Diabetes

Question 1

Targets for diabetes with monotherapy

Answer 1

Patients prescribed a single drug associated with hypoglycaemia (such as a sulfonylurea) should usually aim for an HbA1c level of 53 mmol/mol (7.0%).

Question 2

Targets for diabetes with dual therapy

Answer 2

When two or more antidiabetic drugs are prescribed, a target HbA1c level of 53 mmol/mol (7.0%) is recommended for patients in which it is appropriate.

Question 3

What are sulphonylureas associated with?

Answer 3

Sulfonylureas, such as gliclazide, glimepiride, glipizide, and tolbutamide, may cause hypoglycaemia; it is more likely with long-acting sulfonylureas such as glimepiride, which have been associated with severe, prolonged and sometimes fatal cases of hypoglycaemia. Sulfonylureas are also associated with modest weight gain, probably due to increased plasma-insulin concentrations.

Question 4

How should metformin be prescribed?

Answer 4

Standard-release metformin hydrochloride is recommended as the first choice for initial drug treatment for all patients, due to its positive effect on weight loss, reduced risk of hypoglycaemic events, and the additional long-term cardiovascular benefits associated with its use.

The dose of standard-release metformin should be increased gradually to minimise the risk of gastro-intestinal side-effects.

Question 5

Cautions for gliclazide

Answer 5

Can encourage weight gain; elderly; G6PD deficiency

Elderly
Prescription potentially inappropriate (STOPP criteria) if prescribed a long-acting sulfonylurea (e.g. glibenclamide, chlorpropamide, glimepiride) in type 2 diabetes mellitus (risk of prolonged hypoglycaemia).

See also Prescribing in the elderly.

Question 6

Insulin regimes

Answer 6

Question 7

How is mixed insulin like humulin M3 or novomix prescribed?

Answer 7