Click for Trajenta® (linagliptin) Prescribing information for Great Britain and Northern Ireland and Ireland
Click for Jardiance® (empagliflozin) Prescribing information for Great Britain and Northern Ireland and Ireland

Question 1

James, aged 39, has recently been diagnosed with type 2 diabetes. He is overweight, with a BMI of 29kg/m2. James works full time as a university librarian and travels by train and bus to work. What would be the first steps you should take to support James to reach his agreed target?

Boehringer Ingelheim has no control of the content of the external websites listed in References below.

References

  1. Klein S, Sheard NF, Pi-Sunyer X, et al. Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. Diabetes Care 2004;27(8):2067-73
  2. Diabetes Education and Self Management for Ongoing and Diagnosed (DESMOND). What is the DESMOND Programme? https://www.desmond.nhs.uk/about-us [Accessed March 2022]
  3. X-PERT Health. Programmes. https://www.xperthealth.org.uk/Programmes [Accessed March 2022]

Question 2

At diagnosis James had an HbA1c of 67mmol/mol. After 3 months of making changes to his diet and activity levels his HbA1c is now 52mmol/mol. At what stage does NICE recommend that medication should be started?

Boehringer Ingelheim has no control of the content of the external websites listed in References below.

References

  1. NICE NG28. Type 2 diabetes in adults: management, 2015 (2022 update). https://www.nice.org.uk/guidance/ng28 [Accessed March 2022]
  2. SIGN SIGN154. Pharmacological management of type 2 diabetes, 2017. https://www.sign.ac.uk/media/1090/sign154.pdf [Accessed March 2022]
  3. Davies MJ, D’Alessio DA, Fradkin F, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018;41:2669-2701

Question 3

Hannah is 73 years old, and has had type 2 diabetes for a number of years, during which her blood glucose has been well controlled. She is being treated with metformin 1g bd but over the past 6 months her HbA1c has crept up, and is currently 62mmol/mol. Hannah manages well in general although she lives alone and her only daughter lives 80 miles away. Which of the following would NOT be appropriate?

Boehringer Ingelheim has no control of the content of the external websites listed in References below.

References

  1. NICE CG76. Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence, 2009. https://www.nice.org.uk/guidance/cg76 [Accessed March 2022]
  2. Strain WD, Hope SV, Green A, et al. Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative. Diabetic Med 2018; 35(7):838-245

Question 4

Hannah is taking her metformin as prescribed and has not noticed any changes in her diet or activity levels that might explain the rise in her HbA1c over the past 6 months. Her current BMI is 26.8kg/m2 and this has been stable for the past few years, although it has been higher in the past. Hannah tries to keep her weight down as much as she can. Her HbA1c is 62mmol/mol, just above the threshold NICE recommends for intensification of therapy. Her most recent eGFR is 54ml/min/1.73m2, indicating mild renal impairment. Hannah is keen to aim for a tighter target for her HbA1c and is happy to take another oral hypoglycaemic agent in order to achieve this. Which of these options is LESS appropriate for Hannah?

Boehringer Ingelheim has no control of the content of the external websites listed in References below.

References

  1. Davies MJ, D’Alessio DA, Fradkin F, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018;41:2669-2701
  2. Strain WD, Hope SV, Green A, et al. Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative. Diabetic Med 2018;35(7):838-245
  3. Trajenta (linagliptin) Summary of Product Characteristics Summary of Product Characteristics SmPCs available at EMC: www.medicines.org.uk (GB) and https://www.emcmedicines.com/en-GB/northernireland/ (NI) and https://www.medicines.ie (IE) [Accessed March 2022]
  4. Jardiance (empagliflozin) Summary of Product Characteristics Summary of Product Characteristics SmPCs available at EMC: www.medicines.org.uk (GB) and https://www.emcmedicines.com/en-GB/northernireland/ (NI) and https://www.medicines.ie (IE) [Accessed March 2022]

Question 5

Hannah is now taking metformin with a DPP-4 inhibitor. Her general practice nurse has recommended that she should have another HbA1c test in 3 months’ time to assess her response to this first intensification of therapy. What target would be most suitable for Hannah on this new regimen?

Boehringer Ingelheim has no control of the content of the external websites listed in References below.

References

  1. NICE NG28. Type 2 diabetes in adults: management, 2015 (2022 update). https://www.nice.org.uk/guidance/ng28 [Accessed March 2022]
  2. ADA. Older Adults: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021;44:S168–S179
  3. Strain WD, Hope SV, Green A, et al. Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative. Diabetic Med 2018;35(7):838-245

PC-GB-104631 V2

Date of preparation: March 2022