Type 2 Diabetes

Question 1

What is the first line treatment for type 2 diabetes?

Answer 1

Metformin - IR

Change to MR - if patient has G.I effects (nausea, vomiting etc

Question 2

What can be given if metformin is contraindicated?

Answer 2

If patient does not have CVD risk:

• Gliptin
• Pioglitazone
• Sulphonylurea
• SGLT2i (last line)

Question 3

What must be done on all type 2 diabetic patients?

Answer 3

A CV risk assessment (QRISK score) / CV status (check if they already have a CV condition)

Question 4

If CVD risk is greater than 10%, what must be done for type 2 diabetes? Or they already have a CVD?

Answer 4

Add SGLT2i to metformin (only after tolerability to metformin).

Also check DKA risk, illness, low carb or keto diet.

Question 5

If CVD risk is lower than 10%, what must be done for type 2 diabetes?

Answer 5

Continue with metformin and intensify treatment if needed

Question 6

What is the dual therapy treatment for type 2 diabetes?

Answer 6

Metformin

+

• Gliptins or
• Pioglitazone or
• Sulphonylurea or
• SGLT2i

Question 7

What are the triple therapies for type 2 diabetes?

Answer 7

Metformin + 2 of these:
- Gliptins or
- Pioglitazone or
- Sulphonylurea or
- SGLT2i or
- Insulin (with or without drugs)

Insulin + 1 or 2 of these:
- Gliptins or
- Pioglitazone or
- Sulphonylurea or
- SGLT2i

Metformin + GLP1 mimetics + one of these:
- Gliptins or
- Pioglitazone or
- Sulphonylurea or
- SGLT2i or
- Insulin (with or without drugs)

Question 8

When can GLP-1 mimetic be given and not given?

Answer 8

GLP1 helps with weight loss

Given to patients with:
- BMI 35kg/m2 or higher
- medical problems associated with obesity

• would benefit from weight loss although BMI lower than 35kg/m2

Question 9

When should GLP1 mimetic therapy be continued?

Answer 9

If the patient has had beneficial metabolic response - a reduction of at least 11mmol/mol in HbA1c and weight loss of at least 3% of initial body weight in 6 months

Question 10

What the first love treatment for Type 2 diabetes and chronic kidney disease?

Answer 10

Offer ACE or ARB

Then titrate to highest dose which can be tolerated

Then add SGLT2 inhibitors (e.g. dapagliflozin)

Question 11

What must be checked before starting SGLT2 inhibitors?

Answer 11

Check if increased risk of diabetic ketoacidosis (DKA), so if:

• they have had a previous episode of DKA
• are unwell with intercurrent illness
• are following a low carbs or ketogenic diet (they would need to change their diet)