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1. Guidelines > T2DM RACGP guideline > Flashcards

T2DM RACGP guideline Flashcards

1
Q

What is the recommended weight loss for patients who are overweight or obese with T2DM?

A

5-10%

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2
Q 
What is target HbA1c?
A - <5%
B - <6%
C - <7%
D - <8%
A

C - <7%

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3
Q 
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

A - women <2.5, men <3.5

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4
Q

Which vaccinations are recommended or need to be considered in patients with T2DM?

A

Recommended: influenza, pneumococcus, diphtheria-tetanus-acellular pertussis (dTpa).
Consider: herpes zoster

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5
Q

List five (5) situations which would make a person high risk for T2DM regardless of their AUSDRISK score?

A 
>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)
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6
Q

How often should high risk patients be screened for diabetes and with what tests?

A

Fasting BSL or HbA1c every 3 years

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7
Q

How often should normal risk adults >40 years old be screen with a screening tool (also name the screening tool)?

A

3 yearly AUSDRISK

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8
Q

If a patient has an impaired glucose tolerance or impaired fasting glucose, what should their follow up be?

A

Fasting BSL or HbA1c every 12 months

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9
Q

Name as many exercise recommendations for adults with T2DM as you can.
(There are 4)

A

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

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10
Q

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

A

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

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11
Q 
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
A

C - 3 months

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12
Q 
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
A

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”

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13
Q 
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
A

C - 3-6 months

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14
Q

Which second line antidiabetic agent is recommended as the “next step” for patients with CVD and insufficient glycaemic control?

A

SGLT2 inhibitors

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15
Q 
What is the target blood pressure for patients with T2DM and HTN?
A - = 120/80
B - = 130/80
C - = 140/80
D - = 140/90
A

D - = 140/90

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16
Q 
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

A - maximum tolerated dose

17
Q 
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
A

B - fenofibrate

18
Q

For patients who require anticoagulation (i.e. for AF/CVA) which is the preferred anticoagulants
A - direct oral anticoagulants (DOACs)
B - warfarin

A

A - direct oral anticoagulants (DOACs)

  • assuming normal renal function
19
Q

What is the recommended interval for those with no or minimal retinopathy?

A

1-2 years

20
Q 
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
A

C - 12 monthly

21
Q

Which second line antidiabetic agent is recommended as the “next step” for patients with CKD and insufficient glycaemic control?

A

SGLT2 inhibitor or GLP-1 RA

22
Q

What advise should you give patients regarding the different classes of DM medication and on “sick days”?

A

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

23
Q

For metformin, list a major:

  • side-effect
  • benifit
  • and possible contraindication
  • breif MoA for bonus points
A

SE - GI upset, (DKA in renal failure)
Ci - ESRD

MoA - reduced heapitc glucose output

24
Q

For DDP-4i, list a major:

  • side-effect
  • benifit
  • and possible contraindication
  • breif MoA for bonus points
A

SE - Panceratitis, nasopharyngitis
Benifit - insulin sparking
Ci - pancreastic disease, renal impairment

MoA - reduced metabolism of GLP1 etc

25
Q

For sulfonylureas, list a major:

  • side-effect
  • benifit
  • and possible contraindication
  • breif MoA for bonus points
A

SE - hypoglycaemia, weight gain
Benifit - can use for post parenial control
Ci - renal imparment, severe liver disease elderly

MoA - increase post-perenial insulin

26
Q

For GLP1RA, list a major:

  • side-effect
  • benifit
  • and possible contraindication
  • breif MoA for bonus points
A

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

27
Q

For SGL2i, list a major:

  • side-effect
  • benifit
  • and possible contraindication
  • breif MoA for bonus points
A

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

28
Q

Women diagnosed with GDM should have what screening and when for T2DM?

A

75 g two‐hour oral glucose

tolerance test, preferably at 6–12 weeks postpartum

29
Q

What are the diagnostic sugar levels on:

  • Fasting BSL
  • 2h post glucose load
  • HbA1c
A
  • 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)

30
Q

What are the minimu requirements for the diabetes cycle of care?

A

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

31
Q

What are the 5 A’s of motivational interviewing?

A 
Ask - symptoms and goals
Assess - risk and disease
Advise - managment options
Assist - patient led management plan
Arrange - follow up
32
Q

What is the “rule of 15” for self management of hypoglycaemia?

A

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)

33
Q

What medication should be administered to a patient who is hypoglycaemic and not able to administer their own medication?

A

1mg IM/subcut glucagon
+
20mL 50% dextrose (10% in paeds)

34
Q

What is the definition and brief “principles of management” for hyperosmolar hyperglycaemia?
(formerly known as hyperosmolar, non-ketotic come HONC)

A

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

35
Q

In terms of assessing suitibility to drive - what is the definition of a severe hypoglycaemic event?

A

A hypoglycaemic event that is severe enought that the individual is not able to self-correct the hypoglycaemia

(non-driving period of 6 weeks)

36
Q

What is some advise you can give patients with poorly controlled or IDDM to prevent severe hypoglycaemic events around driving?

A

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

37
Q

Who is responsible for notiving the state driving licence authority about a diagnosis of diabetes?

A

The patients - you are responsible for notifying the patient of their obligation

1. Guidelines (6 decks)

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