Type II Diabetes Therapeutics

Question 1

What is the first line drug in type II diabetes?

Answer 1

Metformin

Question 2

How does metformin work?

Answer 2

Lowers insulin resistance by reducing hepatic gluconeogenesis

Question 3

What is metformin’s effect on weight?

Answer 3

Reduces it

Question 4

What are the side effects of metformin?

Answer 4

GI upset
Lactic acidosis
Liver toxicity

Question 5

When is metformin indicated?

Answer 5

First line drug in T2DM in patients with normal hepatic/renal function

Question 6

Give examples of sulfonylureas

Answer 6

Gliclazide

Glibenclamide

Question 7

How do sulfonylureas work?

Answer 7

Displace ADP-Mg from the SUR1 subunit causing insulin exocytosis

Question 8

What is the effect of sulfonylureas on weight?

Answer 8

Increase

Question 9

Give some side effects of sulfonylureas

Answer 9

Hypoglycaemia
Weight gain
GI upset

Question 10

When are sulfonylureas indicated?

Answer 10

First line in underweight T2DM patients with normal hepatic/renal function
Second line to metformin otherwise

Question 11

How does pioglitazone work?

Answer 11

Agonises PPAR-gama causing promotion of gene expression encoding insulin signalling

Question 12

What is the effect of pioglitazone on weight?

Answer 12

Increase

Question 13

Give some side effects of pioglitazone

Answer 13

Heart failure

Increased fracture risk

Question 14

When is pioglitazone indicated?

Answer 14

Used second line in combination with metformin/sulfonylureas

Question 15

Give examples of GLP-1 receptor agonists

Answer 15

Exenatide

Liraglutide

Question 16

Give some effects of GLP-1 receptor agonists

Answer 16

Reduced appetite
Delayed gastric emptying
Increased insulin secretion
Weight loss

Question 17

Give some adverse effects of GLP-1 receptor agonists

Answer 17

Nausea
Injectable
Pancreatitis

Question 18

When are GLP-1 receptor agonists indicated?

Answer 18

Used in combination with oral glucose lowering drugs as third/fourth line

Question 19

Give examples of DPP-IV inhibitors

Answer 19

Sitagliptin

Linagliptin

Question 20

How do DPP-IV inhibitors work?

Answer 20

Inhibit DPP-IV delaying the breakdown of incretin hormones

Question 21

What are some adverse effects of DPP-IV inhibitors?

Answer 21

Less potent than GLP-1 receptor agonists

Pancreatitis

Question 22

When are DPP-IV inhibitors indicated?

Answer 22

Used in combination as dual/triple therapy

Question 23

Give examples of SGLT2 inhibitors

Answer 23

Empagliflozin

Dapagliflozin

Question 24

How do SGLT2 inhibitors work?

Answer 24

Block glucose reabsorption causing it to be urinated out

Question 25

What is the effect of SGLT2 inhibitors on weight?

Answer 25

Weight loss

Question 26

Give some side effects of SGLT2 inhibitors

Answer 26

Thrush | Increased risk of UTIs

Question 27

When are SGLT2 inhibitors indicated?

Answer 27

Second line in combination with metformin