Type 2 Diabetes

Question 1

What percentage of people with diabetes have type 2?

Answer 1

89%

Question 2

Is T2DM mono or polygenic?

Answer 2

Polygenic

Question 3

If your parent has diabetes what is your lifetime risk?

Answer 3

40%

Question 4

If you identical twin has diabetes what is your 15 year risk?

Answer 4

76%

Question 5

What is the main risk factor associated with T2DM?

Answer 5

Obesity

Question 6

What percent of people with T2DM are overweight/obese?

Answer 6

90%

Question 7

Describe the pathology of diabetes in relation to obesity

Answer 7

Obesity –> adiposity & free fatty acids & adiopkines
–> insulin resistance –> lipotoxicity in addition to genetic vulnerability of beta cells leads to an inability to produce insulin and thus diabetes

Question 8

What is insulin resistance syndrome associated with?

Answer 8

• hypertension
• hyperlipidaemia
• hyperglycaemia
• polycystic ovarian syndrome
• high risk of metabolic syndrome

Question 9

State three ways of which a patient with T2DM could present

Answer 9

1. with symptoms
2. after screening
3. due to concurrent illness e.g. CVD

Question 10

What are typical symptoms of T2DM?

Answer 10

blurred vision, polyuria, recurrent UTIs, tiredness

Question 11

What values must the following tests be to indicate diabetes:
HbA1c
Fasting glucose 
2-hr glucose 
Random glucose?

Answer 11

HbAc1 - >48
Fasting glucose >7
2-hr/random glucose >11

Question 12

State four aims of diabetes management

Answer 12

• treat symptoms
• prevent microvascular complications
• prevent cardiovascular complications
• screen for complications & treat complications early

Question 13

What is the most important aspect of diabetes management?

Answer 13

LIFESTYLE

Question 14

In T2DM what is the target HbA1?c

Answer 14

<53 but anywhere between 48-58 may be adequate

Question 15

Is gradual or intensive therapy better?

Answer 15

Gradual

Question 16

What are risk factors for failure to reach HbA1c target?

Answer 16

Female, younger, obese, no BP/lipid target, complex therapies, human factors

Question 17

Name a class of drugs that are harmful to cardiovascular health

Answer 17

Thiazolidinediones

Question 18

What is the risk of DDP4 inhibitors and Thhiazolindinediones?

Answer 18

Increase risk of heart failure and fluid retention

Question 19

What drugs are beneficial to cardiovascular health?

Answer 19

SGLT2 inhibitors, pioglitazone (alpha glucoside inhibitor), liraglutide (GLP1 inhibitor)

Question 20

What is the difference between basal and bolus insulin?

Answer 20

basal - slow acting

bolus - fast acting

Question 21

Name the first line treatment for diabetes

Answer 21

Metformin

Question 22

What drugs have a risk of hypoglycaemia?

Answer 22

Sulfonylureas & insulin

Question 23

Name two drugs that cause weight gain

Answer 23

• sulfonylureas

- thiazolidinedione

Question 24

Name two drugs that cause weight loss

Answer 24

• SGLT2 inhibitors

- GLP 1 receptor agonist

Question 25

How long is each drug tried for before a step up?

Answer 25

3 months

Question 26

What other medication should also be given to diabetics in addition to anti-diabetic drugs?

Answer 26

• blood pressure medication (target 130/80)

- cholesterol mediation in >40yo as primary prevention (aim for less than 4 total)

Question 27

When should metformin dose be reduced?

Answer 27

eGFR of <30 = stop

eGFR 30-45 = reduce from 1g BD to 500mg

Question 28

What are the side effects of SGLT 1 inhibitors and GLP1 receptor agonists

Answer 28

GI upset

Question 29

Why is there an increased risk for diabetics in pregnancy?

Answer 29

Increased risk of pre-eclampsia & foetal malformation may lead to termination if blood sugars are not well controlled