Diabetes management: a case-based discussion

Dr Rinki Murphy uses a case-based approach to diabetes management incorporating the new Diabetes Management Guidance and discusses where the newly funded dulaglutide fits.

Topics

Intro
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Case intro
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Treating to target to minimise diabetic complications and maximise longevity
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How do we optimise his management?
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If we were to add in a new medication, what would it be and why?
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Do we need to down titrate existing medications and up titrate new ones?
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What monitoring do we need to do?
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What are the expected benefits of this for our case?
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What if our case was already taking insulin? How would this change things? Do we stop insulin?
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Fast forward a decade. What would we need to do now?
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Special authority criteria
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Take-home messages
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Take home messages

Assess all people with T2D for history of HF, and consider prescribing SGLT2i as these reduce hospitalisation and mortality from HF.
Lower glucose lowering response expected from SGLT2i with lower eGFR but these still provide cardiorenal benefits.
If SGLT2i not indicated (due to eGFR<30, on VLCD/ketogenic diet) or not tolerated (due to recurrent thrush/UTI) then consider switching to GLP1RA.
Start Trulicity 1.5mg once fortnightly then after two doses may take 1.5mg weekly and discuss with patients how to minimise nausea with eating less, avoiding fatty foods to increase tolerance and aid weight loss.

Resources

Best Practice e-Journal - Diabetes Special Edition bpacnz (2021)
Trulicity (dulaglutide 1.5 mg/0.5 mL) solution for injection NZ Data Sheet (2021)
Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet (2019)
Type 2 Diabetes Management Guidance. NZSSD and MOH (2021)
Decision to fund two new medicines for type 2 diabetes - Amended with Q&A PHARMAC (2021)

Patient Resources

Presenter

Rinki Murphy

Diabetes Physician

Rinki is an Associate Professor in Medicine at the University of Auckland and Principle investigator at the Maurice Wilkins Centre for Biodiscovery. She is a diabetologist at Auckland and Counties Manukau DHBs.