Type 2 Diabetes

Question 1

Biguanide

Answer 1

Metformin (take with/after food)

GI side effects - increase dose slowly OD-BD-TDS (over weekly intervals or offer MR PREPS)

C/I:
lactic acidosis: dyspnoea, ab pain, muscle cramps, asthenia, hypothermia
eGFR = <30mL/min

Question 2

Sulfonylureas

Answer 2

Gliclazide(SA)
Glimperide
Tolbutamide (SA)
Glibenclamide (LA) - okay in pregnancy - avoid in elderly, risk of falls

Side effects: weight gain, N+V, D, risk of hypos, hepatic impairment

C/I: G6PD def, acute porphyria/ketoacidosis
Avoid, reduce dose in renal/hepatic impairment

Question 3

Thiazolidinediones

Answer 3

Pioglitazone

Side effects/avoid:
Heart failure risk
Risk of bladder cancer
Continue if HbA1c has decreased by 0.5% within 6 months of commencing treatment

Question 4

Sodium glucose co-transporter 2 inhibitors

Answer 4

Canagliflozin *
Dapagliflozin
Empagliflozin

MHRA warnings
Associated with DKA RISK
Lower limb amputation *
Ensure adequate hydration

Question 5

Alpha-glucosidase inhibitors

not commonly used

Answer 5

Acarbose

GI side effects

Interferes with sucrose absorption

Question 6

Dipeptidylpeptidase-4-inhibitors

GLIPTINS

Answer 6

Sitagliptin
Alogliptin
Linagliptin

C/I: DKA
Side effects: GI/skin reactions
Discontinue: acute pancreatitis (severe ab pain)

Question 7

Meglitinides

Answer 7

Repaglinide

Risk of hypo

Question 8

HbA1c values:

Answer 8

48mmol/mol (met or lifestyle alone)

53mmol/mol (2+ anti-diabetic drugs or drug associated with hypo risk)

Question 9

HbA1c values:

Answer 9

48mmol/mol (metformin) or (lifestyle alone, 3 months prior to drug treatment)

53mmol/mol (2+ anti-diabetic drugs or drug associated with hypo risk)

Question 10

Intensification treatment

Answer 10

1. Metformin + Sulfonylurea or Pio or DPP4i or SGCT2i *

2. Combine above:
met + sulf + dpp4i
met + sulf + pio
met + sulf + sgct2i
met + pio + sgct2i*

*not dapagliflozin
OR start insulin