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
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
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)
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
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
6
Q
What are examples of incretins?
A
GIP and GLP-1
7
Q
What do GLP1 analogues do?
A
- Help patients lose weight
- Protect against cardiovascular disease
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
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
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
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