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Type 2 diabetes mellitus

Clinical Discipline(s)/Organ System(s)
Endocrinology, General Practice, Renal Medicine
Progress Test Topic(s)
Homeostasis
Description
A 53 year old Māori man, who is obese, visits the diabetic nurse for a routine review. You are asked to see him first. He says he feels well and is managing his medications but complains that no matter what he does he continues to gain weight and has been unsuccessful in his attempts to quit smoking.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Glucose homeostasis
   - Define the metabolic syndrome
   - Currently accepted theory of pathophysiology of type 2 diabetes mellitus
   - Pathology of microvascular and macrovascular complications of diabetes mellitus
   - Pharmacology of metformin, sulphonylureas, GLP1 analogues, DPPIV inhibitors, alpha glucosidase inhibitors, intermediate and mixed insulin, statins
Clinical and Communication Skills 
   - Elicit a history from a patient with type 2 diabetes mellitus; consider microvascular and macrovascular complications
   - Examine a patient with diabetes mellitus; include foot, vascular, eye and neurological examinations
   - Differential diagnosis of type 2 diabetes mellitus
   - Perform capillary blood glucose and urine dipstick
   - Interpret urine dipstick, HbA1c, urine albumin:creatinine ratio and ECG
   - Management of type 2 diabetes mellitus, including starting oral agents and changing to insulin
   - Complications of type 2 diabetes mellitus and strategies to prevent them
   - Management of diabetic retinopathy, neuropathy, diabetic ulcers and nephropathy. Outline when a referral to a specialist is required
   - Role of the diabetic nurse specialist and dietitian
   - Primary prevention and assessing cardiovascular risk including goals for blood pressure control in patients with diabetes mellitus
   - Medical and non-medical approaches to smoking cessation
   - Medical and non-medical approaches to obesity, including role of bariatric surgery
Personal and Professional Skills 
   - Encourage self-management in an asymptomatic patient
   - Respect for autonomy; respect and uphold patient rights
   - Encourage exercise, smoking cessation and weight loss
   - Communication of absolute risk
   - Consider health literacy needs of patient and family/whānau
   - Consider patient and family/whānau cultural and spiritual needs
Hauora Māori 
   - Ethnic disparities in rates and management of type 2 diabetes and its complications
   - Barriers to healthcare for Māori with diabetes
   - Wider determinants and diabetes including disproportionate impact of socioeconomic deprivation on Māori
   - Role of Māori-led services for chronic disease and smoking cessation
   - Appropriate engagement and consultation with whānau in smoking cessation and management of type 2 diabetes
Population Health 
   - Epidemiology of type 2 diabetes mellitus
   - Principles of primary and secondary prevention
   - Origins of obesity
   - Distribution of obesity in the New Zealand population: possible explanations and implications for health care
   - Approaches to prevention of obesity and diabetes: strengths and limitations of each
   - Burden of disease attributable to smoking
   - Aids to smoking cessation: what is working?
Conditions to be considered relating to this scenario
Common
type 2 diabetes mellitus, obesity, monogenic diabetes mellitus, type 1 diabetes mellitus