TYPE 2 DIABETES Flashcards
What is type 2 diabetes characterised by?
Insulin resistance
When does T2DM develop
Typically develops later in life
RF
- obese
- smokers
- increased age
- physical inactivity, poor diet choices
Which BMI is considered obese, how do you adjust for ethnicity and which one in particular?
Non-asian
> 30 obese
> 25 overweight
Asian
>28 obese
> 23 overweight
Patient with pre-diabetes
HbA1c of 42-47mmol/mol
* Can try and prevent diabetes with lifestyle advice
When is diabetes considered?
Diabetic considered HbA1c of 48mmol/mol +
T2DM: target HbA1c
48mmol or lower (6.5%)
1st line for T2DM
- Metformin
- MR if standard release not tolerated
When would you need to intensify treatment if on Metformin?
- If HbAlc is 58mmol mol or more, then intensify treatment
Treatment of diabetes (low CVD risk)
- Assess HbA1c, kidney function and cardiovascular risk
> Treat with Metformin
> Aim for individually agreed threshold - If HbA1c above the individually agreed threshold
> Add in DPP-4i, Pioglitazone, SU or SGLT-2i
> Aim for the individually agreed threshold - If HbA1c above the individually agreed threshold
> Triple therapy by adding or swapping class of anti-diabetic
> Aim for the individually agreed threshold
Classes of antidiabetic drugs
DPP-4i: ‘Gliptins
SU: Sulfonylurea
SGLT-2i: ‘Flozins
Treatment of Diabetes (High CVD Risk)
- Assess HbA1c, kidney function and cardiovascular risk
> Treat with Metformin
> Once metformin is tolerated: add a SGLT-2i
> If metformin is not tolerated: alone SGLT-2i
> Aim for the individually agreed threshold - If HbA1c above the individually agreed threshold
> Follow the guidelines for dual and triple therapy
> If patient at any point develops high risk - consider an SGLT-2i
When is a diabetic pt considered high risk for CVD?
Established atherosclerotic CVD / HF or a of QRISK2 > 10%
If patient cannot tolerate metformin due to side effects
Use MR preparation
Treatment of diabetes (metformin resistant)
- Assess HbA1c, kidney function and cardiovascular risk
> Treat with DPP-41, Pioglitazone, SU or SGLT-2i
> High risk of cardiovascular disease: SGLT-2i
> Aim for the individually agreed threshold - If HbA1c above the individually agreed threshold
> Treat with DPP-4i + Pioglitazone or
> DPP-4 + SU or Pioglitazone + SU
> Aim for the individually agreed threshold - If HbA1c still not controlled,
> insulin therapy to aim for individually agreed threshold