Diabetes II

Non enzymatic reaction between the active carbonyl groups of reducing sugars and free amines of nucleic acids, proteins and lipids

3.5 -5.6 mmol/l

Diagnostic test which reflects the average plasma glucose over the previous 8 to 12 weeks

48mmmol/mol

The plasma glucose over the past two to three months

Reliable; Easy sample of collection; Convenient for patients

May be affected by a variety of geentic and illness related factors; it cannot detect early onset of dysglycaemia

Insulin analogues

New generation insulins; AID systems; Adjunctive treatments

Immunotherapies target the immune response responsible for beta-cell destruction, while non immune modulators aim to preserve beta-cell function or improve metabolic control.

Teplizumab is an anti-CD3 monoclonal antibody that modulates T-cell activity and can delay progression from stage 2 to stage 3 type 1 diabetes in eligible patients.

Trials investigating immune-modulating therapies, antigen-specific immunotherapy, beta-cell replacement using stem-cell-derived islet cells, encapsulated islet cells and combination therapies to preserve beta-cell function.

Treatments that replace lost pancreatic beta cells using donor islet cells or stem-cell-derived insulin-producing cells, with the aim of restoring endogenous insulin production.

Lifestyle modification; Metformin; SGLT2 inhibitors; GLP1 receptor agonists; DPP4 inhibitors; Sulfonylureas; Thiazolidinediones; Insulin when required.

Primarily reduces hepatic gluconeogenesis, lowering hepatic glucose output. It also improves insulin sensitivity and has a low risk of hypoglycaemia when used alone.

Block sodium-glucose cotransporter 2 in the proximal renal tubule, reducing glucose reabsorption and increasing urinary glucose excretion. They can also provide cardiovascular and renal benefits in appropriate patients.

DPP4 inhibitors are drugs that prevent the breakdown of incretin hormones such as GLP1 and GIP, increasing glucose-dependent insulin secretion and reducing glucagon secretion.

GLP1 receptor agonists mimic the incretin hormone GLP1, increasing glucose-dependent insulin secretion, reducing glucagon secretion, slowing gastric emptying and increasing satiety, which can improve glycaemic control and promote weight loss.

Semaglutide; Liraglutide; Dulaglutide; Exenatide; Lixisenatide.

Cardiovascular benefits, including reduced risk of major cardiovascular events with certain agents; kidney benefits in selected patients; reduced appetite and body weight; and improved metabolic risk factors.

A dual GIP and GLP1 receptor agonist that improves glucose-dependent insulin secretion, reduces glucagon secretion, slows gastric emptying and reduces appetite, leading to improved glycaemic control and substantial weight loss.

Improve glycaemic control and reduce glucotoxicity; use incretin-based therapies such as GLP1 receptor agonists or DPP4 inhibitors to enhance glucose-dependent insulin secretion; address obesity and insulin resistance through lifestyle changes and appropriate medication.