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T2DM - Coggle Diagram
T2DM
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Biguanides
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MOA
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- Reduces hepatic gluconeogenesis
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Adverse Effect
GI disturbance (overdose, acute illness)
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GLP-1 Receptor Agonists
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MOA
- Binds GLP-1 receptor enhancing incretin effect
- Increased glucose dependant insulin secretion
- Decreases glucose dependant glucagon release
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DPP-4 Inhibitors
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MOA
Inhibition of DPP-4 enzyme, preventing breakdown of GLP-1 and GIP
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CVO Trials
Safe with no benefit
- sitagliptin
- saxagliptin
- alogliptin
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Thiazolidinediones
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MOA
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- Promotes adipogenesis and fatty acid uptake
Reduces circulating FA / lipids
- Increases insulin sensitivity
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Diagnostic criteria
- Symptoms of diabetes + Random plasma glucose conce > 11.1mmol.L
- Fasting plasma glucose => 7.0 mmol/L
- 2-hr plasma glucose > 11.1 mmol/L during a 75 Oral Glucose Tolerance Test (OGTT)
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Treatment Targests
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Trials
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ACCORD study
As compared with standard therapy,the use of intensive therapy to target normal glycated haemoglobin levels for 3.5 years increased mortality and did not significantly reduce major cardiovascular events.
Sulphonylureas
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MOA
- Blocks ATP sensitive K+ channels on the pancreatic beta cell
- Depolarisation of cell opens voltage gated Ca2+ channels
- Ca2+ influx causes insulin exocytosis
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