Management Of T2DM

Which of the following statements might cause a false high HbA1c EXCEPT

• Patient on iron supplement for anemia

• 1st degree family history of T2DM

• On steroid treatment

• Patient on antipsychotic treatment

These statements are the diagnostic criteria for T2DM EXCEPT

• HbA1c >= 6.3

• FPG >= 7 with symptoms

• Capillary FBG > 5.6 without symptoms

• Random Plasma Glucose >= 11.1 with symptoms

What are the control targets for patients with T2DM?

I. HbA1c < 7 or <= 6.5 (for most cases)

II. LDL: <= 2.6 (most cases)

III. BP >= 140-149/90-99

IV. Weight loss of 10% in 1 month

V. Exercise 150 min/week

• All of the above

• I, II, III

• I, II, V

• I, III, V

A 54-year-old woman with long-standing T2DM, HTN, and CKD stage 3A is on perindopril 8 mg od, HCTZ 12.5 mg od, metformin XR 1 g od, and S/C Mixtard 24 units BD. She was recently referred to a nephrologist and was started on SGLT2i. Her eGFR dropped from 44 to 39 ml/min, 6 weeks after starting the medication. Clinically, she has mild ankle edema with a blood pressure of 130/80 mmHg. WHICH OF THE FOLLOWING IS THE RIGHT ACTION?

• Continue the same medication

• Reduce perindopril dose

• Stop HCTZ

• Stop SGLT2-I

Uncle S is a 60-year-old man with underlying diabetes mellitus (DM) and an HbA1c of 8.0%. He is currently on Metformin 1g BD and subcutaneous Mixtard 8u BD. He was recently discharged for coronary heart disease (CHD) last month. His eGFR is >45 ml/min/1.73 m². What is the best HbA1c target for this patient?

• <6.5

• 7.1-8.0

• 6.6-7.0

• <6.0

A 55-year-old man was seen in the clinic for optimization of his medication. He has long-standing T2DM, HTN, IHD, and CKD stage 3B on empagliflozin 10 mg od, s/c insulin 20 units BD, losartan 100 mg od, cardiprin 100 mg od, and atorvastatin 40 mg. His blood pressure was 138/80 mmHg. Latest blood tests showed

- creatinine 160 umol/L,

- K 4.5 mmol/L,

- HbA1c 7%,

- urine FEME: protein 3+, blood 1+

What is the next appropriate management?

• Add ARB

• Add loop diuretic

• Increase empagliflozin to 25 mg od

• TCA 3 months with repeated RP

The following are some of the suggested criteria for referral to a nephrologist EXCEPT:

• A pregnant CKD patient with baseline eGFR 27

• CKD patient with rapid eGFR decline >5 ml/min/1.73 m²/year

• Unexplained persistent proteinuria & microscopic hematuria

• Asymptomatic T2DM patient with moderately increased albuminuria (microalbuminuria) who has not been commenced on anti-proteinuria therapy yet

If patients with T2DM aged > 40 years and with no history of cardiovascular disease, does initiating statin therapy reduce the risk of cardiovascular events?

• Yes

• No

A 48-year-old man, BMI 31, newly diagnosed with T2DM. HbA1c is 7.8%. No complications. He is motivated to change his lifestyle.

What is the most appropriate first-line management?

• Take another 3 months with repeat HbA1c

• Start with lifestyle modification and metformin

• Offer insulin initiation

• TCA PRN

A 32-year-old man with T2DM, BMI 28, HbA1c 10.5%.

Tried maximum dose of metformin, SGLT2i and SU for 6 months with no success.

What is the next best step?

• Start basal insulin + continue metformin

• Off metformin and SGLT2i

• Optimize diet

• Tca 3 month