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Worksheets739 ME updated guidelines 25-26
Total questions: 10
Worksheet time: 5mins
A 52-year-old man is newly diagnosed with Type 2 Diabetes. His HbA1c is 68 mmol/mol. He has no other significant past medical history. His cardiovascular risk assessment places him at moderate risk. What is the most appropriate initial pharmacological management according to NICE 2025 guidelines?
Lifestyle advice only, with a review in 3 months.
Standard-release Metformin monotherapy.
Metformin and a Sulphonylurea.
Metformin and an SGLT-2 inhibitor.
An SGLT-2 inhibitor monotherapy.
A 65-year-old woman with Type 2 Diabetes presents for a review. Her current medication is Metformin 1g BD. She was recently hospitalised for a myocardial infarction. What is the most appropriate adjustment to her anti-diabetic regimen?
Add a Sulphonylurea.
Add a DPP-4 inhibitor.
Add an SGLT-2 inhibitor and subcutaneous Semaglutide.
Switch to a basal-bolus insulin regimen.
Add an SGLT-2 inhibitor.
A 70-year-old man with Type 2 Diabetes and chronic heart failure with reduced ejection fraction is started on anti-diabetic medication. He has no contraindications to first-line agents. What is the recommended initial therapy?
Pioglitazone.
A DPP-4 inhibitor.
Metformin monotherapy.
Metformin and an SGLT-2 inhibitor.
A GLP-1 receptor agonist.
A 58-year-old patient with Type 2 Diabetes is found to have an eGFR of 25 ml/min/1.73 m². Metformin is contraindicated due to the renal impairment. What is the most appropriate pharmacological option?
A. A Sulphonylurea.
B. Pioglitazone.
C. Dapagliflozin
D. A DPP-4 inhibitor.
E. Insulin.
An 82-year-old frail woman with Type 2 Diabetes (eGFR 55 ml/min/1.73 m²) is started on medication. Her frailty level places her at risk of adverse events from SGLT-2 inhibitors (e.g., dehydration). What is the most appropriate initial treatment?
An SGLT-2 inhibitor.
Metformin alone.
Metformin and an SGLT-2 inhibitor.
A Sulphonylurea.
A GLP-1 receptor agonist.
A 60-year-old man with T2DM, obesity, and no cardiovascular disease has been on Metformin, an SGLT-2 inhibitor, and Liraglutide (a GLP-1 receptor agonist) for 9 months. His HbA1c remains above target at 60 mmol/mol, and he has had no significant weight loss. What is the most appropriate action regarding the GLP-1 receptor agonist?
Increase the dose of Liraglutide.
Switch to subcutaneous Semaglutide.
Add a DPP-4 inhibitor.
Stop the GLP-1 receptor agonist.
Commence insulin.
You are initiating therapy for a patient with T2DM and ASCVD. The plan is for metformin, an SGLT-2 inhibitor, and subcutaneous semaglutide. According to NICE 2025, what is the correct sequence for introducing these medicines?
Start all three simultaneously.
Start semaglutide first, then add the others once tolerated.
Start metformin, then add the SGLT-2 inhibitor once tolerated, then add semaglutide once the SGLT-2 inhibitor is tolerated.
Start the SGLT-2 inhibitor and semaglutide together, then add metformin.
Start metformin and semaglutide together, then add the SGLT-2 inhibitor.
A 32-year-old woman with T2DM and obesity is being considered for a GLP-1 receptor agonist. What is a crucial piece of counselling that must be provided, according to the 2025 guidelines?
The medicine must be taken with food to avoid nausea.
Effective contraception must be used.
It should be stopped immediately if she develops symptoms of pancreatitis.
It will eliminate the need for any other diabetes medications.
It can be safely continued throughout pregnancy.
A patient with T2DM is taking Metformin and an SGLT-2 inhibitor. They develop gastroenteritis with vomiting and diarrhoea. According to NICE 2025, what should be included in their "sick day rules"?
Double the dose of metformin to control hyperglycaemia.
Continue all medications as normal.
Temporarily stop the SGLT-2 inhibitor and metformin due to the risk of dehydration and ketoacidosis.
Switch to short-acting insulin immediately.
Only stop the SGLT-2 inhibitor but continue metformin.
A 35-year-old man is diagnosed with T2DM. He is started on Metformin and an SGLT-2 inhibitor. After 3 months, his HbA1c remains above target. What is the next most appropriate step?
Add a Sulphonylurea.
Start a basal insulin regimen.
Consider adding a GLP-1 receptor agonist.
Add a DPP-4 inhibitor.
Refer for bariatric surgery.
