TYPE 2 DIABETES Flashcards

1
Q

What is type 2 diabetes characterised by?

A

Insulin resistance

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2
Q

When does T2DM develop

A

Typically develops later in life

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3
Q

RF

A
  • obese
  • smokers
  • increased age
  • physical inactivity, poor diet choices
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4
Q

Which BMI is considered obese, how do you adjust for ethnicity and which one in particular?

A

Non-asian
> 30 obese
> 25 overweight

Asian
>28 obese
> 23 overweight

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5
Q

Patient with pre-diabetes

A

HbA1c of 42-47mmol/mol
* Can try and prevent diabetes with lifestyle advice

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6
Q

When is diabetes considered?

A

Diabetic considered HbA1c of 48mmol/mol +

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7
Q

T2DM: target HbA1c

A

48mmol or lower (6.5%)

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8
Q

1st line for T2DM

A
  • Metformin
  • MR if standard release not tolerated
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9
Q

When would you need to intensify treatment if on Metformin?

A
  • If HbAlc is 58mmol mol or more, then intensify treatment
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10
Q

Treatment of diabetes (low CVD risk)

A
  1. Assess HbA1c, kidney function and cardiovascular risk
    > Treat with Metformin
    > Aim for individually agreed threshold
  2. If HbA1c above the individually agreed threshold
    > Add in DPP-4i, Pioglitazone, SU or SGLT-2i
    > Aim for the individually agreed threshold
  3. If HbA1c above the individually agreed threshold
    > Triple therapy by adding or swapping class of anti-diabetic
    > Aim for the individually agreed threshold
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11
Q

Classes of antidiabetic drugs

A

DPP-4i: ‘Gliptins
SU: Sulfonylurea
SGLT-2i: ‘Flozins

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12
Q

Treatment of Diabetes (High CVD Risk)

A
  1. 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
  2. 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
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13
Q

When is a diabetic pt considered high risk for CVD?

A

Established atherosclerotic CVD / HF or a of QRISK2 > 10%

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14
Q

If patient cannot tolerate metformin due to side effects

A

Use MR preparation

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15
Q

Treatment of diabetes (metformin resistant)

A
  1. 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
  2. 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
  3. If HbA1c still not controlled,
    > insulin therapy to aim for individually agreed threshold
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