T2DM Flashcards
What are the risk factors for T2DM?
- Family Hx
- Black and African Caribbean backgrounds (3X)
- South Asian backgrounds (6X)
- Increasing age
- Low fibre, high glyaemic index diet
- Inactivity
- Obesity
- Socio-economic deprivation
- Metabolic syndrome
What is metabolic syndrome?
- HTN
- High blood lipids
- Fatty liver
- Abdominal adiposity (increased waist circumference)
What is the treatment ladder for T2DM?
- Lifestyle
- Lifestyle+ metformin
Unless GI side effects
>58mmol/mol: - Lifestyle + metformin + further drugs OR Insulin
DPP-4 inhibitor, pioglitazone, sulfonylurea or SGLT-2 inhibitor
Still >58mmol/mol - Lifestyle + metformin + 2 further drugs
Triple therapy not effective and BMI >35 - Metformin + sulfonylurea + GLP-1 mimetic
How would you advise a patient on diet and exercise?
- Minimise refined carbohydrates
- Cut portions by 1/3
- Aim for 150 mins of moderate or 75 min of vigorous exercise per week
What does metformin do?
Increases insulin sensitivity and decreases liver production of glucose
What are the side effects of metformin?
o Diarrhoea and abdominal pain
o Lactic acidosis
What are the contraindications of metformin?
Avoid if eGFR <30ml/min
What does pioglitazone do?
- Activates PPAR-gamma receptors on adipocytes to promote adipogenesis and fatty acid uptake
- Increases insulin sensitivity
- Decreases liver production of glucose
What are the side effects of pioglitazone?
- Bone fracture
- Increased Rx infection
- Visual impairment
- Weight gain
- Bladder cancer
What are long periods of taking pioglitazone potentially associated with?
o HF
o Bladder cancer
o Bone fracture
What does Sulfonylureas do?
Stimulate insulin release from pancreas
What are the side effects of Sulfonylureas?
o Weight gain
o Hypoglycaemia
o Increased risk of CV disease and MI when used as monotherapy
Name a Sulfonylureas
- Gliclazide
- Glimepiride
What are incretins?
Hormones produced by the GI tract
What do incretins do?
o Increase insulin secretions
o Inhibit glucagon production
o Slow absorption by GI tract
What is the main incretin?
GLP-1
What is the most common DPP-4 inhibitor?
Sitagliptin
What are the side effects of sitagliptin?
- GI tract upsets
- Symptoms of upper respiratory tract infection
- Pancreatitis
What do DPP-4 inhibitors do?
Inhibits DPP-4 to prevent the inhibition of GLP-1
- Increases insulin secretions
- Inhibits glucagon production
- Slow absorption by GI tract
What is the most common GLP-1 mimetic?
Exenatide
Litaglutide
What are the side effects of GLP-1 mimetics?
- GI tract upset
- Weight loss
- Pancreatitis
Give an example of an SGLT-2 inhibitor?
End in: -gliflozin
- Empagliflozin
- Canagliflozin
- Dapagliflozin
What do SGLT-2 inhibitors do?
Inhibit the SGLT-2 protein
- SGLT2 protein is responsible for reabsorbing glucose from the urine into the blood
Which SGLT-2 inhibitors show evidence of reducing CV events?
- Empagliflozin
- Canagliflozin
What are the side effects of SGLT-2 inhibitors?
- UTIs/Urosepsis
- Constipation
- Balanoposthitis
- Fournier’s gangrene
- Diabetic ketoacidosis
What is DESMOND?
Programme that supports people in identifying their own health risks and responding to them by setting their own specific behavioural goals
