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Endocrinology > T2DM > Flashcards

T2DM Flashcards

1
Q

Briefly describe the pathophysiology of T2DM

A
  • Insulin resistance

- Reduced production of insulin

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2
Q

What are the three main symptoms of T2DM?

A
  • Polydipsia
  • Polyuria
  • Weight loss (unintentional)
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3
Q

Describe the oral glucose tolerance test (OGTT)

A
  • Patient is fasted overnight
  • Baseline fasting plasma glucose is measured
  • 75g glucose drink given
  • 2 hours later, plasma glucose is measured again
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4
Q

What are the diagnostic criteria for T2DM in each of the following…

  1. HbA1c
  2. Random glucose
  3. OGTT
  4. Fasting glucose
A
  1. HbA1c > 48 mmol/mol
  2. Random glucose > 11 mmol/L
  3. OGTT > 11 mmol/L
  4. Fasting glucose > 7 mmol/L
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5
Q

What is the cut-off value for diagnosing pre-diabetes on HbA1c?

A

42 mmol/mol

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6
Q

What are the long term complications of poorly controlled T2DM? How can these be classified?

A

Microvascular:
- Diabetic neuropathy, nephropathy and retinopathy

Macrovascular:

  • IHD and MI
  • Stroke
  • Hypertension

Infection-related complications:

  • Bacterial, e.g. skin/soft tissue infections, UTIs
  • Fungal, e.g. candidiasis
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7
Q

Describe the conservative management of diabetes

A

Lifestyle modification:

  • Exercise
  • Weight loss
  • Smoking cessation
  • Optimise management of other medical conditions
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8
Q

NICE guidelines recommend the following HbA1c treatment targets in T2DM…

A
  • 48 mmol/mol in new T2 diabetics

- 53 mmol/mol in diabetics who have moved beyond metformin alone

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9
Q

Briefly describe the first, second and third line pharmacological management of T2DM

A

First line:
- Metformin alone, titrated up as tolerated

Second line:
- Metformin plus any ONE of the following: pioglitazone, sulfonylurea, DPP4-i or SGLT2-i

Third line:

  • EITHER Metformin plus any TWO of the following: pioglitazone, sulfonylurea, DPP4-i or SGLT2-i
  • OR Metformin plus insulin
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10
Q

A patient is established on maximum metformin monotherapy but their blood glucose remains high. What is the cut off-value for initiating second line therapy?

A

58 mmol/mol

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11
Q

A patient is established on maximum metformin monotherapy AND pioglitazone, but their blood glucose remains high. What is the cut off-value for initiating third line therapy?

A

58 mmol/mol

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12
Q

What is the initial starting dose/frequency of metformin?

A

500mg OD

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13
Q

Which class does metformin belong to?

A

Metformin is a biguanide

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14
Q

How does metformin work?

A

Increases insulin sensitivity

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15
Q

What are the common side effects of metformin?

A
  • GI upset

- Lactic acidosis

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16
Q

Pioglitazone is a thiazolidinedione. How does it work?

A

Increases insulin sensitivity

17
Q

Pioglitazone may increase the risk of…

A

Bladder cancer

18
Q

Give an example of a sulfonylurea

A

Gliclazide

19
Q

How do sulfonylureas work?

A

Stimulate insulin release (from the pancreas)

20
Q

Sulfonylureas increase the risk of episodes of…

A

Hypoglycaemia

21
Q

Which anti-diabetic medications can cause:

a) Hypoglycaemia
b) Weight gain
c) Weight loss

A

a) Sulfonylureas (e.g. gliclazide) and insulin
b) Pioglitazone and Sulfonylureas (e.g. gliclazide)
c) GLP-1 mimetics (e.g. exenatide) and SGLT2 inhibitors (e.g. empagliflozin)

22
Q

What are incretins?

A

Hormones produced in the GI tract. They are secreted in response to large meals and reduce blood sugar by the following mechanisms:

  • Increase insulin secretion
  • Inhibit glucagon production
  • Slow absorption by the GI tract
23
Q

The main incretin is…

A

Glucagon like peptide 1 (GLP-1)

24
Q

Incretins are inhibited by an enzyme called…

A

Dipeptidyl peptidase 4 (DPP-4)

25
Q

How do DPP-4 inhibitors work?

A

Inhibit DPP-4, thereby increasing GLP-1 activity

26
Q

Give an example of a DPP-4 inhibitor

A

Sitagliptin

27
Q

How do GLP-1 mimetics work

A

Mimic the action of GLP-1

28
Q

Give an example of a GLP-1 mimetic

29
Q

Both GLP-1 mimetics and DPP4 inhibitors work via utilising incretins. Which side effect do these meds have in common?

30
Q

Give an example of an SGLT2 inhibitor

A

Empagliflozin

31
Q

How do SGLT2 inhibitors work?

A

The SGLT-2 protein is responsible for reabsorbing glucose from the urine. SGLT-2 inhibitors block the action of this protein, causing glucose to be excreted in the urine.

32
Q

SGLT2 inhibitors increase the risk of developing…

33
Q

NICE guidelines suggest the use of ONE of which two anti-diabetic medications preferentially in patients with cardiovascular disease?

A

SGLT-2 inhibitors (e.g. empagliflozin) and GLP-1 mimetics (e.g. exenatide) - coincidentally these can both cause weight loss as a side effect

Endocrinology (13 decks)

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