treatments for type 2 diabetes

Question 1

Rescue therapy and first-line treatment

Answer 1

Rescue therapy and first-line treatment

For symptomatic hyperglycemia, consider insulin or a sulfonylurea
Assess HbA1c, cardiovascular risk, and kidney function
Consider SGLT2 inhibitors for people with type 2 diabetes and chronic kidney disease
Offer metformin as first-line treatment
Consider DPP-4 inhibitors or pioglitazone if metformin is not tolerated
Consider adding an SGLT2 inhibitor if metformin tolerability is confirmed
Canagliflozin, dapagliflozin, and empagliflozin are recommended SGLT2 inhibitors
Ertugliflozin can be used if blood glucose is well controlled

Question 2

Pharmacological management

Answer 2

Pharmacological management

Type 2 diabetes treatment options: diet/exercise, metformin, sulfonylurea/insulin, bariatric surgery

Question 3

Alternative medications if metformin is not tolerated

Answer 3

Alternative medications if metformin is not tolerated

Consider DPP-4 inhibitors, pioglitazone, or sulfonylurea
SGLT2 inhibitors can be used as an alternative
Canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin are recommended SGLT2 inhibitors

Question 4

Sites of action for diabetes medications

Answer 4

Sites of action for diabetes medications

Metformin, GLP-1, fat analogues, a-Glycosidase inhibitors, insulin, lipase inhibitors, TZD, meglitinides, SGLT2 inhibitors, DPP IV inhibitors

Question 5

Medications for Diabetes Mellitus Type 2

Answer 5

Medications for Diabetes Mellitus Type 2

Biguanide (metformin), sulfonylureas, meglitinides, thiazolidinediones, alpha-glucosidase inhibitors, SGLT2 inhibitors, GLP-1 agonists, DPP-4 inhibitors

Question 6

Biguanides (Metformin)

Answer 6

Biguanides (Metformin)

Decreases hepatic gluconeogenesis
Makes insulin more effective in peripheral tissues
Used in obese diabetics
Does not stimulate insulin release
Metabolized by the kidney, so not recommended for renal patients

Question 7

Sulfonylureas

Answer 7

Sulfonylureas

Stimulates pancreatic cells to secrete more insulin
Increases sensitivity of peripheral tissues to insulin
Used to treat non-obese Type 2 diabetics
May encourage weight gain

Question 8

Meglitinides

Answer 8

Meglitinides

Stimulates pancreatic cells to secrete more insulin
Taken just before meals
Rapid onset, limited duration of action
Major adverse effect is hypoglycemia
Used in non-obese diabetics

Question 9

Thiazolidinediones (Glitazones)

Answer 9

Thiazolidinediones (Glitazones)

Sensitizes peripheral tissues to insulin
Used in obese diabetics
Inhibits glucose production in the liver
Improves sensitivity to insulin in muscle and fat tissue
May cause weight gain and have associations with bladder cancer, heart failure, and fractures in women

Question 10

Alpha-glucosidase Inhibitor

Answer 10

Alpha-glucosidase Inhibitor

Slows carbohydrate digestion and delays glucose absorption
Taken with meals
No longer recommended by NICE

Question 11

Other Type 2 Diabetes Medications

Answer 11

Other Type 2 Diabetes Medications

SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors
Other medications include amylin mimetics, bile acid sequestrants, and dopamine-2 agonists