DM

Question 1

x

Answer 1

x

Answer 2

x

Question 3

Diagnosis of DM ?

Answer 3

can be made by either a plasma glucose or a HbA1c sample.

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Diagnostic criteria vary according to whether patient is symptomatic (polyuria, polydipsia etc) or not.

If patient symptomatic:

fasting glucose greater than or equal to 7.0 mmol/l

random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)

HbA1c of greater than or equal to 48 mmol/mol (6.5%) is diagnostic of diabetes mellitus
HbAlc value of less than 48 mmol/mol (6.5%) does not exclude diabetes

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if patient asymptomatic the same as above however must be demonstrated in two separate occasions

Question 4

criteria for HB1AC diagnosis ?

Answer 4

A HbA1c between of 42-47 mmol/mol is indicative of prediabetes.

HbA1c of greater than or equal to 48 mmol/mol (6.5%) is diagnostic of diabetes mellitus

HbAlc value of less than 48 mmol/mol (6.5%) does not exclude diabetes (i.e. not sensitive as fasting samples for detecting diabetes)

patients without symptoms, the test must be repeated to confirm the diagnosis

Question 5

misleading HbA1c results can be caused by

Answer 5

increased red cell turnover

Vitamin B12/folic acid deficiency - alcoholism
opiate dependence
chronic aspirin consumption
lead poisoning
Iron-deficiency anaemia
Splenectomy
suspected gestational diabetes

people taking medication that may cause hyperglycaemia

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lower HbA1c reading shorter red cell life span. HbA1c being an under-estimate of blood sugar would be

hereditary spherocytosis as this would reduce the red blood cell life span.

haemolytic anaemia

Sickle-cell anaemia

GP6D deficiency

Hereditary spherocytosis

Haemodialysis

Question 6

what is impaired fasting glucose ?

Answer 6

greater than or equal to 6.1 but less than 7.0 mmol/l

Question 7

Why is an oral glucose tolerance test done?

Answer 7

This can be a useful test in helping to diagnose:

Pre-diabetes
Gestational diabetes in pregnant women
Insulin resistance

Question 8

oral glucose tolerance test how is it performed ?

Answer 8

not to eat, or drink certain fluids, for up to 8 to 12 hours before the test.

measure your blood glucose level before the test

Further blood sample after 2 hours

Question 9

OGTT results for interpretation

Answer 9

without diabetes
Fasting value (before test): under 6 mmol/L
At 2 hours: under 7.8 mmol/L

impaired glucose tolerance (IGT)
Fasting value (before test): 6.0 to 7.0 mmol/L
At 2 hours: 7.8 to 11.0 mmol/L

Diabetic levels
Fasting value (before test): over 7.0 mmol/L
At 2 hours: over 11.0 mmol/L

Question 10

x

Answer 10

x

Question 11

drug of choice in type 2 diabetes mellitus

Answer 11

1) metformin should be titrated up slowly to minimise the possibility of gastrointestinal upset
metformin not tolerated - standard release metformin

Question 12

SGLT-2 inhibitors SHOULD ONLY BE GIVEN AS SECOND LINE
in addition to metformin if any of the following apply

Answer 12

the patient has a high risk of developing cardiovascular disease (CVD, e.g. QRISK ≥ 10%)

the patient has established CVD
IHD

the patient has chronic heart failure

metformin should be established and titrated up

Question 13

If metformin is contraindicated
if the patient has a risk of CVD, established CVD or chronic heart failure what should be given ?

Answer 13

SGLT-2 monotherapy

Question 14

2nd line managmnet in addition to metformin if the patient doesn’t have a risk of CVD, established CVD or chronic heart failure:

Answer 14

DPP-4
or pioglitazone or a sulfonylurea

Question 15

what is third line therapy ?

Answer 15

triple therapy
METFORMIN + DPP-4/SULFONYLUREA /PIOGLITAZONE + (SAME AS BEFORE - SGLT-2 ONLY USED IF NICE GUIDLINE INDICATIONS APPLY)

Question 16

if triple therapy no effective ?

Answer 16

consider switching one of the drugs for a GLP-1 mimetic
or
insulin therapy

Question 17

indication to start GLP-1 mimetic ?

Answer 17

BMI ≥ 35 kg/m² and specific psychological or other medical problems associated with obesity or
BMI < 35 kg/m² and for whom insulin therapy would have significant occupational implications or weight loss would benefit other significant obesity-related comorbidities

Question 18

only continue glp -1 if ?

Answer 18

reduction of at least 11 mmol/mol [1.0%] in HbA1c
and
weight loss of at least 3% of initial body weight in 6 months

Question 19

we only start dual therapy/ 2nd line managmnet without the indication for SGLT2 when ?

Answer 19

when on max dose of metformin
AND
If the HbA1c has risen to 58 mmol/mol (7.5%)!!!!

Question 20

x

Answer 20

x

Question 21

There are two main types of IGR :

Answer 21

impaired fasting glucose (IFG) - due to hepatic insulin resistance

impaired glucose tolerance (IGT) - due to muscle insulin resistance

Question 22

Which impairment leads to higher risk of T2DM

Answer 22

IGT are more likely to develop T2DM cardiovascular disease