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Diabetes – NICE guidelines

Diabetes – NICE guidelines. By Aradhana , Muninder , Amandeep , Vikash. Diagnosis. Symptomatic – One off reading -FBG >7.0 or RBG >11.1 -HBA1C 48mmol/l Asymptomatic – at least 2 readings -HBA1C and FBG together - 2 FBG or 2 RBG Sensible to rpt in 4-6 weeks (no evidence). Mgmt.

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Diabetes – NICE guidelines

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  1. Diabetes – NICE guidelines By Aradhana, Muninder, Amandeep, Vikash

  2. Diagnosis • Symptomatic – One off reading • -FBG >7.0 or RBG >11.1 • -HBA1C 48mmol/l • Asymptomatic – at least 2 readings • -HBA1C and FBG together • - 2 FBG or 2 RBG • Sensible to rpt in 4-6 weeks (no evidence)

  3. Mgmt • Step 1: Lifestyle and rpt HBA1C in 3/12 • Low GI, high fibre • Aim for 5-10% wt loss • Step 2: Metformin od for first week, bd for 2nd week, tds for 3rd week starting does is always 500mg Common s.e’s: transient FOR 2-3 WEEKS Increase to max (1g TDS) before adding on rx

  4. Step 3: Add-in sulphonylurea • Ensure counselling for hypos (elderly/drivers) • Alternatives Glitazones/gliptins • Glitazones: CIs inc – CCF, LF, Ca Bladder, fractures, wt gain • Gliptins: CIs inc – CKD REMEMBER TARGET IS HBA1C 6.5% until step 4

  5. Step 4: Exenatide - pros: occupational and BMI >35 - cons: Have to loose 3% wt and 1% drop in HBA1C in 6 months Insulin - Pros: better ctrl - Cons: hypos, wt gain, lipdystrophy Both are given subcut. ?pt compliance NEW HBA1C target 7.5% in Step 4

  6. Risks • Lipids – TC 4mmol/l and LDL-C <2mmol/l • BP – <140/80, if 130/80 with end organ damage • Footcare – annual neurovascular check • Eyes – annual retinopathy screening • Nerves - ?1st line rx in dm • Renal function – ACR with 6 mthly u+e’s

  7. AKT questions • 1. 55 years old male presents with h/ohtn. He has a FH of DM and requests a health check. HBA1C result comes back at 48mmol/l. • What do you do? • A. Start metformin • B. Rpt test • C. Advice only • D Start metformin and gliclazide

  8. 2. At what level of creatinine would you consider reducing metformin? • A. 108 • B. 136 • C. 150 • D. 80

  9. 3. 57 years old lorry driver with dm. He is obese and claims to have good bm ctrl. Which is the least suitable? • A. Pioglitazone • B. Gliclazide • C. Exenatide • D. Saxagliptin

  10. 4. 55 years old DM pt on max dose of Metformin and Sitagliptin. He is a lorry driver and his HBA1C is 7%. What is the next best mgmt? • A. Insulin • B. Pioglitazone • C. Linogliptin • D. Rosiglitazone • E. Exenatide

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