Type 2 diabetes

Question 1

what is type 2 diabetes and when can it occur

Answer 1

-insulin resistance
-later development
-prediabetes

Question 2

what is prediabetes HbA1c level?

Answer 2

42-47mmol/mol

Question 3

how can you prevent prediabetes

Answer 3

via lifestyle

Question 4

when is prediabetes considered diabetes

Answer 4

when hba1c level is 48mmol

Question 5

first line tx of diabetes low cvd risk

Answer 5

• assess hb1ac, kidney function, cardiovascular risk
  ->tx metformin
  -> aim = individually agreed threshold

Question 6

second line tx of diabetes low CVD risk

Answer 6

• if hb1ac is above individually agreed threshold
  -> add DPP-4i (gliptins), proglitazone, sulfonylurea or SGLT-2i (flozins)

Question 7

3rd line tx of diabetes with low CVD risk

Answer 7

• if hb1ac is above individually agreed threshold
  ->triple therapy by adding or swapping class of anti-diabetic
  ->aim = individually agreed threshold

Question 8

1st line tx of diabetes with high CVD risk

Answer 8

• assess HbA1C, kidney function + cardiovascular risk
  ->inc risk: established atherosclerotic CVD.HF or a QRISK2 >10%
  -> tx metformin
  ->once metformin tolerated add SGLT-2i
  ->aim for individually agreed threshold

Question 9

if pt develops high risk

2nd line tx of diabetes with high CVD risk

Answer 9

• if HbA1c above individually agreed follow guidelines for dual therapy as low CVD risk
  -> if pt develops high risk then consider SGLT-2i

Question 10

1st line tx of diabetes if metformin resistant

Answer 10

• assess hb1ac, kidney function, cardiovascular risk
  -> tx DPP-4i, pioglitazone, SU, SGLT-2i
  ->if high risk of CVD then SGLT2i
  ->aim for individually agreed threshold

Question 11

2nd line tx of diabetes if metformin resistant

Answer 11

above individual agreed threshold
->tx DPP-4i + pioglitazone or PP4i + SU or P+SU
->aim for individual agreed threshold

Question 12

tx if metformin resistant due to s/e

Answer 12

use MR formulation