Type 2 diabetes medication Flashcards
What is the HbA1c target for patients on one medication with lifestyle factors?
48 mmol/mol
What is the target HbA1c for patients changing lifestyle?
48mmol/mol
What is the first line medication for type 2 diabetes?
Metformin
What is the mechanism of action of metformin?
Activation of the AMP-activated protein kinase (AMPK)
Increases insulin sensitivity
Why is metformin a good option?
Doesn’t cause weight gain or Hypoglycaemia
What is the most common side effect of metformin?
Gastrointestinal upset
nausea, anorexia, diarrhoea
What can metformin cause in those with severe liver disease or renal failure?
Lactic acidosis
When should metformin be temporarily stopped?
When undergoing iodine-containing x-ray contrast media
Discontinued on the day of the procedure and for 48 hours thereafter
What are other contraindications of metformin?
CKD- creatinine is > 150 µmol/l (or eGFR < 30 ml/min)
Alcohol abuse
recent myocardial infarction- hypoxic tissue can cause lactic acidosis
What can be considered if patients can tolerate side effects of metformin?
Modified-release metformin should be considered
What is teh mechanism of action of SGLT-2 inhibitors?
Reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion
What are examples of SGLT-2 drugs?
Canagliflozin
Dapagliflozin
Empagliflozin
What is the main benefit of SGLT-2 drugs?
Cause weight loss
What are the adverse effects of SGLT-2 inhibitor drugs?
Urinary and genital infection
Normoglycaemic ketoacidosis
Increased risk of lower-limb amputation
What needs to be closely monitored in someone taking SGLT-2 inhibitor drugs?
Feet- due to the risk of LL amputation
What is the mechanism of acion of sulphonylureas?
They increase pancreatic insulin secretion
What are examples of sulphonylurea drugs?
Gliclazide
Glimepiride
What is the main contraindication of sulphonylurea drugs?
Breast feeding and pregnancy
What are the main adverse effects of sulphonylurea drugs?
- Hypoglycaemia- Sweaty, dizzy, confused
- Increased appetite and weight gain
What other adverse effects can sulphonylurea drugs cause?
- Cholestatic liver dysfunction
- Gastrointestinal disturbance.
What are rare effects of sulphonylurea drugs?
Bone marrow suppression
Peripheral neuropathy
What is an example of a Dipeptidyl peptidase 4 (DPP-4) inhibitors?
Vildagliptin
Sitagliptin
What is the mechanism of action of DPP-4 drugs?
Increase levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown
What are the advantages of DPP-4 drugs?
Don’t cause weight gain or hypoglycaemia
Whne would DPP-4 drugs be preferable to Thiazolidinedione?
If further weight gain would cause significant problems
What is the mechanism of action of Thiazolidinedione?
Agonists to the PPAR-gamma receptor and reduce peripheral insulin resistance.
What are examples of Thiazolidinediones?
Pioglitazone
What is the main contraindication of Thiazolidinediones?
- Heart failure as they can cause fluid retention
What are the main adverse effects of Thiazolidinediones?
weight gain
liver impairment
fluid retention
What is there an increased risk of with Thiazolidinediones?
Increased risk of fractures
Increased risk of bladder cancer
What needs to be monitored in a patient Thiazolidinediones?
LFT’s
What are examples of Glucagon-like peptide-1 (GLP-1) mimetics drugs?
Exenatide
What is the mechanism of action of GLP-1 drugs?
Increase insulin secretion and inhibit glucagon secretion
What can GLP-1 drugs result in?
Weight loss
