Type 2 Diabetes

Question 1

What is the general goal for BP in patients with T2DM?

Answer 1

<140/90

Question 2

Is aspirin recommended for all T2DM patients for primary prevention?

Answer 2

no

Question 3

Do GLP1 agonists have benefit in CV disease secondary prevention?

Answer 3

yes

Question 4

Is there any evidence for CV benefit for combined SGLT2i and GLP1 agonists?

Answer 4

no

Question 5

What is the mechanism of CV risk factor reduction by SGLT2 inhibitors?

Answer 5

Lowers blood glucose levels
Lowers BP via osmotic diuresis
Increases urinary caloric loss with reductions in body weight
Reduces albuminuria 
Reduces myocardial stretch
Reduces plasma uric acid

Question 6

Which patients should be taking SGLT2 inhibitors?

Answer 6

T2DM patients with established CVD or CKD and HbA1c >7%

Question 7

What are the relative contraindications for SGLT2 inhibitors?

Answer 7

Genital thrush infections
Recurrent UTIs
Ketosis prone
Frail elderly
Prone to dehydration
Immunocompromised
Active foot ulcer (issue with amputation)

Question 8

What is the effect of lower eGFR on SGLT2 inhibitors?

Answer 8

Glucose lowering efficacy is reduced with lower eGFR

However BP lowering and CV and renal benefits are maintained

Question 9

What causes euglycaemic diabetic ketoacidosis with SGLT2 inhibitors?

Answer 9

Occurs due to an absolute or relative lack of insulin

Euglycaemic because kidneys continue to excrete glucose

Question 10

What are the precipitants for euglycaemic ketoacidosis?

Answer 10

Prolonged fasting
Sepsis
Reduction in insulin
Significant alcohol intake
Exercise