T2D - Initial information and Advice.

Question 1

When beginning treatment how often should HbA1C be checked?

Answer 1

3-6 monthly intervals until stable on unchanging anti diabetic treatment then every 6 months to ensure adequate blood glucose control

Question 2

How does HbA1C target differ between groups

Answer 2

48mmol/mol (6.5%) in most patient groups

Using drugs associated with hypoglycaemia such as sulfonylurea - 53mmol/mol (7.0%)

58mmol/mol (7.5%) considered high and may require intensifying treatment.

Consider co-morbidities, duration of treatment, age and risk of adverse effects.
Other consideration - fall risk or people who drive or operate machinery.

Question 3

When is glucose self-monitoring recommended?

Answer 3

Patients using insulin therapy.
History of hypoglycaemic episodes.
Taking drugs that increase risk of hypoglycaemia whilst driving or operating machinery (such as a sulfonylurea).
Pregnancy.

Question 4

Why is metformin dose increased gradually when commencing

Answer 4

Increased over several weeks to minimise risk of adverse effects.

Question 5

Monitoring requirements when starting metformin

Answer 5

Renal function (lactic acidosis risk)

Question 6

Dual therapy of metformin and SGLT-2 inhibitor is recommended as a first line in which patient groups and why?

Answer 6

High risk of CVD, heart failure, atherosclerotic cardiovascular disease

Cardiovascular benefit

Question 7

In patients taking dual therapy of metformin and SGLT-2 inhibitor as first line - how should each drug be commenced?

Answer 7

Metformin introduced initially gradually - once metformin tolerated comfortably then add the SGLT-2 inhibitor.