Pharmacology of non-insulin treatment options in diabetes for type 2 diabetes Flashcards

1
Q

What does cardiorenal mean?

A

first manifestation of cardiovascular complications in type 2 diabetes

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2
Q

What are the objectives of treating T2D?

A

Reducing the risk of:

  • cardiovascular morbidity and mortality
  • chronic kidney disease
  • microvascular complications

Weight reduction

  • increasing physical activity
  • decreasing dietary fat
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3
Q

What are lifestyle interventions for T2D?

A
  • Compliance
  • Lifestyle and patient education
  • 150 min moderate/vigorous exercise per week over 3 days
  • Dietitian
  • Local education programmes (e.g. Desmond and Xpert)
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4
Q

How is T2DM prevented?

A
  • Early treatment and prevention key to reducing T2DM burden
  • Intensive diet and exercise programmes can delay onset or prevent T2DM
  • Including use of metformin and TZDs
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5
Q

What are incretins?

A
  • Incretins are hormones secreted by intestinal endocrine cells in response to nutrient intake
  • In response to food intake
  • Incretins influence glucose homeostasis via multiple actions including glucose-dependent insulin secretion, postprandial glucagon suppression, and slowing of gastric emptying
  • Increase beta cells to release insulin
  • Promotes satiety and reduces appetite
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6
Q

What are examples of incretins?

A

GIP and GLP-1

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7
Q

What do GLP1 analogues do?

A
  • Help patients lose weight
  • Protect against cardiovascular disease
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8
Q

What are disadvantages of GLP1 analogues

A
  • Injectable only
  • Large increase in GLP-1 level
  • Induces delay in gastric emptying
  • Likely to induce nausea/ vomiting
  • Induces weight loss
  • Effects are mediated by GLP-1 Receptor
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9
Q

What do DPP-4 Inhibitors do?

A
  • Targets enzymes that break down GLP-1
  • Dipeptidyl-peptidase 4 (DPP-4) is an enzyme present in vascular endothelial lining which inactivates the incretin hormones GIP and GLP-1
  • DPP-4 Inhibitors are competitive antagonists of the DPP-4 enzyme - enhancing the effects of both GIP and GLP-1
  • Glucose dependent reduction in fasting and postprandial glucose levels in addition to decreasing glucagon secretion
  • Low risk hypoglycaemia
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10
Q

What are advantages of DPP-4 Inhibitors?

A
  • Orally available
  • Small increase in endogenous GLP-1
  • Little effect on gastric emptying
  • Do not cause nausea/ vomiting
  • No effect on weight
  • Effects are mediated by multiple receptors
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11
Q

What are SGLT-2i’s?

A
  • Sodium glucose co-transporter 2 inhibitor
  • Inhibits reabsorption of glucose in renal tubules by inhibiting SGLT2 transporter
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