Presentation 5

1. Optimal diabetes control in adults

2. Management principals
1. Preserve Beta cell function.
2. Early aggressive treatment.
3. Reduce glucose toxicity.
4. Treat to target.
5. Information and education.

3. Three corner stones of therapy
 Diet
 Exercise
 Medication

4. Additional metabolic targets
 BP: 130/80 mmHg (with no proteinuria).
 BP: 125/75 mmHg (with proteiuria).
 Total cholesterol < 5mmol/L
 LDL cholesterol < 3mmol/L (diabetes only)
< 2.6mmol/L(additional risk factors)
 HDL cholesterol > 1mmol/L
 Trigliserides < 1.7mmol/L
 BMI = 20-24 kg/m2
 Waist circumfence = 102 cm (f), 88cm (m).

5. Medication for Type 2 diabetic patient
6 classes of drugs:
1. Sulphonylurea
2. Biguanide
3. Acarbose
4. Meglitinides
5. Thiazolidinediones
6. Insulin

6. PHARMACOLOGICAL
MANAGEMENT
SITES OF ACTION OF CURRENT ORAL ANTIDIABETIC AGENTS
 Liver: glucose production - biguanides
- thiazolidinediones
 Pancreas: insulin secretion - sulphonylureas
- meglitinides
insulin replacement - insulin

7. PHARMACOLOGICAL
MANAGEMENT
SITES OF ACTION OF CURRENT ORAL ANTIDIABETIC
AGENTS
 Adipose tissue: peripheral glucose uptake and and muscle
utilization - thiazolidinediones
- biguanides
 Intestine: glucose absorption - alpha-glucosidase
inhibitors

8. Biguanides : metformin(glucophage)
Mechanism of action
 Inhibits hepatic glucose prodution (gluconeogenesis).
 Increases the sensitivity of peripheral tissue to insulin.
 Increases peripheral glucose uptake.
 Decreases glucose absorption from the intestine.