TYPE 2 DIABETES

Question 1

What is type 2 diabetes characterised by?

Answer 1

Insulin resistance

Question 2

When does T2DM develop

Answer 2

Typically develops later in life

Question 3

RF

Answer 3

• obese
• smokers
• increased age
• physical inactivity, poor diet choices

Question 4

Which BMI is considered obese, how do you adjust for ethnicity and which one in particular?

Answer 4

Non-asian
> 30 obese
> 25 overweight

Asian
>28 obese
> 23 overweight

Question 5

Patient with pre-diabetes

Answer 5

HbA1c of 42-47mmol/mol
* Can try and prevent diabetes with lifestyle advice

Question 6

When is diabetes considered?

Answer 6

Diabetic considered HbA1c of 48mmol/mol +

Question 7

T2DM: target HbA1c

Answer 7

48mmol or lower (6.5%)

Question 8

1st line for T2DM

Answer 8

• Metformin
• MR if standard release not tolerated

Question 9

When would you need to intensify treatment if on Metformin?

Answer 9

• If HbAlc is 58mmol mol or more, then intensify treatment

Question 10

Treatment of diabetes (low CVD risk)

Answer 10

1. Assess HbA1c, kidney function and cardiovascular risk
   > Treat with Metformin
   > Aim for individually agreed threshold
2. If HbA1c above the individually agreed threshold
   > Add in DPP-4i, Pioglitazone, SU or SGLT-2i
   > Aim for the individually agreed threshold
3. If HbA1c above the individually agreed threshold
   > Triple therapy by adding or swapping class of anti-diabetic
   > Aim for the individually agreed threshold

Question 11

Classes of antidiabetic drugs

Answer 11

DPP-4i: ‘Gliptins
SU: Sulfonylurea
SGLT-2i: ‘Flozins

Question 12

Treatment of Diabetes (High CVD Risk)

Answer 12

1. Assess HbA1c, kidney function and cardiovascular risk
   > Treat with Metformin
   > Once metformin is tolerated: add a SGLT-2i
   > If metformin is not tolerated: alone SGLT-2i
   > Aim for the individually agreed threshold
2. If HbA1c above the individually agreed threshold
   > Follow the guidelines for dual and triple therapy
   > If patient at any point develops high risk - consider an SGLT-2i

Question 13

When is a diabetic pt considered high risk for CVD?

Answer 13

Established atherosclerotic CVD / HF or a of QRISK2 > 10%

Question 14

If patient cannot tolerate metformin due to side effects

Answer 14

Use MR preparation

Question 15

Treatment of diabetes (metformin resistant)

Answer 15

1. Assess HbA1c, kidney function and cardiovascular risk
   > Treat with DPP-41, Pioglitazone, SU or SGLT-2i
   > High risk of cardiovascular disease: SGLT-2i
   > Aim for the individually agreed threshold
2. If HbA1c above the individually agreed threshold
   > Treat with DPP-4i + Pioglitazone or
   > DPP-4 + SU or Pioglitazone + SU
   > Aim for the individually agreed threshold
3. If HbA1c still not controlled,
   > insulin therapy to aim for individually agreed threshold