Endocrine

Focus

Summary

Goal of Therapy

Achieve glycaemic control (target HbA1c ≤ 7%) to prevent micro/macrovascular complications. Combine lifestyle + pharmacological therapy.

Non-Pharm Management

Diet & exercise, weight management, smoking cessation, regular glucose monitoring, education.

Primary Drug Classes

1.   Biguanides (Metformin)  

2.   Sulfonylureas (-ide)  

3.   DPP-4 inhibitors (-gliptin)  

4.   SGLT2 inhibitors (-gliflozin)  

5.   GLP-1 analogues (-glutide)

Mechanism of Action

- Metformin: ↓ hepatic glucose production, ↑ insulin sensitivity.

- Sulfonylureas: Stimulate pancreatic insulin release.

- DPP-4 inhibitors: Prolong incretin action → ↑ insulin, ↓ glucagon.

- SGLT2 inhibitors: Block glucose reabsorption in kidneys → ↑ urinary glucose excretion.

- GLP-1 analogues: Mimic incretin → ↑ insulin, ↓ appetite, slow gastric emptying.

Secondary Drug Classes

- Acarbose: Inhibits intestinal α-glucosidase → delays carbohydrate absorption.

- Pioglitazone: Improves insulin sensitivity (PPAR-γ agonist).

- Insulin: Replaces or supplements endogenous insulin (last line in T2DM).

Contraindications /Cautions

- Metformin: eGFR < 30 (renal impairment), risk of lactic acidosis.

- Sulfonylureas: Hypoglycaemia risk, weight gain.

- SGLT2 inhibitors: Genital infections, dehydration.

- Pioglitazone: Fluid retention, heart failure.

- Insulin: Hypoglycaemia, weight gain.

Comparative Advantages

- Metformin: 1st-line, weight neutral/loss, CV benefits.

- SGLT2 inhibitors: CV + renal protection.

- GLP-1 analogues: Weight loss, low hypoglycaemia risk.

- DPP-4 inhibitors: Well tolerated, safe in elderly.

Common ADRs

- Metformin: GI upset (take with food).

- Sulfonylureas: Hypoglycaemia, weight gain.

- SGLT2 inhibitors: UTIs, thrush.

- GLP-1 analogues: Nausea, vomiting.

- Pioglitazone: Oedema, weight gain.

Adherence Issues

Fear of injections (GLP-1, insulin), weight gain, hypoglycaemia, complex regimens, GI side effects.

Counselling Points

- Take metformin with meals.

- Recognise hypoglycaemia signs (shakiness, sweating, dizziness).

- Stay hydrated with SGLT2 inhibitors.

- Continue lifestyle changes even on meds.

High-Yield Suffixes

-ide = Sulfonylureas  -gliptin = DPP-4 inhibitors -gliflozin = SGLT2 inhibitors -glutide = GLP-1 analogues