Type 2 Diabetes Flashcards
What causes T2DM?
Resistance to insulin, usually associated with obesity
What is the target HbA1c for all type 2 diabetics?
<53mmol/mol (7%)
What should the BP target be for a type 2 diabetic?
<140/90mmHg
Briefly, what is the step-wise treatment for T2DM?
STEP 1 - diet/lifestyle changes for 3 months
STEP 2 - monotherapy metformin
STEP 3 - if above not tolerated or needs intensification, then switch/add DPP4 inhibitor, or pioglitazone, or sulphonylurea
STEP 4 - if above not tolerated/needs intensification, then give/add SGLT2-inhibitor
STEP 5 - if triple therapy not tolerated, then consider insulin treatment
How is the dosing of metformin given? Why is it given this way?
500mg OD 7/7, then BD 7/7, then TDS 7/7
It is titrated to reduce side effects
What other form of metformin can be given to minimise side effects?
Modified release
What complication can arise from metformin, and hence which organ needs to be functioning?
It can cause lactic acidosis, so renal function in patient must be good
Which class of anti-diabetic drug can cause the most weight gain?
Sulphonylureas
What are some examples of sulphonylureas?
Gliclazides
Glipizides
What risks are associated with the use of sulphonylureas?
They can increase the risk of hypos, and renal/hepatic impairment
What drugs are considered to be SGLT-2 inhibitors?
Dapagliflozin
Empagliflozin
In which patient groups are SGLT-2 inhibitors recommended in?
CV patients
What must patients taking SGLT-2 inhibitors have good functioning in, and why?
Renal function, because SGLT-2 inhibitors inhibit renally absorbed glucose
What 2 complications can arise from SGLT-2 inhibitors?
DKA
Fourniers gangrene
What is an examples of a thiazolidindione?
Pioglitazone
