Diabetes Flashcards
(30 cards)
How often is a diabetic review carried out?
annually
What are the 5 main components of the diabetic review history?
- lifestyle assessment (diet, activity, alcohol, smoking)
- current health
- history of hypo-/hyper-glycaemic episodes
- medication review and compliance
- patient concerns
What 9 examinations/investigations should be carried out at the annual diabetic review?
- BP
- Weight/BMI
- HbA1c
- lipids
- U&Es
- Urinalysis
- Fundoscopy
- cardiovascular examination
- foot examination
What are the diagnostic criteria for diabetes?
Random blood glucose >11.1
Fasting blood glucose >7.0
OGTT >11.1
HbA1c >48mmol/L
Symptoms + 1 positive blood test
Asymptomatic + 2 positive blood tests
What are the criteria of pre-diabetes?
Fasting blood glucose 6.1 - 6.9
OGTT 7.8 - 11
HbA1c 42-47
What is the most appropriate initial management of an asymptomatic patient with newly diagnosed diabetes and HbA1c of 49mmol/L?
- Lifestyle changes alone
What is the most appropriate initial management of symptomatic patients with newly diagnosed diabetes?
- Metformin
What is the mechanism of action of Metformin?
- Biguanide
- reduces hepatic glucose output
What are the benefits of metformin?
- weight neutral
- oral, once-a-day
- low risk of hypoglycaemia
What are the major side-effects of metformin?
- lactic acidosis
- GI disturbance
- B12 deficiency
When is metformin contraindicated?
- AKI
- eGFR<30
What are the two most common drugs used in combination with Metformin for dual therapy of diabetes?
- Gliclazide (sulfonylureas)
- Sitagliptin (DPP4 Inhibitor)
What are the criteria for stepping up diabetes therapy?
HbA1c >48mmol/L on lifestyle or Metformin monotherapy
HbA1c >58mmol/L on 2 or more drugs
What are the HbA1c targets for T2DM?
<48mmol/L if controlled with lifestyle or metformin monotherapy
<53mmol/L if on 2 or more drugs or 1 drug associated with hypoglycaemia
What is the mechanism of action of Gliclazide?
Sulfonulurea
Increases insulin secretion
What are the benefits of Gliclazide?
Very effective
Cheap
Well tolerated
What is the main side-effects of Gliclazide?
Hypoglycaemia risk
What is the mechanism of action of Sitagliptin?
DPP4 inhibitor
Incretin effect - increases GLP-1 mediated insulin secretion
What are the benefits of Sitagliptin?
Weight neutral
Low risk of hypoglycaemia
What are the major side-effects of Sitagliptin?
Pancreatitis
Limited evidence of efficacy
What drug may be considered for additional drug treatment in obese patients?
Exanetide - GLP-1 agonist
What is the mechanism of action of Exanetide?
- GLP-1 agonist
- Increases glucose-dependent insulin secretion \
- Slows gastric emptying
- Increases satiety
What are the benefits of Exanetide?
- weight loss
- low risk of hypoglycaemia
- can be taken once weeky
What are the limitations of Exanetide?
- given by injection
- expensive
- GI side-effects
