Type 2 diabetes mellitus Flashcards
(37 cards)
What is the diagnostic criteria for diabetes mellitus?
Either:
- Symptoms + one abnormal glucose test
- Polyuria, polydipsia, weight change, fatigue, frequent UTI or candida infections
- Two abnormal glucose tests at separate times
Glucose tests:
- Fasting >7.0mmol/L
- Random >11.1mmol/L
- HbA1c >6.5% (48mmol/mol)
Give five risk factors for T2DM
- Obesity and inactivity
- Poor diet: low fibre; high glycaemic index
- FHx
- Asian; african; black communities
- PMH of gestational diabetes
- Drugs: eg. statins; corticosteroids
- PCOS
- Metabolic syndrome
List five complications of T2DM
- Macrovascular: CVD; stroke; TIA; peripheral artery disease
- Microvascular: nephropathy; retinopathy; neuropathy
- Metabolic: dyslipidaemia; DKA; HHS
- Psychological: anxiety; depression
- Frequent infections
What is metabolic syndrome?
Three of the following:
- Increased waist circumference
- Hypertriglyceridaemia
- HTN
- Insulin resistance
- Prothrombotic state
Greatly increases the risk of developing T2DM
Outline monitoring of HbA1c and CBG in T2DM
- HbA1c monitoring
- 3-6-monthly until HbA1c stable on unchanging therapy
- 6-monthly thereafter
- CBG self-monitoring, only offer if any of:
- On insulin
- Evidence of hypoglycaemic episodes
- Oral medication that increases risk hypoglycaemia while driving or operating machinery
- Pregnant, or planning to become pregnant
What are the targets for HbA1c, BP, total cholesterol, and LDLs in diabetes mellitus?
- HbA1c 48-59 mmols/mol (6.5-7.5%)
- BP <140/80
- <130/80 if end organ damage present
- Total cholesterol <4 mmol/L
- LDL <2 mmol/L
What HbA1c targets are given for T2DM?
- 48 mmol/mol (6.5%)
- Monotherapy not associated with hypoglycaemia
- 53 mmol/mol (7.0%)
- Sulfonylurea monotherapy: risk of hypoglycaemia
- Not adequately controlled by single drug
State three pieces of lifestyle management for diabetes mellitus
- Diet:
- High fibre
- Low-glycaemic index carbohydrates
- Low saturated and trans fatty acids
- Weight loss (5-10% target)
- Increase exercise: improves insulin sensitivity
Outline patient education courses for diabetes mellitus
Offer structured education with annual reinforcement and review
- T1DM: DAFNE course
- Education on glycaemic index of food, and insulin doses
- T2DM: DESMOND course
What is the DVLA guidance for diabetes mellitus?
All patients must be able to:
- Produce CBG >5 mmol/L
- At least 45 minutes prior to driving
What medications are considered if a person is symptomatically hyperglycaemic?
Insulin or sulfonylurea
Review treatment once blood glucose control is achieved
Outline the initial drug treatment options for T2DM
- Metformin
- Started once HbA1c rises to 48 mmol/mol on lifestyle
- Consider modified release if not tolerated
- DPP-4i; pioglitazone; sulfonylurea; or SGLT-2i
- If metformin not tolerated
Outline the first intensification of drug treatment for T2DM who can take metformin
If HbA1c >58 mmol/mol (7.5%) whilst taking monotherapy, consider:
- Metformin, plus:
- DPP-4i
- Pioglitazone
- Sulfonylurea
- SGLT-2i
Outline the second intensification of drug treatment for T2DM who can take metformin
If HbA1c rises to 58 mmol/mol (7.5%) on dual therapy, consider:
- Triple therapy:
- Metformin + DPP-4i + SU
- Metformin + pioglitazone + SU
- Metformin + pioglitazone/SU + SGLT-2i
- Insulin-based treatment
What is the indication for GLP-1 mimetics in T2DM?
All of:
- Triple therapy not effective/tolerated, or contraindicated
- BMI 35+, and
- Obesity-associated psychological or medical problems
- BMI <35, and either
- Contraindications to insulin therapy
- Weight loss will benefit other obesity-related problems
Describe the mechanism of action of Metformin
- Decreases hepatic glucose production
- Decreases glucose absorption
- Increases insulin-mediated glucose uptake
Name two side-effects of Metformin?
- Gastric: abdominal pain, anorexia, diarrhoea, NaV
- Vitamin-B12 deficiency
- Lactic acidosis
Name three contraindications for metformin
- CKD eGFR <30 ml/min: increased risk of lactic acidosis
- Liver failure
- Cardiac failure
Outline the first intensification of drug treatment for T2DM where metformin is contraindicated or not tolerated
If HbA1c rises to 58 mmol/mol, consider:
- DPP-4i + pioglitazone
- DPP-4i + sulfonylurea
- Pioglitazone + sulfonylurea
Outline the second intensification of drug treatment for T2DM where metformin is contraindicated or not tolerated
If HbA1c rises to 58 mmol/mol on dual therapy, consider:
- Insulin-based treatment
Name one drug in the DPP-4 inhibitors class
Outline their mechanism of action
Sitagliptin; Vildagliptin
Name two side effects of Sitagliptin (DPP-4i)?
- GI disturbances
- Hypoglycaemia (uncommon)
- Pancreatitis
What is a benefit of DPP-4i over other oral hypoglycaemic medication?
Weight neutral
Name three side effects of Pioglitazone
- GI disturbance
- Oedema
- Weight gain
- Liver impairment
- Associated with increased risk of:
- Heart failure
- Bladder cancer
- Bone fracture
