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

Question 1

What does cardiorenal mean?

Answer 1

first manifestation of cardiovascular complications in type 2 diabetes

Question 2

What are the objectives of treating T2D?

Answer 2

Reducing the risk of:

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

Weight reduction

• increasing physical activity
• decreasing dietary fat

Question 3

What are lifestyle interventions for T2D?

Answer 3

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

Question 4

How is T2DM prevented?

Answer 4

• 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

Question 5

What are incretins?

Answer 5

• 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

Question 6

What are examples of incretins?

Answer 6

GIP and GLP-1

Question 7

What do GLP1 analogues do?

Answer 7

• Help patients lose weight
• Protect against cardiovascular disease

Question 8

What are disadvantages of GLP1 analogues

Answer 8

• 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

Question 9

What do DPP-4 Inhibitors do?

Answer 9

• 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

Question 10

What are advantages of DPP-4 Inhibitors?

Answer 10

• 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

Question 11

What are SGLT-2i’s?

Answer 11

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