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• What is the primary biguanide medication mentioned?

  Metformin
• Why should the dosage of metformin be increased gradually?

  To minimize the risk of GI side effects
• How much should the metformin dosage be increased weekly?

  By 500 mg
• When should metformin be taken to reduce side effects?

  With food
• What caution should be taken when prescribing metformin?

  Cautions in renal impairment
• What is a common transient side effect of metformin?

  Diarrhea
• Name two other common side effects of metformin.

  Anorexia and nausea & vomiting
• What are the advantages of metformin?

  • Reduced HbA1c by 1-2%
  • Not associated with weight gain
  • Not associated with hypoglycemia when given alone
  • Beneficial effects on lipid profile
  • No blood glucose monitoring required
  • Good evidence base
  • Not expensive
• What are examples of sulphonylureas?

  Glibenclamide, gliclazide, glimepiride, glipizide
• How much does sulphonylureas decrease HbA1c?

  By 1-2%
• When are sulphonylureas considered first line treatment?

  If metformin is intolerant
• What are the advantages and disadvantages of sulphonylureas?

  Advantages:

  • Good evidence base
  • Inexpensive

  
  

  Disadvantages:

  • Weight gain
  • Increased risk of hypoglycaemia (1 in 100)
• What is an example of a thiazolidinedione?

  Pioglitazone
• How much does thiazolidinediones decrease HbA1c?

  By 1%
• Why are thiazolidinediones useful in renal failure?

  As a substitute for metformin
• What is the risk of hypoglycaemia with thiazolidinediones?

  Low risk of hypoglycaemia
• What side effect do thiazolidinediones cause?

  Weight gain
• In which patients are thiazolidinediones contraindicated?

  Heart failure, fractures, haematuria
• What are Dipeptidylpeptidase-4 inhibitors commonly known as?

  Gliptins
• How do gliptins affect weight?

  They do not appear to cause weight gain
• How long does it take for gliptins to exert their effect?

  It takes time to exert effect
• How do gliptins compare to sulphonylureas regarding hypoglycaemia?

  Less incidence of hypoglycaemia than sulphonylureas
• What is the approximate decrease in HbA1c from gliptins?

  Approximately 0.7%
• What are examples of SGLT2 inhibitors?

  Dapagliflozin, canagliflozin, empagliflozin
• How much does SGLT2 inhibitors decrease HbA1c?

  By 5 mmol/mol
• What are the benefits of SGLT2 inhibitors?

  Weight loss and BP reduction
• What is a side effect of SGLT2 inhibitors?

  Polyuria
• What infections are associated with SGLT2 inhibitors?

  Genital infections
• What is a caution for SGLT2 inhibitors?

  Care with hypovolaemia / loop diuretics
• What is the age limit for SGLT2 inhibitors?

  Cannot be given to >85 years
• When cannot SGLT2 inhibitors be used based on eGFR?

  If eGFR < 45
• What are examples of meglitinides?

  Repaglinide, nateglinide
• What are the advantages and disadvantages of meglitinides?

  Advantages:

  • Used as mono or with metformin

  
  

  Disadvantages:

  • Weight gain
  • Increased risk of hypoglycaemia (less than SU)
  • Expensive
• What is the place of GLP-1 in therapy?

  3rd line with:

  • Metformin and SU or TZD if:
  • BMI > 35 kg/m²
  • HbA1c > 58 mmol/mol
  • Diagnosis < 10 years

  OR

  • BMI < 35 kg/m² and can't tolerate insulin