Using Oral Hypoglycaemic in Diabetes: After completing this module you should have: 1 . Awareness of the role of metformin as initial therapy for type 2 diabetes and the potential for side effects with metformin, the role of dose titration and an understanding of dose limitation 2 . Understanding of the use of metformin in renal impairment and the thresholds for stopping metformin therapy 3 . Understanding of the issues relating to the use of other oral hypoglycaemic agents in the presence of renal impairment 4 . Understanding of the therapeutic options for second-line therapy including the advantages and disadvantages of the various agents 5 . Understanding of the options for third-line therapy 6 . Understanding of the importance of preconception planning for patients with diabetes and the issues to be addressed 7 . Awareness of current driving regulations for patients on oral hypoglycaemic agents 8 . Knowledge of how to monitor patients with diabetes of uncertain type if insulin is not started 9 . Ability to list the features which suggest the diagnosis of slowly evolving type 1 diabetes in symptomatic patients without ketosis Introduction In 2013 there were an estimated 3.2 million people aged 17 years and older diagnosed with diabetes in the UK, resulting in a prevalence of 6%. By 2025 it is estimated that 5 million people will have diabetes in the UK (Diabetes UK, 2014 [pdf]). The large majority of these patients (approximately 90%) have type 2 diabetes. This epidemic of diabetes has major implications for the health of the population as type 2 diabetes reduces life expectancy and has further implications for morbidity such as blindness, foot ulceration and renal failure as well as profound effects on nearly all measures of quality of life. The financial cost of managing diabetes is considerable. Estimates vary and range between £3.9 billion (National Audit Office, 2012 [pdf]) and £10 billion per year (Diabetes UK, 2014). Much of this cost is the result of treating potentially avoidable complications. For many years there were few treatment innovations in this area but more recently a number of new treatment options have become available with more new treatments on their way in the near future. Therefore the glycaemic management options for treating type 2 diabetes have become more complex, and the aim of this module is to allow the rational application of the available evidence to the use of oral hypoglycaemic agents in type 2 diabetes. Two specific areas where there are particular prescribing issues, namely in patients with renal impairment and women contemplating pregnancy, will be highlighted. The glycaemic management of diabetes only makes up one part of the multifactorial approach needed, but the use of various patient education models, and agents to target blood pressure (BP) and lipids, are beyond the scope of this module. Likewise the use of insulin in type 2 diabetes is an important topic in its own right; only the place of insulin in the treatment options will be addressed here. Finally there is an emerging recognition that type 1 and type 2 diabetes may not be as completely distinct as we have believed hitherto and for some patients it is not immediately apparent whether their diabetes is type 1 or type 2. This module will attempt to address this difficult clinical situation.
Posted on: Sat, 09 Aug 2014 19:57:40 +0000
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