New Diabetes Drugs - University of Dundee
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Transcript New Diabetes Drugs - University of Dundee
Katy Daniels
GLP
-1 (gut hormone) + GIP = incretin effect
=Augmentation of insulin after oral glucose
Type
2 diabetics little incretin effect
Reduced GLP-1 secretion
GIP lost insulinotropic property
GLP-1
Only
broken down by DPP-4
for type 2 diabetes
Inhibits
incretin breakdown
Indirectly
increase own insulin secretion
Moderate
HBA1c reduction (~1%)
Which
one to choose?
Start
– 2nd
line: Metformin or Sulphonylurea +
HBA1c ≥ 6.5% + not suitable for other one
– 3rd line: Metformin + Sulphonylurea +
HBA1c ≥ 7.5%
– Thiazolidinedione
is an alternative in 2nd
line case but not 3rd
•
Continue
– HBA1c
reduces by ≥ 0.5% in 6 months
DPP-4
Inhibitor if:
Weight gain would cause significant
problem
Thiazolidinedione contraindicated
eg heart failure
Previous
intolerance or poor response
to Thiazolidinedione
GLP
-1 (gut hormone) + GIP = incretin effect
=Augmentation of insulin after oral glucose
Type
2 diabetics little incretin effect
Reduced GLP-1 secretion
GIP lost insulinotropic property
GLP-1
Only
broken down by DPP-4
for type 2 diabetes
Effects:
Stimulates post-prandial insulin
secretion
Slows gastric emptying
Reduces appetite
Administered:
Subcutaneous injection
Twice daily
Less
hypos compared to insulin
BIG benefit of weight loss
Only licensed to lower blood sugars,
not as weight loss agent
Nausea and vomiting
£830
per person per year
Start:
BMI
≥ 35 (+ probs assoc. with high wt)
BMI < 35 + insulin unacceptable or weight
loss beneficial to co-morbidities
Continue Metformin and Sulphonylurea
Combination with insulin
Continue:
HbA1c
reduction ≥ 1.0% AND
Initial body weight reduction ≥ 3%
Metformin
still first line
DPP-4
Inhibitors alternative where
Thiazolidinediones were previously
only other oral option
Exenatide
- good for weight loss but
?help in sugar control
Further
new drugs on their way