WorksheetsManagement Of T2DM
Total questions: 10
Worksheet time: 5mins
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
