Diabetes

Question 1

Diagnostic tests used for DM

Answer 1

HbA1c - >48mmol/L (normal 20-41)
RBG - >11mmol/L (normal 4-7)
FBG - >7mmol/L (normal <6)

Question 2

Diagnostic criteria for DM

Answer 2

Symptomatic + 1 +ve test
OR
2 +ve tests (tested 3-6 months apart)

Question 3

DM symptoms

Answer 3

polyuria
polydipsia
fatigue
weight loss
blurred vision
recurrent infections, UTIs, thrush

Question 4

Who gets screened for diabetes?

Answer 4

Symptomatic
OR
FH+ve + overweight + >35yrs old

Question 5

in which people is HbA1c not a reliable diagnostic test?

Answer 5

Pregnant women
Children <18
People who are acutely unwell
People symptomatic for <2 months

Question 6

What lifestyle advice should be provided?

Answer 6

Exercise - at least 150 mins (2.5hrs) / week
- start with 10 mins a day, intense exercise - increase to 30

Diet - see dietician

Lifestyle responsible for biggest drops in HbA1c

Question 7

Algorithm for drugs involved in medical management of DM

Answer 7

1) Lifestyle + Metformin
2) Sulphonylurea
3) Gliptin
4) Pioglitazone
5) SGL-2i
6) GLP-1 mimetic
7) Insulin therapy

Question 8

Stepwise progression of therapies + HbA1c targets

Answer 8

Monotherapy - metformin only - 48 mmol/L

Dual - therapy - +sulphonylurea - 53 mmol/L

Triple therapy - 53 mmol/L

Insulin therapy - 58mmol/L

Question 9

Sulphonylureas - names, MoA, +ves and -ves

Answer 9

Gliclazide, Glimepride, Tolbutamide
Augment Insulin production
+ves - drop HbA1c fast
-ves - weight gain, hypos (<4mmol/L)

Question 10

Metformin - MoA, +ves, -ves

Answer 10

Increases sensitivity to insulin

+ves - weight neutral/loss, no hypos, cardioprotective
-ves - renal impairment (dont start if eGFR <30), mild GI upset

Question 11

Gliptins - Names, MoA etc

Answer 11

Sitagliptin, Linagliptin
Augments insulin production

Check renal and liver function 3 monthly. Hypos

Question 12

Pioglitazone - MoA etc

Answer 12

Reduces peripheral insulin resistance

CI in bladder cancer, anyone with a high ALT

Question 13

SGLT-2i - Names, MoA etc

Answer 13

Canagliflozin, Dapagliflozin
Reversibly inhibits sodium-glucose co-transporter in proximal renal tubule - wee out glucose

-ves - UTIs/thrush, volume depletion, dose reduction in renal/hepatic impairment

Question 14

GLP-1 mimetic - MoA etc

Answer 14

Increases insulin production, reduces glucagon production

only use if triple therapy not tolerated

Question 15

Follow-up and monitoring

Answer 15

Annual screening:

• retinopathy
• diabetic foot exam
• nephropathy - proteinuria, ACR (albumin:creatinine ratio)
• Q-risk - CVD
• weight, height, BMI, waist circumference

6 months:
- HbA1c