Lecture 27: Treatment of Diabetes 2 Flashcards
describe the two main classifications of diabetes
Type 1
- autoimmune response to pancreatic B cell component
Type 2
- hyperglycaemia due to impaired insulin secretion, insulin resistance, ^ hepatic gluc. prod.
describe LADA classification of diabetes
- latent autoimmune diabetes in adulthood
- 6-10% of T2D Px
- lack of metabolic syndrome features
- poor glucose control w/ oral agents
- patient losing weight
- evidence of autoimmune disease (thyroid disease and pernicious anaemia)
- anti-GAD (glutamic acid decarboxylase) antibodies
give the diagnostic criteria for T1D and T2D
Type 1
- hyperglycaemia
- w/ DKA, rapid weight loss, BMI <25, PHx/FHx of autoimmune disease
Type 2
- HbA1c>48mmol/mol on 2 occasions >3 months apart
- fasting plasma gluc. > 7
- random plasma gluc. > 11.1
when can you NOT use HbA1c in diagnosis of diabetes
- T1D
- ^ RBC turnover –> pregnancy, anaemia, haemoglobinopathies
- blood sugar levels rapidly risen (e.g from drugs or acute illness)
how might you set a target HbA1c for a Px
- set individual target (may be above 48mmol/mol)
- offer lifestyle advice and meds to help achieve and maintain target
- inform Px w/ higher HbA1c that any reduction towards target is good for their health
- avoid intensive management levels
give examples of non-pharmacological management of T2D
- education
- diet
- lifestyle –> weight loss and exercise
- foot care
- retinal photography
what to look out for in a Px suspected of diabetes
KEVIN’S got DM
K - kidneys E - eyes V - vascular I - infections N - neuropathy S - skin
list some of the choices of drug treatments in diabetes
- biguanides (metformin)
- sulfonylureas (e.g. gliclazide)
- glucagon like peptide-1 analogue (e.g. liraglutide, exanitide)
- dipeptidylpeptidase IV inhibitors (e.g. sitagliptin)
- sodium-glucose co-transport 2-inhibitors (SGLT2i) (e.g. dapagliflozin)
- thiazolidinediones (e.g. pioglitazone)
- meglitinides (e.g. repaglinide)
- a-glucosidase inhibitors (acarbose)
list choices of therapy for diabetes
- lifestyle measures
if HbA1c >48mmol/mol after lifestyle interventions
- monotherapy –> first line metformin
- alternative monotherapy if metformin not tolerated or contraindicated
- -> depends on severity of hyperglycaemia
- -> comorbidities
- -> need to avoid hypoglycaemia
- -> patient preference
what drugs would be the preferred choice for Px w/ established or high risk of CVD
- GLP-1 RA
- SGLT2 inhibitors
describe MoA of metformin in diabetes treatment
- activates liver AMP-kinase reducing liver glucose output
- ^ liver, muscle, and fat cell sensitivity to insulin
- ^ peripheral glucose uptake and utilisation
give a benefit of using metformin to treat diabetes
enhances natural insulin signal therefore unlikely to cause hypoglycaemia on its own
give some side effects of using metformin
- causes weight loss
- GI adverse effects v common e.g. flatulence, nausea, diarrhoea
describe MoA of sulfonylureas (SU) in diabetes treatment
- bind to sulfonylurea receptor (SUR)
- closing ATP-K+ channels
- dec. K+ efflux
- B cell depolarisation and insulin release
what diabetes Px can SU be prescribed to
T2D Px w/ functioning B cells
