T2DM RACGP guideline Flashcards
What is the recommended weight loss for patients who are overweight or obese with T2DM?
5-10%
What is target HbA1c? A - <5% B - <6% C - <7% D - <8%
C - <7%
What is target spot ACR? A - women <2.5, men <3.5 B - men <2.5, women <3.5 C - women <1.5, men <2.5 D - men <1.5, women <2.5
A - women <2.5, men <3.5
Which vaccinations are recommended or need to be considered in patients with T2DM?
Recommended: influenza, pneumococcus, diphtheria-tetanus-acellular pertussis (dTpa).
Consider: herpes zoster
List five (5) situations which would make a person high risk for T2DM regardless of their AUSDRISK score?
>40yo + overweight Prev IGT/IFG 1st degree relative with DM Pacific Islands, Indian subcontinent, ATSI Prev CV event (MI/stroke/PVD) Hx of GDM Hx of PCOS On antipsychotics
- high risk AUSDRISK score >/= 12 (1:14 risk w/in 5 years)
How often should high risk patients be screened for diabetes and with what tests?
Fasting BSL or HbA1c every 3 years
How often should normal risk adults >40 years old be screen with a screening tool (also name the screening tool)?
3 yearly AUSDRISK
If a patient has an impaired glucose tolerance or impaired fasting glucose, what should their follow up be?
Fasting BSL or HbA1c every 12 months
Name as many exercise recommendations for adults with T2DM as you can.
(There are 4)
150 minutes or
more of moderate-to-vigorous intensity aerobic activity per week, spread
over at least three days/week, with no more than two consecutive days
without activity
resistance exercise 2–3 sessions/week on non-consecutive days, total of 60m/week
Prolonged sitting should be interrupted every 30 minutes
Flexibility training and balance training are recommended 2–3 times/week
for older adults with diabetes; yoga and tai chi may be included
Options for weight management for those with BMI >40 include:
A - nutritionally balanced calorie-restriction
B - Weight management medication
C - Metabolic surgery
D - All of the above
D - All of the above
*weight management surgery SHOULD be recommended to Mx T2DM in those with BMI >40 or those with poor control with BMI >35.
It can also be considered in those with BMI >30 with poor control
In patients who are newly diagnosed with T2DM how long is an appropriate trial of healthy behaviour interventions? A - 4 weeks B - 6 weeks C - 3 months D - 6 months
C - 3 months
A patient in your practice with new T2DM, on your review they have a cap BSL of 28, ++ ketones in their urine and mention they have lost 5kg unintentionally over the last 1 month. Your initial management should be: A - Metformin B - Metformin + DPP4 inhibitor C - Metformin + sulfonylurea D - Insulin +/- metformin
D - Insulin +/- metformin
“Individuals with metabolic decompensation (eg marked hyperglycaemia,
ketosis or unintentional weight loss) should receive insulin with or without
metformin to correct the relative insulin deficiency”
After how many months should a dose adjustment or additional agent be commenced? A - 4-6 weeks B - 2-3 months C - 3-6 months D - 6-8 months
C - 3-6 months
Which second line antidiabetic agent is recommended as the “next step” for patients with CVD and insufficient glycaemic control?
SGLT2 inhibitors
What is the target blood pressure for patients with T2DM and HTN? A - = 120/80 B - = 130/80 C - = 140/80 D - = 140/90
D - = 140/90
In patients with T2DM and known CVD statins dosing should be: A - maximum tolerated dose B - titrated to HDL >1.0 C - titrated to total cholesterol <4 D - titrate to non-LDL <2.5
A - maximum tolerated dose
Which of the following is NOT a good second line agent for patients with T2DM and known prior CVD? A - ezetimibe B - fenofibrate C - bile acid binding resins D - nicotinic acid
B - fenofibrate
For patients who require anticoagulation (i.e. for AF/CVA) which is the preferred anticoagulants
A - direct oral anticoagulants (DOACs)
B - warfarin
A - direct oral anticoagulants (DOACs)
- assuming normal renal function
What is the recommended interval for those with no or minimal retinopathy?
1-2 years
How often should urinary ACR and eGFR be assessed in patietns with T2DM (as a minimum)? A - 3 monthly B - 6 monthly C - 12 monthly D - 2 yearly
C - 12 monthly
Which second line antidiabetic agent is recommended as the “next step” for patients with CKD and insufficient glycaemic control?
SGLT2 inhibitor or GLP-1 RA
What advise should you give patients regarding the different classes of DM medication and on “sick days”?
Metformin - withold if hehydrated (DKA)
SGLT2i - ALWAYS withold when sick (euglycaemic DKA)
GLP1 RA - withold if N+V (will exac)
SU - withold if poor intake (hypo risk)
DDP-4i - ok to continue
Insulin - regular BSL monitoring, titrate to BSLs
For metformin, list a major:
- side-effect
- benifit
- and possible contraindication
- breif MoA for bonus points
SE - GI upset, (DKA in renal failure)
Ci - ESRD
MoA - reduced heapitc glucose output
For DDP-4i, list a major:
- side-effect
- benifit
- and possible contraindication
- breif MoA for bonus points
SE - Panceratitis, nasopharyngitis
Benifit - insulin sparking
Ci - pancreastic disease, renal impairment
MoA - reduced metabolism of GLP1 etc
