Diabetes management

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  • Created by: MazzaW
  • Created on: 07-12-19 14:06

Lifestyle changes

T2DM only

Dietary control: aim to reduce calorific load (decreased obesity, decreased insulin resistance) and decrease refined sugar intake

Physical exercise: aim to increase insulin sensitivity and improve calorie utilisation

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Biguanides

Example: metformin

T2DM only- 1st line

Inhibit hepatic gluconeogenesis

Advantages: weight neutral/weight loss, cheap, long track record

Disadvantages: GI adverse effects, increased risk of lactic acidosis

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Sulphonylureas

Examples: gliclazide, glimepiride, tolbutamide

Increase insulin secretion from pancreas

Advantages: low cost, long track record

Disadvantages: hypo risk, weight gain

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Thiazolidinediones

Examples: pioglitazone, rosiglitazone, troglitazone

Enhance lipogenesis, decreased lipolysis, decreased plasma free fatty acids

Advantages: insulin sensitisers

Disadvantages: fluid retention, weight gain, increased peripheral fracture rate, ?bladder cancer

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SGLT2 inhibitors

Examples: empagliflozin, dapagliflozin, canagliflozin

Prevents renal glucose reabsorption

Advantages: weight loss, may have renoprotective effect

Disadvantages: UTIs, uncertain long-term effects, high cost

Metabolic effects: decreased HbA1c, decreased weight

Renal effects: decreased BP, inhibition of tubuloglomerular feedback, decreased proximal tubule Na reabsorption, decreased glomerular hyperfiltration, decreased tubular inflammation, decreased tubular fibrosis

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GLP-1

Actions: promotes satiety, decreases appetite, slows rate of gastric emptying, decreased hepatic glucose output, enhances glucose-dependent insulin secretion, suppresses post-prandial glucagon secretion

Short half-life (1-2 mins) due to cleavage at c-terminus by DPP-IV  so would require continuous infusion if used as treatment

Can increase half-life by inhibiting DPP-IV to decrease degradation of GLP-1 OR use incretin mimetics to enhance effects

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DPP-IV inhibitors

Examples: sitagliptin, saxagliptin, vildagliptin, linagliptin

Inhibits DPP-IV to increase half-life of GLP-1

Advantages: oral, no hypos, well-tolerated, some licensed at low GFR

Disadvantages: long term effects uncertain, high cost

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GLP-1 mimetics

Examples: exenatide, liraglutide, lixisenatide

Resistant to DPP-IV so enhanced incretin effects

Advantages: no hypos, weight loss

Disadvantages: SC injection, adverse effects (N+V), long term effects uncertain, high cost

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