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Flashcards in T2DM RACGP guideline Deck (37)
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1

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

5-10%

2

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

C - <7%

3

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

4

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

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

5

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)

6

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

Fasting BSL or HbA1c every 3 years

7

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

3 yearly AUSDRISK

8

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

9

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

10

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

11

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

12

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"

13

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

14

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

SGLT2 inhibitors

15

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

16

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

17

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

18

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

19

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

1-2 years

20

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

21

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

22

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

23

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

24

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

25

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

26

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

27

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

28

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

29

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)

30

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