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Week 14- Endocrinology > Type 2 diabetes care > Flashcards

Type 2 diabetes care Flashcards

1
Q

What are the microvascular complications of diabetes?

A
  • Retinopathy
  • Nephropathy
  • Foot disease (ulceration)
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2
Q

What are the macrovascular complications of diabetes?

A
  • Myocardial infarction
  • Stroke
  • Heart failure
  • Peripheral vascular disease
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3
Q

What is the management of macrovascular complications of diabetes? (simple)

A
  • Glycaemic control

* Conventional CV risk factor modification (smoking, BP, Cholesterol)

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4
Q

What are the biomedical targets for Type 2 diabetes?

A
  • HbA1c: 7% (or individualised)
  • BP: <130/80 (ACEi or ARB, CCB, Thiazide diuretic)
  • Cholesterol: statin if >40 yrs
  • Normal body weight
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5
Q

What are the lifestyle measures for type 2 diabetes?

A

•Diet and calorie restriction
- weight watchers
- 800kcal diet with food reintroduction
•Increased physical activity

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6
Q

What is the suffix for DPP-4 inhibitors?

A

Gliptins

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7
Q

What is the suffix for GLP-1 receptor agonists?

A

Tides

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8
Q

What is the suffix for SGLT-2 inhibitors?

A

Flozin

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9
Q

What is the first line drug for T2DM?

A

Metformin (sometimes SU)

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10
Q

What is the second line drug treatment of T2DM?

A
  • Two agents

* Add SU, Flozin (SGLT-2i), Gliptin (DPP-4 i) or Glitazone

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11
Q

What is the third line drug treatment?

A
  • Three agents

* Add SU, flozin, Gliptin or Glitazone or start injectable therapy with GLP-1 agonist or insulin

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12
Q

What is the 4th line drug treatment of T2DM?

A
  • Four agents

* Add SU, Flozin, Gliptin or glitazone or start injectable therapy with insulin or GLP-1 agonist

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13
Q

What is the mechanism of action of metformin?

A
  • Suppress hepatic gluconeogenesis, reducing glucose output from the liver
  • Increases peripheral insulin sensitivity, increasing glucose uptake and utilisation
  • increase AMPK activity
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14
Q

What are the pros of metformin?

A
  • Moderate efficacy
  • Weight reduction
  • Low hypo risk
  • CV benefit
  • Extensive experience
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15
Q

What are the cons of metformin?

A
  • GI side effects
  • Cant use if eGFR<30
  • Small risk of lactic acidosis
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16
Q

What is the mechanism of action of sulfonylureas?

A
  • Close potassium channels on beta cells, stimulating the release of stored insulin
  • Increased cellular uptake and glycogenesis; reduces gluconeogenesis
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17
Q

What are the pros of sulfonylureas?

A
  • High efficacy

* Extensive experience

18
Q

What are the cons of sulphonylureas

A
  • No cardiovascular benefit
  • Weight gain
  • High hypo risk
  • Caution in CKD
19
Q

When should you consider prescribing a sulphonylurea first line?

A
  • Metformin not tolerated

* Osmotic symptoms (but once resolved add metformin)

20
Q

What is the mechanism of action of DPP-4 inhibitors?

A
  • Inhibit DPP-4 and enhance the effects of endogenous incretins e.g. GLP-1
  • Increase glucose mediated insulin secretion, suppress glucagon secretion
21
Q

What are the pros of DPP-4 inhibitors?

A
  • Low/moderate efficacy
  • Low hypo risk
  • Few adverse effects
22
Q

What are the cons of DPP-4 inhibitors?

A
  • Weight neutral
  • No CV benefit
  • Reduce dose in CKD
23
Q

What is the mechanism of action of SGLT2i?

A
  • Inhibits SGLT2 in the proximal convoluted tubule of the kidney
  • Decreases renal reabsorption of glucose
24
Q

What are the pros of SGLT2i?

A
  • Moderate efficacy
  • CV benefit (BP and HF)
  • Renal benefit (CANA)
  • Weight loss
  • Low hypo risk
25
Q

What are the cons of SGLT2i?

A
  • Risk of GU infection

* Small risk of hypovolaemia/DKA

26
Q

What is the mechanism of action of thiazolidinediones (glitazones)?

A
  • PPAR gamma receptor agonists

* Increase the sensitivity of fat, muscles, and liver to endogenous and exogenous insulin

27
Q

What are the pros of glitazones?

A
  • Moderte efficay
  • Probably low CV protection
  • Low hypo risk
  • Past experience
28
Q

What are the cons of glitazones?

A
  • Weight gain
  • fluid retention
  • Fractures
29
Q

Which T2DM drugs cause weight gain?

A
  • Sulphonylurea
  • Glitazone
  • Insulin
30
Q

Which T2DM drugs cause weight loss?

A
  • Metformin
  • SGLT2i
  • GLP-1 receptor agonists
31
Q

What is the mechanism of action of GLP-1 receptor agonists?

A
  • Increase glucose mediated insulin secretion
  • Suppresses glucagon secretion
  • Increases satiety and appetite
32
Q

What are the pros of GLP-1 agonists?

A
  • High efficacy
  • CV benefit
  • Low hypo risk
  • Weight loss
33
Q

What are the cons of GLP-1 agonists?

A
  • Injected
  • GI side effects
  • Uncertain safety re. pancreas
34
Q

What is the mechasnim of action of insulin?

A
  • Increase glucose uptake and utilisation in skeletal muscle
  • Reduces hepatic output, increases glycogenesis
  • Decrease lipolysis
  • Decrease gluconeogenesis
35
Q

What are the pros of insulin?

A
  • High efficacy

* Extensive experience

36
Q

What are the cons of insulin?

A
  • Injected
  • No CV benefit
  • Weight gain
  • Highest hypoglycaemia risk
37
Q

What should you stop if you add GLP-1 agonist?

A

DPP-4 inhibitor

38
Q

What are the risks of prescribing in the elderly?

A
  • polypharmacy risk with drug interactions
  • Increased likelihood of adverse events to drugs
  • Increased likelihood of hypoglycaemia
39
Q

What are the prescribing considerations in renal disease?

A
  • Stop metformin when eGFR<30ml/min/1.73m2
  • Caution with SU as increased risk of hypoglycaemia
  • Dose-dose reduction required for some tides and gliptins
  • SGLT2i are less effective at glucose lowering in CKD (eGFR>60)
  • Renal protection with CANA
40
Q

What are the prescribing considerations in heart failure?

A
  • May use metformin in chronic heart failure, withhold during acute episodes of failure
  • Stop or do not initiate glitazone
  • Flozins reduced hospitalisation for heart failure with and without diabetes

Week 14- Endocrinology (10 decks)

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