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T2DM (Guidelines, GLP1 Agonists, Causes, SGLT2 inhibitors, Complications,…

- - - - SGLT2i
        
        empagliflozin (EMP-REG) > canagliflozin (CANVAS) > dapagliflozin
      - GLP1
        
        Liraglutide (LEADER) > Semaglutide (SUSTAIN) > Dulaglutide
  - - - SLGT2: Empagliflozin or canagliflozin
        GLP-1: Liraglutide or semaglutide
- - - - Bydureon once weekly
      - Byetta TDS
    - - OD
    - - One weekly
- - - - With metformin = Xigduo
    - - With metformin = Vokanamet
    - - With metformin = Synjardy
- - - - Usually due to underling illness (CVA, MI, Infx)
        
        Leads to dehydration, ACKi, hyperosmolarity and 2ndary complications
    - - More common in T2
        
        Pts have enough residual insulin to suppress ketogenesis
  - - - s/e of over-tx
        
        Most common with meds that increase insulin levels independent of blood glucose levels
        
        Sulphonureas
        
        Insulin
        
        Of concern in pts with co-morbidities eg elderly
  - - - Coronary artery disease
        MI, ACS, unstable angina
      - Cerebrovascular disease
        CVA, Stroke, TIA
      - Peripheral vascular disease
        Intermittent claudication
        Ischaemic toes / feet
        Amputation
    - - Retinopathy
        Asymptomatic until too late
      - Nephropathy
        Asymptomatic until end stage
      - Neuropathy
        Peripheral / autonomic
        Symptomatic but often missed
      - all require screening
  - - - PAD + peripheral neuropathy and hyperglycaemic diabolical for foot protection
        
        Poor wound healing, reduced awareness of injury, frequent mechanical altercations to feet
        
        Ulceration, infection, ischaemia
        
        Often leads to surgical intervention, amputation
- - - - Statins
      - Fibrates
      - Ezetimibe
      - Niacin (less common bc s/e)
    - - LDL < 2.6
        HDL >1 (men) > 1.2 (women)
        TG < 3.9
    - - Primary tx is statins
        
        Generally don't use combinatinos - hepatic effects and other s/e - exception is addition of ezetimibe in selected settings
    - - High intensity
        
        Atorvastatin 40-80mg
        
        Rosuvastatin 20-40mg
        
        Lowers LDL cholesterol by ≥ 50%
      - Moderate intensity
        
        Atorvastatin 10-20mg
        
        Rosuvastatin 5-10mg
        
        Simvastatin 20-40mg
        
        Pravastatin 40-80mg
        
        Lovastatin 40mg
        
        Fluvastatin XL 80mg
        
        Pitavastatin 2-4mg
        
        Lowers LDL cholesterol by 30-50%
  - - - .<140/90 mmHg
      - Previously stricter but evidence has changed - renal impairement
      - Stricter: 130/80
        Young
        Microalbuminuria
        At least one additional CVD RF
    - - ACEi / ARBs
        Renoprotective effective
      - Multi drug regimen
  - - - All pt >50 y/o with at least 1 additional CVD risk factor
        RF:
        
        Fhx IHD
        
        HTN
        
        Smoking
        
        Dyslipidaemia
        
        Albuminuria
      - Consider: those < 50 y/o with multiple risk factors
    - - Clopidogrel
- - - - 2 hou oral glucose tolerance test (OGTT)
        75g oral glucose pre and 2hr post BG