T2DM Flashcards
T2DM progression on pancreas
Starts as insulin resistance in the muscle and liver and progresses to secretory deficit
diabetes complications
- Retinopathy (leading cause)
- Cardiovascular disease (2-3x)
- 10 fold ERSD increase
- every 30sec amputation
- trans generational effects
- erectile dysfunction
- depression and anxiety
diabetes mortality ratios
Heart disease and stroke = 0.6
Cancer = 0.15
All other = 0.25
Shortens life span by 6 years
Does diabetes diagnosis decrease mortality?
NO
even people with impaired glucose tolerance have twice the mortality rate
Core ominous octect
Decreased insulin production
decreased glucose uptake
Additional ominous octect
- Increased glucagon
- decreased incretin effect
- increased lipolysis
- increased glucose reabsorption
- nerotransmitter dysfunction
- increased hepatic glucose production
extra ominous octect
inflammation
vascular insulin resistance
Life style impact
can reduce progression by 58% and increase insulin resistance but hard to keep up
Alpha-glucosidase inhibitors
Acarbose, 25% RR but 90% of people can’t tolerate GI A/E
Pioglitazone
72% RR but heart failure change (still used some places)
Rosiglitazone
62% RR but massive cardiac side effects
sulfonylureas
Work too well and cause hypoglycaemia
still use glicazide MR
thiazolidinediones TZD
cause heart attacks and heart failure
ACE inhibitors
Ramipril has no effect on T2DM progression
Metformin
31% RR decrease with manageable side effects
Treatment of <1.5% over target
start metformin and lifestyle
Treatment of >1.5 over target
Two agents, Metformin + SGLT2 is preferable
Treatment initiation with metabolic decompensation
(Very high glucose, ketosis, weight loss, polyuria, polydipsia, volume depletion), start insulin and +/- metformin till regulated then drop to metformin or metformin +
Ideal diabetes drug dose
Best at middle dose, high doses don’t increase glycemic control and only serve adverse effects
Metformin dosing
Start slow as GI side effects are common in the first two weeks 250mg BID, 250mg TID, 500mg BID, 500mg TID
metformin evidence
only about 600 people tested, and only controls sugars, provides no complication risk benefit
