Diabetes Presentation

Question 1

Macro and microvascular complications of diabetes - how are they screened for?

Answer 1

• Diabetic foot checks - peripheral neuropathy and peripheral vascular disease
• Annual eye screening - retinopathy
• UACR - nephropathy

Question 2

Retinal changes in diabetic retinopathy

Answer 2

Question 3

Factors affeting HbA1C readings

Answer 3

• Splenectomy
• Iron deficiency anaemia
• B12/folate deficiency anaemia - megaloblastic
• Pregnancy
• CKD
• Blood transfusions

Question 4

When is a statin offered to someone with T2DM?

Answer 4

• CKD stage 3 or more and/or microalbuminuria - irrespective of lipid profile
• 84 years and younger and QRISK is 10% or more
• CKD- all patients
• 85 years and older taking into account preferences etc

Aim for greater than 40% reduction in non-HDL cholesterol

Question 5

When is aspirin initiated in patient with T2DM?

Answer 5

• Do not routinely offer for primary prevention

Can offer for secondary prevention of: ACS
* Stable angina
* PAD (if clopidogrel contrindicated)

Question 6

What BP readings should someone with T2DM be aiming for, if commencing on antihypertensives, which?

Answer 6

• ACEi/ARB is preferred
• Caution with ARB with afro-caribbean patients as risk of adverse effects
• If under 80, aim for BP below 140/90 if ACR is less than 70mg/mmol
• If over 80, aim for BP below 150/90
• If ACR is above 70mg/mmol, aim for below 130/80