Treatment of Type 1 and Type 2 Diabetes Mellitus

Question 1

For type 1 diabetes mellitus, what are the different types of therapy for patients?

Answer 1

• Multiple daily injection basal-bolus insulin regimens

- Mixed (biphasic) regimen

Question 2

First line choice for patient with type 1 DM?

Answer 2

Multiple daily injection basal-bolus insulin regimens.

• Insulin detemir twice daily (long acting)

alt:

Question 3

What is the initial treatment of type 2 DM?

Answer 3

Metformin hydrochloride

• weight loss
• reduced risk of hypoglycaemic events
• long-term cardiovascular benefits associated

Question 4

If monotherapy is contraindicated, what mono-therapy should be used instead?

Answer 4

First choice:
- Sulfonylurea

or

• Dipeptidyl peptidase-4 inhibitor

or

• Pioglitazone

Question 5

What is the first intensification of treatment for DMT2?

Dual therapy

Answer 5

Metformin hydrochloride combined with one of the following:

• a sulfonylurea
• pioglitazone
• dipeptidylpeptidase-4 inhibitor
• Na-glucose co-transporter 2 inhibitor

Question 6

What is the second intensification of treatment for DMT2?

Triple therapy

Answer 6

Metformin + dipeptidylpeptidase-4 inhibitor + sulfonylurea

Metformin + pioglitazone + sulfonylurea

Metformin + sulfonylurea _ one of the Na glucose co-transporter 2 inhibitors

Metformin + pioglitazone + Na glucose co-transporter 2 inhibitor

Question 7

If triple therapy is not effective, what can be added to change the treatment?

Answer 7

Glucagon-like peptide- 1 receptor agonist can be added as part of a triple combination regimen as part of a triple combination regimen with metformin and sulfonylurea.

Question 8

If metformin is not tolerated, what should the initial mono-therapy be?

Answer 8

First Choice:
Sulfonylurea: (glibenclamide, gliclazide, glimepiride, glipizide, or tolbutamide)

or

a dipeptidyl peptidase-4 inhibitor (linagliptin, saxagliptin, sitagliptin, or vildagliptin)

or

Pioglitazone.

Question 9

If intensification therapy is not effective, what drug can be added?

Answer 9

Insulin with metformin continued unless it is contra-indicated or not tolerated:

• Human isophane OD or BD
• Human isophane insulin in combination with a short acting insulin
• Biphasic preparations

Question 10

What are the side effects and contraindications and use in pregnancy of metformin?

Answer 10

Side effects:
Abdominal pain, decreased appetite, GI disorder, nausea, altered taste, vomiting

Contraindications:
Acute metabolic acidosis (including lactic acidosis and diabetic ketoacidosis)

Pregnancy:
Can be used in pregnancy for both pre-existing and gestational diabetes

Question 11

Names of sulfonylureas? (5)

Answer 11

Glibenclamide
Gliclazide
Glimepiride
Glipizide
Tolbutamide

Question 12

What are the side effects, contraindications, cautions and use in pregnancy of Sulfinylureas?

Answer 12

Side effects:
Abdominal pain, diarrhoea, hypoglycaemia, nausea

Contraindications:
Presence of ketoacidosis

Cautions:
Can encourage weight gain, in the elderly (STOPP criteria), G6PD deficiency

Pregnancy:
Generally be avoided because of the risk of neonatal hypoglycaemia

Question 13

What are the names of dipeptidylpeptidase-4 inhibitors? (5)

Answer 13

Alogliptin 
Linagliptin 
Sitagliptin
Saxagliptin 
Vildagliptin

Question 14

What are the dose adjustments for renal impairment for dipeptidylpeptidase-4 inhibitors?

Answer 14

Reduce dose to 12.5 mg once daily if creatinine clearance 30–50 mL/minute.

Reduce dose to 6.25 mg once daily if creatinine clearance less than 30 mL/minute.

Question 15

Names of sodium glucose co-transporter 2 inhibitors?

Answer 15

Canagliflozin
Dapagliflozin
Empagliflozin

Question 16

Names of glucagon-like peptide-1 receptor agonists?

Answer 16

Dulaglutide
Exenatide
Liraglutide
Lixisenatide