Management of T2DM

Question 1

What are the blood pressure targets for diabetics?

Answer 1

140/80

or 130/80 if there is kidney, eye or cerebrovascular damage

Question 2

What is the initial treatment for T2DM?

Answer 2

Offer standard release metformin, gradually increase the dose over several weeks to minimise the risk of GI side effects.

Question 3

How often should we monitor blood pressure in patients with T2DM and HTN?

Answer 3

Every 1-2 months until target reached. Once attined check every 4-6 months

Question 4

What is the first line antihypertensive in diabetics?

Answer 4

ACEi

Question 5

In adults with T2DM, how often should we measure HbA1c levels?

Answer 5

Measure at 3-6 monthly intervals until stable and unchanging therapy. Then at 6 month intervals once stable.

Question 6

When might be want to ‘relax’ a HBA1c target?

Answer 6

Consider for older/frail patients who are unlikely to achieve long term risk reduction benefits, or whom tight blood glucose control poses a high risk of hypoglycemia e.g. in those at risk of falling.

Question 7

Other than good diet and medication control, what else could lower a persons HBA1c value that we should be weary of?

Answer 7

Deteriorating renal function or sudden weight loss

Question 8

If a patient cannot tolerate metformin due to GI side effects how could this be managed?

Answer 8

Consider a trial of modified release metformin

Question 9

At what eGFR should we review the dose of metformin?

Answer 9

Review <45ml/min/1.73

Question 10

At what eGFR should we stop metformin?

Answer 10

<30ml/min/1.73

Question 11

Pioglitazone should NOT be offered to who?

Answer 11

Patients with heart faiure, hepatic impairment, DKA,

Question 12

If initial drug treatment with metformin has not controlled HBA1c what can we consider dual therapy with?

Answer 12

Metformin and DPP-4 inhibitor
Metformin and pioglitazone
Metformin and sulfonylurea

Question 13

What insulin should be offered to patients with T2DM?

Answer 13

Intermediate acting insulins may also be referred to as ‘isophane’or ‘NPH’ (Neutral Protamine Hagedorn) insulins.

e.g. Humalin I and Insulatard

injected twice daily

Question 14

When would we consider an long acting insulin analogue over an intermediate insulin in patients with T2DM?

Answer 14

Consider insulin detemir or insulin glargin if the person needs assistance from a carer or health professional so that can reduce the number of injections to once daily.

The person’s life is restricted by hypoglycemic episodes
or do not reach their targets because of this/

Question 15

What should we be aware of when starting TCAs in T2DM patients with neuropathy, especially if already taking antihypertensives?

Answer 15

Be aware of hypotension

Question 16

How often should patients be screened for eye disease?

Answer 16

At least once a year - earlier if vision problems arise.