Type 2 diabetes care Flashcards
(40 cards)
What are the microvascular complications of diabetes?
- Retinopathy
- Nephropathy
- Foot disease (ulceration)
What are the macrovascular complications of diabetes?
- Myocardial infarction
- Stroke
- Heart failure
- Peripheral vascular disease
What is the management of macrovascular complications of diabetes? (simple)
- Glycaemic control
* Conventional CV risk factor modification (smoking, BP, Cholesterol)
What are the biomedical targets for Type 2 diabetes?
- HbA1c: 7% (or individualised)
- BP: <130/80 (ACEi or ARB, CCB, Thiazide diuretic)
- Cholesterol: statin if >40 yrs
- Normal body weight
What are the lifestyle measures for type 2 diabetes?
•Diet and calorie restriction
- weight watchers
- 800kcal diet with food reintroduction
•Increased physical activity
What is the suffix for DPP-4 inhibitors?
Gliptins
What is the suffix for GLP-1 receptor agonists?
Tides
What is the suffix for SGLT-2 inhibitors?
Flozin
What is the first line drug for T2DM?
Metformin (sometimes SU)
What is the second line drug treatment of T2DM?
- Two agents
* Add SU, Flozin (SGLT-2i), Gliptin (DPP-4 i) or Glitazone
What is the third line drug treatment?
- Three agents
* Add SU, flozin, Gliptin or Glitazone or start injectable therapy with GLP-1 agonist or insulin
What is the 4th line drug treatment of T2DM?
- Four agents
* Add SU, Flozin, Gliptin or glitazone or start injectable therapy with insulin or GLP-1 agonist
What is the mechanism of action of metformin?
- Suppress hepatic gluconeogenesis, reducing glucose output from the liver
- Increases peripheral insulin sensitivity, increasing glucose uptake and utilisation
- increase AMPK activity
What are the pros of metformin?
- Moderate efficacy
- Weight reduction
- Low hypo risk
- CV benefit
- Extensive experience
What are the cons of metformin?
- GI side effects
- Cant use if eGFR<30
- Small risk of lactic acidosis
What is the mechanism of action of sulfonylureas?
- Close potassium channels on beta cells, stimulating the release of stored insulin
- Increased cellular uptake and glycogenesis; reduces gluconeogenesis
What are the pros of sulfonylureas?
- High efficacy
* Extensive experience
What are the cons of sulphonylureas
- No cardiovascular benefit
- Weight gain
- High hypo risk
- Caution in CKD
When should you consider prescribing a sulphonylurea first line?
- Metformin not tolerated
* Osmotic symptoms (but once resolved add metformin)
What is the mechanism of action of DPP-4 inhibitors?
- Inhibit DPP-4 and enhance the effects of endogenous incretins e.g. GLP-1
- Increase glucose mediated insulin secretion, suppress glucagon secretion
What are the pros of DPP-4 inhibitors?
- Low/moderate efficacy
- Low hypo risk
- Few adverse effects
What are the cons of DPP-4 inhibitors?
- Weight neutral
- No CV benefit
- Reduce dose in CKD
What is the mechanism of action of SGLT2i?
- Inhibits SGLT2 in the proximal convoluted tubule of the kidney
- Decreases renal reabsorption of glucose
What are the pros of SGLT2i?
- Moderate efficacy
- CV benefit (BP and HF)
- Renal benefit (CANA)
- Weight loss
- Low hypo risk
