T2DM theraputics Flashcards
What are the different oral-antihyperglycaemic agents available ?
Biguanides - Metaformin
Sulphonylureas: (think Gli…)
- Glicazide (most common one used)
- Glibenclamide
- Glimeparide
Thiazolidinediones - Pioglitazone
What is the first line treatment of T2DM ?
Metaformin
How does metaformin work ?
- It reduces HBA1c by reducing insulin resistance
- Doesn’t really affect weight
- Helps prevent micro and macrovascular complications
- Doesn’t cause hypo’s
Is metaformin safe to be used in pregnancy ?
yes
What are the potential side effects of metaformin ?
- GI problems - anorexia, nausea, vomiting, diarrhoea, abdo pain, taste disturbances
- Can cause anaemia (rare) due to interfering in B12 and folic acid absorption
- Lactic acidosis (rare)
- Liver failure
- Rash
- Renal toxicity
Due to Renal toxicity being a potential complication of metaformin use, what would indicate this is potentially happening and what would you do ?
- Avoid or stop if eGFR <30ml/min or serum creatinine >150μmol/l
- Half dose if eGFR 30-45 ml/min
What are the effects of sulphonylureas ?
- Reduces HBA1c by increasing insulin secretion
- Helps prevent microvascular complications but not macrovascular
What are the adverse effects of sulphonylureas ?
- Risk of hypo’s
- Can cause weight gain
- GI upset and headaches
When would you not give a SU (sulphonylurea)?
Avoid in severe renal or hepatic failure
What is the 2nd line agent used in the treatment of T2DM ?
Sulphonylureas - glicazide
What are the effects of Thiazolidinediones?
- Reduces HBA1c by increasing insulin sensitivity
- Doesn’t cause hypo’s unless used with a SU
- Weight gain is very common - due to increased S/C fat and fluid retention
- Helps prevent again micro and macrovascular complications except microalbuminuria
What is the main side effects to be worried about in patients on a Thiazolidinedione?
- Heart failure - Fluid retention results in near doubling of risk of admission with heart failure
- Also increased risk of hip fractures
In what patients are Thiazolidinediones (glitazones) not recommended in ?
Not recommended in those aged over 65 due to increased risk of hip fracture
What is the incretin effect ?
The incretin effect is when you give oral glucose and it produces a greater response than when given IV glucose
What are the other newet treatments available ?
- GLP-1 receptor agonists
- DPP-4 inhibitors
- SGLT2 inhibitors
Give examples of GLP-1 agnoists
- Exenatide
- Exendin
- Liraglutide
- Lixisenatide
What are the benefits of GLP-1 agnosits ?
- Promote insulin secretion from pancreas without hypoglycaemia
- Suppress glucagon (which is increased in T2DM)
- Decrease gastric emptying – early satiety
- Act on hypothalamus – reduce appetite – resulting weight loss (~3kg)
What are the potential side effects of GLP-1 agonists ?
- Nausea – usually resolves in most by 6-8 weeks
- Injectable
- Pancreatitis, Pancreatic Cancer????
Give examples of DPP-IV inhibitors
- Vildagliptin,
- Sitagliptin,
- Saxagliptin,
- Linagliptin
Think (liptin)
What are the benefits of DPP-IV inhibitors ?
- Promote insulin secretion from pancreas without hypoglycaemia
- Suppress glucagon (which is increased in T2DM)
- Weight neutral
- Limited side effects
What are the disadvantages of DPP-IV inhibitors ?
Generally well-tolerated but do have increased risk of pancreatitis
Give examples of the SGLT2 inhibtors
- DAPAGLIFLOZIN
- CANAGLIFLOZIN
- EMPAGLIFLOZIN
(Think flozin)
How do SGLT-2 inhibitors work ?
- Decrease sugar uptake and make you pee it out
- Possible CV benefit
What are the disadvantages of SGLT-2 inhibitors ?
- Increase in thrush
- Increase in urine infections
- Dad said theres meant to be controversy about it and has possible side effects
