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Type 2 diabetes mellitus - Coggle Diagram

- - - - insulin sensitising agent - reduces hepatic gluconeogenesis
    - - first line for T2DM, PCOS, Gestational DM
    - - Acute heart failure, eGFR<30(CKD), hepatic impairment(metformin metabolised in liver), with contrast
    - - GI disturbances
        
        use extended release form
      - lactic acidosis(overuse, acute illness), B12 deficiency)
- - - - block ATP sensitive potassium channels on B cell of pancreas, increasing insulin secretion
    - - hypoglycemia, weight gain, beta cell burn out
    - - CAROLINA - glimepiride v sitagliptin - glimepiride is safe but no CV benefits
- - - - inhibits DPP 4 enzyes which break down GLP1 and GIP
    - - does not cause hypoglycaemia
    - - Tecos - sitagliptin
      - Savor: saxagliptin (a/w heart failure)
      - examine: alogliptin
      - safe but no benefit
- - - - Binds GLP1 receptor, enhancing the incretin effect i.e. increases glucose-dependent insulin secretion and decreases glucose dependent glucagon
    - - gi disturbance, pancreatitis, medullary thyroid cancer, retinopathy
    - - weight loss, reduced BP, reduced lipids, satiety, psoriasis
    - - secondary prevention
        
        LEADER; AMPLITUDE-O: Liraglutide
        
        SUSTAIN 6: Semaglutide
      - REWIND: Dulaglutide ( ? Primary prevention)
      - also showed benefit in diabetic kidney disease (ELIXA, REWIND, DKD-LEADER trials)
- - - - Inhibit SGLT2 transporter in proximal convoluted tubule - prevents reabsorption of glucose + increases excretion via kidneys
    - - Good evidence for secondary prevention of CVD (EMPA-REG, CANVAS, DECLARE-TIMI 58)
      - heart failure: DAPA-HF, Emporer reduced
- - - - blocks ATP dependent potassium channels in pancreatic beta cells
- - - - bind to peroxisome proliferator - activates PPAR-gamma in adipocytes - promotes adipogenesis + fatty acid uptake - reduced circulating lipids - increased insulin sensitivity
    - - helps with non-alcoholic steatohepatitis and no acoholic fatty liver disease
    - - heart failure, bladder cancer, fractures, hepatotoxicity, weight gain
      - contraindicated in HF or hx bladder cancer
- - - - Inhibit α-Glucosidase in the GI tract slowing down the
        glucose transport through GI tract
    - - diarrhoea + flatulence, poorly tolerated
- - - - autonomic symptoms: tremor, palpitations, anxiety, arousal, sweating, hunger, arrhythmias, paresthesis
      - neurological symptoms: cognitie impairment, behavioural changes, psychomotor abilities, seizure, coma