Type 2 Diabetes Drugs

Question 1

first line management of T”DM?

Answer 1

metformin

Question 2

side effects of metformin?

Answer 2

GI upset
lactic acidosis
B12 deficiency
liver failure
weight loss
rash

Question 3

does metformin increase risk of hypoglycaemia?

Answer 3

no

Question 4

examples of sulphonylureas (SURs)?

Answer 4

gliclazide
glibenclamide
glimeparide

Question 5

side effects of SURs?

Answer 5

hypoglycaemia
increased appetite and weight gain
SIADH
abdo pain
diarrhoea
nausea
can cause liver dysfunction

Question 6

how do SURs work?

Answer 6

increase insulin secretion by insulin independent action

Question 7

adverse effects of pioglitazone (type of thiazolidinedione)?

Answer 7

weight gain
increased fracture risk
increased risk of bladder cancer
worsens heart failure
fluid retention
liver dysfunction

Question 8

example of incretin analogue?

Answer 8

exanetide (GLP1 mimetic)

- (GLP1 is one of the main incretin hormones)

Question 9

other incretin hormone?

Answer 9

GIP

Question 10

side effects of incretin analogues?

Answer 10

delay gastric emptying
decreased appetite (weight loss)

Question 11

examples of DPP-4 inhibitors?

Answer 11

sitagliptin

vildagliptin

Question 12

how do DPP-4 inhibitors work?

Answer 12

DPP-4 enzyme inhibits action of incretin hormones so blocking DPP-4 promotes action of incretins

Question 13

side effects of DPP-4 inhibitors?

Answer 13

..

Question 14

do DPP-4 inhibitors cause weight gain or hypoglycaemia?

Answer 14

no doesnt cause either

Question 15

example of SGLT-2 inhibitors?

Answer 15

dapagliflozin

Question 16

how do SGLT2 inhibitors work?

Answer 16

reduce reabsorption of glucose in convoluted tubule of kidneys so glucose is passed via urine

Question 17

side effects of SGLT2 inhibitors?

Answer 17

increased UTI risk (die to glycosuria)
weight loss
thrush (glycosuria)

Question 18

example of alpha-glucosidase inhibitor?

Answer 18

acarbose

Question 19

first line management of T2DM?

Answer 19

metformin

Question 20

when should a second drug be added to metformin?

Answer 20

if HbA1c has risen to 58 while taking metformin

Question 21

what second drug should be added to metformin if HbA1c is >58?

Answer 21

any one of

• SUR
• SGLT2 inhibitor
• gliptin (DPP-4 inhibitor)
• pioglitazone (not really used)

Question 22

when is a 3rd drug added?

Answer 22

if HbA1c still >58 on two drugs

Question 23

triple therapy combinations if HbA1c >58 on 2 drugs?

Answer 23

metformin + any combination of SUR, SGLT2, DPP4 and pioglitazone