GP Vivas · metabolic-and-endocrine-health
Type 2 diabetes — structured viva
Structured oral on type 2 diabetes: defending metformin-first with UKPDS numbers, the comorbidity-before-HbA1c selection logic, cardiorenal outcome-trial evidence, hyperglycaemic emergencies, and the remission conversation.
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Target exams
RACGP CCEFRACGP oralsMRCGP SCA
Prompt
The examiner opens: 'A registrar tells you every diabetic patient just needs metformin and a target of 7% — talk me through why that is no longer good enough.' The viva branches through trial evidence, drug selection, emergencies, insulin and remission.
Stem
You are the GP supervisor. A first-year registrar claims that all type 2 diabetes patients need is metformin and an HbA1c below 53 mmol/mol. [3]
References8ShowHide
- [1]UK Prospective Diabetes Study (UKPDS) Group Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) Lancet, 1998.PMID 9742976
- [2]UK Prospective Diabetes Study (UKPDS) Group Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) Lancet, 1998.PMID 9742977
- [3]Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association and the European Association for the Study of Diabetes Diabetologia, 2022.PMID 36151309
- [4]Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes N Engl J Med, 2015.PMID 26378978
- [5]Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy N Engl J Med, 2019.PMID 30990260
- [6]McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction N Engl J Med, 2019.PMID 31535829
- [7]Pasquel FJ, Umpierrez GE Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment Diabetes Care, 2014.PMID 25342831
- [8]Lean MEJ, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial Lancet, 2018.PMID 29221645