Type 2 DM drugs

Question 1

Metformin

• Class
• MOA
• Side effects
• Dose?

Answer 1

• Biguanide class.
• Decreases hepatic glucose output. Increases insulin sensitivity.
• Weight gain, GI upset, CI if eGFR<30.
• Start on 500mg OD, build up to 500-800mg TD with meals. Monitor HbA1c.

Question 2

Gliclazide/Glimepiride

• Class
• MOA
• Side effects

Answer 2

• Sulphonylurea class
• Acts on beta cells to increase insulin secretion. Ineffective if no beta cell mass.
• Weight gain, hypoglycaemia, hyponatraemia, GI upset.

Question 3

Gliptins/Exenatide

• Class
• MOA
• Side effects

Answer 3

• DPP4 inhibitors
• Increases incretin levels (GLP-1), usually released by intestines in response to food. Promote insulin, suppress glucagon. Inactivated by DPP4.
• Only work when blood glucose is high so no risk of hypoglycaemia.
• Weight loss (good), pancreatitis

Question 4

Poiglitazone

• Class
• MOA
• Side effects

Answer 4

• Thiazolidinedione
• Increase insulin sensitivity and decrease resistance
• Weight gain, fluid retention, raised LFTs

Question 5

Gliflozin

• Class
• MOA
• Side effects

Answer 5

• SGLT2 inhibitors
• Block reabsorption of glucose in the kidneys, promote excretion in urine
• UTIs, weight loss (good)

Question 6

Insulin

Answer 6

SC insulin last resort.

Risk of weight gain and hypoglycaemia.