T2DM

Question 1

What are the risk factors for T2DM?

Answer 1

• 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

Question 2

What is metabolic syndrome?

Answer 2

• HTN
• High blood lipids
• Fatty liver
• Abdominal adiposity (increased waist circumference)

Question 3

What is the treatment ladder for T2DM?

Answer 3

1. Lifestyle
2. Lifestyle+ metformin
   Unless GI side effects
   >58mmol/mol:
3. Lifestyle + metformin + further drugs OR Insulin
   DPP-4 inhibitor, pioglitazone, sulfonylurea or SGLT-2 inhibitor
   Still >58mmol/mol
4. Lifestyle + metformin + 2 further drugs
   Triple therapy not effective and BMI >35
5. Metformin + sulfonylurea + GLP-1 mimetic

Question 4

How would you advise a patient on diet and exercise?

Answer 4

• Minimise refined carbohydrates
• Cut portions by 1/3
• Aim for 150 mins of moderate or 75 min of vigorous exercise per week

Question 5

What does metformin do?

Answer 5

Increases insulin sensitivity and decreases liver production of glucose

Question 6

What are the side effects of metformin?

Answer 6

o Diarrhoea and abdominal pain

o Lactic acidosis

Question 7

What are the contraindications of metformin?

Answer 7

Avoid if eGFR <30ml/min

Question 8

What does pioglitazone do?

Answer 8

• Activates PPAR-gamma receptors on adipocytes to promote adipogenesis and fatty acid uptake
• Increases insulin sensitivity
• Decreases liver production of glucose

Question 9

What are the side effects of pioglitazone?

Answer 9

• Bone fracture
• Increased Rx infection
• Visual impairment
• Weight gain
• Bladder cancer

Question 10

What are long periods of taking pioglitazone potentially associated with?

Answer 10

o HF
o Bladder cancer
o Bone fracture

Question 11

What does Sulfonylureas do?

Answer 11

Stimulate insulin release from pancreas

Question 12

What are the side effects of Sulfonylureas?

Answer 12

o Weight gain
o Hypoglycaemia
o Increased risk of CV disease and MI when used as monotherapy

Question 13

Name a Sulfonylureas

Answer 13

• Gliclazide

- Glimepiride

Question 14

What are incretins?

Answer 14

Hormones produced by the GI tract

Question 15

What do incretins do?

Answer 15

o Increase insulin secretions
o Inhibit glucagon production
o Slow absorption by GI tract

Question 16

What is the main incretin?

Answer 16

GLP-1

Question 17

What is the most common DPP-4 inhibitor?

Answer 17

Sitagliptin

Question 18

What are the side effects of sitagliptin?

Answer 18

• GI tract upsets
• Symptoms of upper respiratory tract infection
• Pancreatitis

Question 19

What do DPP-4 inhibitors do?

Answer 19

Inhibits DPP-4 to prevent the inhibition of GLP-1

• Increases insulin secretions
• Inhibits glucagon production
• Slow absorption by GI tract

Question 20

What is the most common GLP-1 mimetic?

Answer 20

Exenatide

Litaglutide

Question 21

What are the side effects of GLP-1 mimetics?

Answer 21

• GI tract upset
• Weight loss
• Pancreatitis

Question 22

Give an example of an SGLT-2 inhibitor?

Answer 22

End in: -gliflozin

• Empagliflozin
• Canagliflozin
• Dapagliflozin

Question 23

What do SGLT-2 inhibitors do?

Answer 23

Inhibit the SGLT-2 protein

- SGLT2 protein is responsible for reabsorbing glucose from the urine into the blood

Question 24

Which SGLT-2 inhibitors show evidence of reducing CV events?

Answer 24

• Empagliflozin

- Canagliflozin

Question 25

What are the side effects of SGLT-2 inhibitors?

Answer 25

• UTIs/Urosepsis
• Constipation
• Balanoposthitis
• Fournier’s gangrene
• Diabetic ketoacidosis

Question 26

What is DESMOND?

Answer 26

Programme that supports people in identifying their own health risks and responding to them by setting their own specific behavioural goals