T2DM prevention

Question 1

Life style improvements

Answer 1

Can reduce progression by 58% in patients with impaired glucose tolerance
- Aim for a decrease of 5%
- can also increase insulin sensitivity

Question 2

Metformin

Answer 2

can produce a 31% RR and has tolerable side effects

Question 3

Acarbose

Answer 3

Can produce a 25% RR but 90% of people have intolerable GI side effects

Question 4

Pioglitazone

Answer 4

can produce a 75% RR but high chance of heart failure (still sometimes used)

Question 5

rosiglitazone

Answer 5

can produce a 62% RR but has cardiac side effect

Question 6

Ramipril

Answer 6

No RR for diabetes

Question 7

Do we treat pre diabetes with drugs?

Answer 7

No, the progression to full diabetes only happens in 40% of that population, not worth it

Question 8

Where does GLP1 act

Answer 8

beta-cells (insulin release)
Liver (glucose production)
Small intestine (decreased incretin)
Alpha-cells (increased glucagon)
Brain (NRT dysfunction)

Question 9

where do DPP4s act

Answer 9

Beta-cells (insulin release)
Liver (glucose production)
Small intestine (decreased incretin)
Alpha-cells (increased glucagon)

Question 10

where metformin act

Answer 10

liver?

Question 11

Glycemic treatment targets

Answer 11

A1C (<7) usually
Fasting glucose/ pre meal 4-7
post meal glucose 5-10

Question 12

Step 1: diagnosis

Answer 12

Set A1C goals specific to patient, start metformin and lifestyle. unless >1.5% above target then start with 2 drugs. If metabolically decompensated start insulin

Question 13

Step 2: intensification

Answer 13

If A1C not at target after 3-6 months start secondary drug. SGLT2i is the preferred choice or GLP-1 if weight loss needed.

Question 14

Metabolic decompilation

Answer 14

Polyuria
Polydipsia
Weight loss
Volume depletion

Question 15

Metformin dose titration

Answer 15

Used to prevent GI upset
250mg BID, 250mg TID, 500 BID, 500 TID, 1000 BID