Treatment algorhythm

Question 1

First Line

Answer 1

Metformin

Question 2

Second Line

Answer 2

Sulphonylureas
DPP4 inhibitors
SGLT2 inhibitors

Question 3

Sulphonylureas (examples)

Answer 3

• Gliclazide
• Glipizide
• Glibenclamide
• Glimepiride

Question 4

Third Line

Answer 4

Sulphonylureas
DPP4 inhibitors
SGLT2 inhibitors
GLP1 receptor agonists/insulin

Question 5

Metformin Pros

Answer 5

Weight loss

Low risk of hypos

Question 6

Metformin Risks

Answer 6

GI side effects
Vitamin B12 deficiency
Lactic acidosis
Reduce dose in renal impairement

Question 7

Sulphonylurea Risks

Answer 7

Weight gain
Hypoglyceamia
Avoid in renal impairement

Question 8

DPP4 Inhibitor (examples)

Answer 8

Alogliptin
Linagliptin
Saxagliptin
Sitagliptin
Vildagliptin

Question 9

DPP4 Inhibitor Pros

Answer 9

Low risk of hypos
No impact on weight
Improved post-parandial control

Question 10

DPP4 Inhibitor Risks

Answer 10

Avoid in pancreatitis
MSK pain
Reduce dose in renal impairement

Question 11

GLP-1 Receptor antagonist (examples)

Answer 11

Dulaglutide
Exenatide
Liraglutide

Question 12

GLP-1 Receptor antagonist Pros

Answer 12

Low risk of hypos
Weight loss
Post-parandial control
Slows kidney disease

Question 13

GLP-1 Receptor antagonist Risks

Answer 13

Avoid in pancreatitis/MEN1/Thyroid cancer
GI side effects
Avoid in severe renal impairement

Question 14

SGLT2 inhibitor examples

Answer 14

Dapagliflozin
Empagliflozin
Ertugliflozin

Question 15

SGLT2 inhibitor Pros

Answer 15

Low risk of hypos
Weight loss
Reduces CVD
Reduces BP
Slows renal disease

Question 16

SGLT2 inhibitor Risks

Answer 16

Avoid in fasting, low carb diets
GU infection
Increases Cr
Volume depletion
DKA

Question 17

Insulin Risks

Answer 17

Hypoglyceamia

Weight gain

Question 18

Alpha glucosidase inhibitors example

Answer 18

Acarbose

Question 19

Alpha glucosidase inhibitors Pros

Answer 19

Low risk of hypos
Weight unaffected
Improves post-parandial glucose

Question 20

Alpha glucosidase inhibitors Risks

Answer 20

GI side effects

Reduce dose in renal impairement

Question 21

Thiazolidinedione examples

Answer 21

Pioglitazone

Rosiglitazone

Question 22

Thiazolidinedione pros

Answer 22

Hypos unlikely

Protects against Beta cell failure

Question 23

Thiazolidinedione Risks

Answer 23

Weight gain
Peripheral oedema
Increase risk of heart failure
Macular oedema
Fractures in women
Risk of bladder cancer

Question 24

Metformin Doses

Answer 24

CrCL >/= 60 500 mg PO BD max 2g (MR OD nocte)

CrCL 30-60 500 mg PO OD max 1 g (MR OD nocte)

Question 25

Long acting Sulphonylurea doses

Answer 25

Glibenclamide 2.5 mg OD-BD max 20 mg | Glimepiride 1 mg OD max 4 mg

Question 26

Short acting Sulphonylureas doses

Answer 26

Gliclazide 40 mg OD-BD max 320 mg per day (MR 30 mg OD mane, max 120 mg per day) Glipizide 2.5 mg OD-BD max 40 mg

Question 27

Vildagliptin dose

Answer 27

CrCL >60 50 mg BD | CrCL <60 50 mg OD

Question 28

Triple Oral therapy

Answer 28

Metformin + sulphonylurea + DPP4 inhibitor Metformin + sulphonylurea + Thiazolidinedione Metformin + sulphonylurea + SGLT2 inhibitor Metformin + sulphonylurea + Acarbose