Type 2 diabetes review and a new medicine
AMC Clinical practice station

The task

You are a general practitioner. Mrs Leilani Fotu, aged 59, has had type 2 diabetes for nine years and is here for a review. She takes metformin, a statin and a blood pressure tablet. Recent results: HbA1c 8.9% (74 mmol/mol), eGFR 78 mL/min/1.73 m², urine albumin to creatinine ratio mildly raised, LDL cholesterol 3.1 mmol/L. Review how she is managing, discuss her results and the options for improving treatment, and counsel her about any new medicine you propose. Answer her questions. The examiner will not take part in the conversation.

What this station tests

• Explore why doses are missed before changing treatment; side effects and shift work are common reasons.
• Name the fear behind a refusal, here insulin, and address it directly.
• Counsel on a new medicine with its purpose, how to take it, common effects and who to call.
• Sick-day guidance and warning signs of ketoacidosis, which can occur with normal sugar readings, are a safety requirement with SGLT2 inhibitors.
• Diabetes review includes feet, eyes, kidneys, blood pressure and cholesterol, not only sugar.

Sources for the clinical content

• RACGP: Management of type 2 diabetes, a handbook for general practice
• Kidney Health Australia: CKD management handbook
• healthdirect: Diabetic ketoacidosis
• Medical Board of Australia: Good medical practice, a code of conduct for doctors in Australia

An original practice scenario with invented patients. Not an exam question.

Practise next

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