T2DM Flashcards
what is the cause of t2dm
insulin deficiency and bodys inability to effectively use it
why might type 2 diabetes be present and go undiagnosed for a number of years
symptoms slower in onset and less severe
why is t2dm classfied as a cardiorenal metabolic syndrome
micro and macro vascular complications mean it has a significant effect on mortality and morbidity
the prevalence increases with different risk factors, list some of these
age
obesity
lack of physical exercise
htn
elevated blood lipids
list some modifiable risk factors for t2dm
blood pressure
cholesterol
inactivity
obesity
diet
alcohol
smoking
list some non modifiable risk factors for t2dm
age
sex
ethnicity
genetics
socioeconomic status
what is the term given to diabetic damage to the small blood vessels such as those in the eyes (retinopathy), kidneys (nephropathy) and feet/legs (neuropathy)
microvascular disease
what is the term given to the complications that diabetes causes to the medium to large blood vessels which can lead to:
coronary artery disease
cerebrovascular disease
peripheral vascular disease
macrovascular disease
drug class of metformin
biguanide
moa of metformin
potentiation of insulin action stimulates tissue uptake of glucose and reduces GI absorption of carbohydrates
metformin commonly causes gi disturbances but is useful first line for what reason
weight neutral
drug class of the following
gliclazide
glibenclamide
glimipiride
sulfonurea
moa of gliclazide and other sulfonureas
increase pancreatic beta cells sensitivity to glucose = more insulin to be released from storage granules for a given glucose load
sulfonureas like gliclazide are well tolerated but limited by what side effects
weight gain and hypoglycaemia
drug class of nateglinide and repaglinide
meglitinide
meglitinides moa
inhibit atp sensitive k channels
depolarization of ca channels
intracellular conc of ca increases
stimulates insulin release
benefits of meglitinides
rapid onset action
short duration
can be used flexibly around mealtimes
can be adjusted around eating habits
what is the drug class of pioglitazone and other glitazones/ thiazolidinediones
ppar agonist
enhance insulin sensitivity and promote glucose uptake utilization in peripheral tissue
suppress gluconeogenesis
use of pioglitazone must be continually reviewed and treatment stopped if response is insufficient, what are the associated long term side effects
hf and bladder cancer
how do dpp4 inhibitors/ gliptins work
block normal enzymatic inactivation of incretins, dpp4 and gip
increase endogenous insulin in response to glucose post prandially
reduce amount of glucose produced by liver
true or false, dpp4 inhibitors do not require dose adjustments in the case of renal failure
false
give some benefits of dpp4 inhibitors over sulfonylureas
not associated with weight gain and less hypoglycaemia
dulaglutide and similar ending drugs are glp1 receptor agonists, how do they work
bind and activate glp1 receptor
increase insulin secretion
suppresses glucagon secretion
slow gastric emptying
lower blood glucose levels
true or false, glp 1 receptor agonists have been reserved for combination therapy when other treatment options have failed
true
name a glp 1 receptor agonist that has been shown to have cv benefit and should be considered in patients with t2dm and established cvd
liraglutide
give one advantage of glp 1 receptor agonists esp injections in terms of side effect profile
positive effect on weight
sglt2 inhibitors are also known as gliflozins, how do they work
block glucose reabs in kidneys
promote excretion of excess glucose in urine
sglt2 inhibitors may be suitable for some patients when first line options are not appropriate but use is associated with risk of what?
DKA
which of the oral antidiabetic drugs is contraindicated in patients with heart failure
pioglitazone
All patients with Type 2 diabetes with chronic heart failure or established atherosclerotic CVD should be offered which class of drugs as soon as metformin tolerability is confirmed? Why?
sglt2 inhibitor with proven cv benefit as they have been proven to have cv outcomes
For adults whose type 2 diabetes is managed either by lifestyle and diet, or lifestyle and diet combined with a single drug not associated with hypoglycaemia, support them to aim for an HbA1c level of 48 mmol/mol . For adults on a drug associated with hypoglycaemia, support them to aim for an HbA1c level of
53
