Oral Hypoglycaemic Agents

Question 1

What are the 4 possible ways a diagnosis of diabetes can be confirmed?

Answer 1

Symptoms of hyperglycaemia + 1 of the following results OR 2 of the following results on 2 occasions:
Fasting glucose >/= 7
Random glucose >/= 11

OGTT gives >11 after 2 hours

HbA1c >48

Question 2

What is the target HbA1c for diabetics? How does it change depending on circumstances?

Answer 2

< 48 if lifestyle or metformin

< 53 if on any drug that can cause hypoglycaemia (TZDs or SUs)

Question 3

What is the stepwise progression for oral hypoglycaemic agents?

Answer 3

1. Lifestyle advice: diet, weight control, exercise
2. Metformin monotherapy
3. Dual therapy if HbA1c >58:
   a. Metformin plus DPP4 inhibitor
   b. Metformin plus Pioglitazone
   c. Metformin plus Sulphonylurea
   d. Metformin plus SGLT2 inhibitor
4. If HbA1c remains >58, consider triple therapy:
   a. Metformin plus DPP4 inhibitor plus Sulphonylurea
   b. Metformin plus Pioglitazone plus Sulphonylurea
   c. Metformin plus Pioglitazone/Sulphonylurea plus SGLT2 inhibitor
   d. OR consider insulin therapy.
5. If triple therapy not tolerated, utilise: Metformin plus Sulphonylurea plus GLP1 mimetic

Question 4

How does metformin affect weight?

Answer 4

Reduces weight

Question 5

What are the 2 main side effects of Metformin?

Answer 5

GI side effects - N&V, diarrhoea

Lactic acidosis - if unwell or CKD (don’t use <36 GFR)

Question 6

Give an example of a DPP4 inhibitor. How do they work?

Answer 6

Increase incretin causing increased insulin

Sitagliptin

Question 7

What are 3 common side effects of DPP4 inhibitors?

Answer 7

Pancreatitis

Urticaria

Angiodaema

Question 8

What is the effect of TZDs on weight?

Answer 8

Significant eight gain

Question 9

What 2 drugs can cause hypoglycaemia?

Answer 9

TZDs

SUs

Question 10

What is the effect of sulphonylureas on weight?

Answer 10

Mild weight gain

Question 11

What diabetic drugs should be avoided in renal failure?

Answer 11

Metformin (if GFR <36)

SUs - to be avoided, but not CI

SGLT2 inhibitor - contraindicated

Question 12

In what 2 conditions are TZDs to be avoided in and why?

Answer 12

Cardiac failure - due to fluid retention adverse effect

Osteoperosis - due to fractures

Question 13

What is the effect of GLP1 mimetics on weight?

Answer 13

Weight loss

Question 14

What are examples of GLP1 mimetics?

Answer 14

Exantide

Question 15

Give an example of a SGLT2 inhibitor?

Answer 15

Empagliflozin

Question 16

Give an example of an SU.

Answer 16

Gliclazide