Type 2 diabetes

Question 1

Microvascular complications

Answer 1

retinopathy, neuropathy, nephropathy

Question 2

Macrovascular complications

Answer 2

cerebrovascular disease, cardiovascular, peripheral vascular disease

Question 3

HbA1C level to initiate treatment

Answer 3

48 mmol

Question 4

Target HbA1C when on 2 or more antidiabetic drugs

Answer 4

53 mmol

Question 5

HbA1C level that would provoke intensification of treatment

Answer 5

58 mmol

Question 6

First line treatment

Answer 6

Metformin or if GI disturbances -> Metformin MR

Question 7

When to start SGLT2-inhibitor (-‘flozins’)

Answer 7

(1)Established atherosclerotic CVD
(2) Chronic heart failure
(3) Qrisk2 of 10% or higher (high risk of CVD)
-> as soon as metformin tolerability is confirmed

Question 8

advantage of SGLT2- inhibitor

Answer 8

proven cardiovascular benefit

Question 9

If metformin contraindicated and there is CVD risk or heart failure?

Answer 9

offer SGLT2 inhibitor alone

Question 10

When would pioglitazone not be suitable

Answer 10

History of bladder cancer, heart failure, ketoacidosis and univestigated macroscopic haematuria

Question 11

These can cause weight gain

Answer 11

Pioglitazone, sulfonylureas, insulin

Question 12

Antidiabetic with moderate hypoglycaemia risk, high risk in elderly

Answer 12

Sulfonylurea

Question 13

sulfonylureas to avoid in acute porphyrias

Answer 13

Gliclazide, tolubutamide

Question 14

These drugs are well known to cause volume depletion and hypotension - avoid in elderly

Answer 14

The flozins

Question 15

contraindicated in ketoacidosis

Answer 15

gliptins, pioglitazone, flozins, sulfonylureas

Question 16

gliptin that does not need dose reduction or caution in renal impairment

Answer 16

Linagliptin

Question 17

Gliptins to reduce dose or avoid in hepatic impairment

Answer 17

All gliptins except linagliptin and sitagliptin

Question 18

contraindicated in metabolic acidosis

Answer 18

metformin

Question 19

not associated with hypoglycaemia risk

Answer 19

metformin

Question 20

increased osteoporosis risk

Answer 20

dapagliflozin

Question 21

patient has renal impairment and is on gliptin?

Answer 21

reduce dose or caution (Except lingaliptin)

Question 22

patient has hepatic impairment ans is on gliptin?

Answer 22

caution or avoid (except linagliptin and sitagliptin)

Question 23

patient has renal impairment and is on GLP-1?

Answer 23

Reduse dose or caution or avoid based on eGFFR

Question 24

patient has hepatic impairment ans is on GLP-1?

Answer 24

Caution or avoid (except dulaglutide, exenatide and lixisenatide)

Question 25

second line treatment in the absence of CVD

Answer 25

dual therapy with either DPP-4 inhibitor ('gliptins'), sulfonylureas or pigoglitazone

Question 26

risk of hypoglycemia with gliptins is higher with?

Answer 26

long-acting e.g. glibenclamide

Question 27

when to offer GLP-1 mimetic

Answer 27

1) triple therapy ineffective, contraindicated, not tolerated 2) BMI 35 kg/m2 or more 3) BMI lower than 35 kg/m2 and insulin therapy not appropriate or would beenfit more from weight loss

Question 28

when to offer insulin in type 2 diabetes?

Answer 28

after triple therapy has failed

Question 29

HbA1c definition

Answer 29

measure of average plasma blood glucose levels over 2-3 months

Question 30

Avoid these whilst on insulin

Answer 30

ACE inhibitors oral antidiabetic medication GLP-1 mimetics (reports of DKA)

Question 31

These drugs increase insulin requirements

Answer 31

Thyroid medications oral contraceptives corticosteroids