The inhibition of DPP-4 increases the amount of active plasma incretins which helps with glycemic control. GIP and GLP-1 stimulate glucose dependent secretion of insulin in pancreatic beta cells. GLP-1 has the additional effects of suppressing glucose dependent glucagon secretion, inducing satiety, reducing food intake, and reducing gastric emptying.
What is mode of action of pioglitazone?
selective agonist at Peroxisome Proliferator Activated Receptor Gamma (PPARγ) in target tissues for insulin action such as adipose tissue, skeletal muscle, and liver. Activation of PPAR-gamma receptors increases the transcription of insulin-responsive genes involved in the control of glucose production, transport, and utilization. In this way, pioglitazone both enhances tissue sensitivity to insulin and reduces the production of glucose via the liver (hepatic gluconeogenesis). Thus, insulin resistance associated with type 2 diabetes mellitus is improved without an increase in insulin secretion by pancreatic β cells.
What is mode of action of SGLT-2i?
SGLT2 co-transporters are responsible for reabsorption of glucose from the glomerular filtrate in the kidney. The glucuretic effect resulting from SGLT2 inhibition reduces renal absorption and lowers the renal threshold for glucose, resulting in increased glucose excretion. Additionally, it contributes to reduced hyperglycaemia, assists weight loss, and reduces blood pressure.
