MSRA: Type 2 Diabetes

Question 1

What is first line treatment, and when should it be started?

Answer 1

Metformin
HbA1C 6.5% and above despite diet and lifestyle
Titration dose as needed
Modified release if troubled by GI side effects

Question 2

What HbA1C on Metformin indicates the need for dual therapy?

Answer 2

HbA1C 7.5% or above

Question 3

What is the role of SGLT2 inhibitors in Type 2 diabetes?

Answer 3

Cardioprotective effect
Add on to Metformin first line if high risk of CVD, established CVD or HF
Add on if any of the above develop during treatment course
SGLT2 can be used as an alternative if Metformin monotherapy not tolerated in this group of individuals

Question 4

What are the side effects of sulphonylureas e.g. Gliclazide?

Answer 4

Hypoglycaemia
Weight gain
Cholestasis

Question 5

How can we diagnose Type 2 Diabetes?

Answer 5

Symptomatic with one abnormal blood result or asymptomatic with abnormal blood result on more than one occassion.

HbA1C 6.5% or more
Fasting glucose 7 or more
Random glucose 11.1 or more

Question 6

What is the HbA1C target for a patient taking Metformin?

Answer 6

6.5% (48mmol)

Question 7

What are the possible causes of a falsley low HbA1C?

Answer 7

Increased RBC turnover:
- Sickle cell anaemia
- G6PD deficiency
- Haemodialysis

Question 8

What are the possible causes of a falsely high HbA1C?

Answer 8

Increased RBC Lifespan:
- Splenectomy
- Haematinic deficiencies

Question 9

What is meant by impaired fasting glucose?

Answer 9

Fasting BM 6.1 to 6.9

Question 10

What is meant by impaired glucose tolerance?

Answer 10

2hr 7.8 to 11.0

Question 11

What are the side effects of SGLT2 inhibitors?

Answer 11

Ketoacidosis
Nec fasc (perineum)

Question 12

What are the contraindications to Pioglitazone?

Answer 12

Heart failure
Bladder cancer

Question 13

What is the prediabetic HbA1C range?

Answer 13

6.0 to 6.4%
42 to 47mmol

Question 14

What are the side effects of Metformin?

Answer 14

Gi disturbances are most common
Reduced B12 absorption
Lactic acidosis

Question 15

When to stop Metformin?

Answer 15

Chronic kidney disease
Situations of tissue hypoxia (sepsis, AKI, myocardial infarction)

Question 16

What are the C peptide levels in Type 2 diabetes?

Answer 16

High
(Endogenous Insulin is still being made)

Question 17

What are the NICE criteria for the use of Liraglutide in obesity management?

Answer 17

BMI >35
Prediabetes
High risk of cardiovascular disease e.g. hypertension, dyslipidaemia

Question 18

What are the classifications of obesity?

Answer 18

Overweight 25-30
Obese class 1 30-35
Obese class 2 35-40
Obese class 3 >40

Question 19

What monitoring is needed for patients taking glitazones?

Answer 19

LFTs (baseline before treatment and then periodically throughout the first 6 months)

Question 20

When to start a GLP-1 e.g. Exenatide?

Answer 20

If triple therapy not effective or tolerated, switch one of the agents to a GLP-1 if:
BMI =>35 OR
Insulin would have occupational implications