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
For sulfonylureas, list a major:
- side-effect
- benifit
- and possible contraindication
- breif MoA for bonus points
SE - hypoglycaemia, weight gain
Benifit - can use for post parenial control
Ci - renal imparment, severe liver disease elderly
MoA - increase post-perenial insulin
For GLP1RA, list a major:
- side-effect
- benifit
- and possible contraindication
- breif MoA for bonus points
SE - Nausea and vomiting
Benifit - Weight loss, cardioprotective
Ci - kidney impariment, pancreatic disease, gallbladder disease, personal/FHx of thyroid cancer, sever pre-existing GI sx
MoA - secrete insulin, supress glucagon, supress appetite, slow gastric emptying
For SGL2i, list a major:
- side-effect
- benifit
- and possible contraindication
- breif MoA for bonus points
SE - genitourinary infection (UTI, pyelo, thrush), euglycaemic DKA
Benifit - weight loss, cardioprotective, heart failure treatment, renal protective
Ci - Fasting, peri-operative, acute illness, loop diuretics, renal impairment
MoA - increased urinary glucose loss
Women diagnosed with GDM should have what screening and when for T2DM?
75 g two‐hour oral glucose
tolerance test, preferably at 6–12 weeks postpartum
What are the diagnostic sugar levels on:
- Fasting BSL
- 2h post glucose load
- HbA1c
- Fasting >/= 7.0 x2
- 2h or random BSL >/= 11.1 x2
- HbA1c >/= 6.5 x2
Or any of the above x1
PLUS
symptoms suggestive of hyperglycaemia (lethargy, polyuria, polydipsia, recurrent infections/poor healing, microvascular disease, weightloss)
What are the minimu requirements for the diabetes cycle of care?
At least 6-monthly:
• Weight, height and body mass index (BMI)
• BP
• Assess feet for complications
At least annually: • SNAP + med review • HbA1c • Lipid profile • spot ACR • Review and discuss complication prevention – eyes, feet, kidneys, CVD
At least every two years:
• Optometry review
What are the 5 A’s of motivational interviewing?
Ask - symptoms and goals Assess - risk and disease Advise - managment options Assist - patient led management plan Arrange - follow up
What is the “rule of 15” for self management of hypoglycaemia?
15g of fast acting carbs (e.g. 125mL juice, 6 jelly beans, 3 glucose tabs)
15 mins re-ckeck BSL
15 mins meal or snack (long carbs)
What medication should be administered to a patient who is hypoglycaemic and not able to administer their own medication?
1mg IM/subcut glucagon
+
20mL 50% dextrose (10% in paeds)
What is the definition and brief “principles of management” for hyperosmolar hyperglycaemia?
(formerly known as hyperosmolar, non-ketotic come HONC)
Serum osmolality =/> 320 mosmol/kg
BSL >30mmol/L
Clinical dehydation
Slow rehydration (50% est loss in first 12h then rest of 36h)
Slow BSL normalisation
Manage electrolyte abnormalities
Treat underlying cause
In terms of assessing suitibility to drive - what is the definition of a severe hypoglycaemic event?
A hypoglycaemic event that is severe enought that the individual is not able to self-correct the hypoglycaemia
(non-driving period of 6 weeks)
What is some advise you can give patients with poorly controlled or IDDM to prevent severe hypoglycaemic events around driving?
Check BSL before driving - do no drive if <5mmol?l
Do not drive when there has been >2h between snacks
Carry a glucose monitor and “hypo pack” in the car
Pull over immediately if any signs of hypoglycaemia
Who is responsible for notiving the state driving licence authority about a diagnosis of diabetes?
The patients - you are responsible for notifying the patient of their obligation
