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Endocrine week 2 > T2DM theraputics > Flashcards

T2DM theraputics Flashcards

1
Q

What are the different oral-antihyperglycaemic agents available ?

A

Biguanides - Metaformin

Sulphonylureas: (think Gli…)

  • Glicazide (most common one used)
  • Glibenclamide
  • Glimeparide

Thiazolidinediones - Pioglitazone

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2
Q

What is the first line treatment of T2DM ?

A

Metaformin

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3
Q

How does metaformin work ?

A
  • It reduces HBA1c by reducing insulin resistance
  • Doesn’t really affect weight
  • Helps prevent micro and macrovascular complications
  • Doesn’t cause hypo’s
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4
Q

Is metaformin safe to be used in pregnancy ?

A

yes

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5
Q

What are the potential side effects of metaformin ?

A
  • 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
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6
Q

Due to Renal toxicity being a potential complication of metaformin use, what would indicate this is potentially happening and what would you do ?

A
  • Avoid or stop if eGFR <30ml/min or serum creatinine >150μmol/l
  • Half dose if eGFR 30-45 ml/min
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7
Q

What are the effects of sulphonylureas ?

A
  • Reduces HBA1c by increasing insulin secretion
  • Helps prevent microvascular complications but not macrovascular
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8
Q

What are the adverse effects of sulphonylureas ?

A
  • Risk of hypo’s
  • Can cause weight gain
  • GI upset and headaches
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9
Q

When would you not give a SU (sulphonylurea)?

A

Avoid in severe renal or hepatic failure

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10
Q

What is the 2nd line agent used in the treatment of T2DM ?

A

Sulphonylureas - glicazide

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11
Q

What are the effects of Thiazolidinediones?

A
  • 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
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12
Q

What is the main side effects to be worried about in patients on a Thiazolidinedione?

A
  • Heart failure - Fluid retention results in near doubling of risk of admission with heart failure
  • Also increased risk of hip fractures
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13
Q

In what patients are Thiazolidinediones (glitazones) not recommended in ?

A

Not recommended in those aged over 65 due to increased risk of hip fracture

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14
Q

What is the incretin effect ?

A

The incretin effect is when you give oral glucose and it produces a greater response than when given IV glucose

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15
Q

What are the other newet treatments available ?

A
  • GLP-1 receptor agonists
  • DPP-4 inhibitors
  • SGLT2 inhibitors
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16
Q

Give examples of GLP-1 agnoists

A
  • Exenatide
  • Exendin
  • Liraglutide
  • Lixisenatide
17
Q

What are the benefits of GLP-1 agnosits ?

A
  • 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)
18
Q

What are the potential side effects of GLP-1 agonists ?

A
  • Nausea – usually resolves in most by 6-8 weeks
  • Injectable
  • Pancreatitis, Pancreatic Cancer????
19
Q

Give examples of DPP-IV inhibitors

A
  • Vildagliptin,
  • Sitagliptin,
  • Saxagliptin,
  • Linagliptin

Think (liptin)

20
Q

What are the benefits of DPP-IV inhibitors ?

A
  • Promote insulin secretion from pancreas without hypoglycaemia
  • Suppress glucagon (which is increased in T2DM)
  • Weight neutral
  • Limited side effects
21
Q

What are the disadvantages of DPP-IV inhibitors ?

A

Generally well-tolerated but do have increased risk of pancreatitis

22
Q

Give examples of the SGLT2 inhibtors

A
  • DAPAGLIFLOZIN
  • CANAGLIFLOZIN
  • EMPAGLIFLOZIN

(Think flozin)

23
Q

How do SGLT-2 inhibitors work ?

A
  • Decrease sugar uptake and make you pee it out
  • Possible CV benefit
24
Q

What are the disadvantages of SGLT-2 inhibitors ?

A
  • Increase in thrush
  • Increase in urine infections
  • Dad said theres meant to be controversy about it and has possible side effects
25
Q

When is insulin given in T2DM?

A

When oral agents are no longer able to control the diabetes

26
Q

What would be continued along with when the patient goes on insulin ?

A

Metformin plus or minus SU

27
Q

Appreciate this overview of T2DM treatment

A

Endocrine week 2 (14 decks)

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