Treatment of type 2 diabetes Flashcards
what are the aspects of management?
education lifestyle changes medications treatment targets monitoring for complications
lifestyle advice
dietary changes exercise physical activity reduce alcohol consumption smoking cessation weight loss
most commonly used antidiabetic medication
metformin
what is metformin?
biguanide
contraindications for metformin
CKD
risk of lactic acidosis
poorly tolerated
how many steps of treatment algorithm are there?
4
step 1 of treatment algorithm
metformin
increase dose if needed
monitor renal function
consider modified release preparations if develop adverse GI effects
HBA1c aim on metformin alone
<48mmol/L
step 2 of treatment algorithm
dual therapy
when should step 2 be commenced?
if HBA1c >58mmol/L
dual therapy
metformin + sulfonylurea, DPP-4 inhibitor, pioglitazone or SGLT-2 inhibitor
HBA1c aim for dual therapy
<53mmol/L
when to move on to step 3 of treatment algorithm?
if HBA1c >58mmol/L
step 3 of treatment algorithms
triple therapy or insulin based regimen
triple therapy
metformin, DPP-4 inhibitor and sulfonylurea
metformin, pioglitazone and sulfonylurea
metformin, pioglitazone and SGLT-2 inhibitor
step 4 of treatment algorithm
metformin, sulfonylurea and GLP-1 agonist - strict criteria for GLP-1 agonist
treatment algorithm if metformin is contraindicated
3 steps
step 1 if metformin contraindicated
DPP-4 inhibitor or pioglitazone or sulfonylurea
HBA1c aim for step 1 if metformin contraindicated
<48mmol/L or <53mmol/L if sulfonylurea used
step 2 if metformin contraindicated
sulfonylurea and pioglitazone or
sulfonylurea and DPP-4 inhibitor or
pioglitazone and DPP-4 inhibitor
when to move on to step 2 if metformin contraindicated
> 58 mmol/L HBA1c
step 3 if metformin contraindicated
consider insulin based regimen if HBA1c >58mmol/L
what are the type of insulin regimes?
once/twice daily intermediate acting insulin
intermediate acting insulin and short-acting insulin as separate injections or pre-mixed formula
once daily long-acting insulin therapy
basal-bolus regimes
intermediate acting insulin
NPH
long-acting insulin therapy
glargine
determir
which insulin regime is used first?
intermediate
when is mixed intermediate and short acting insulin used?
after intermediate alone if HBA1c >75mmol/L
when is long acting insulin used?
patients with hypoglycaemia issues with intermediate insulin or when the patient relies on carers for injections
when are basal-bolus insulin regimes used?
patients with poor glucose control on pre-mixed regimes
HBA1c target for management with higher intensification regimes
<53mmol/L
what to do if HBA1c >58mmol/L
intensify medical therapy and reinforce dietary advice, lifestyle changes and drug adherence
