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Hypoglycaemia in type 2 diabetes — SCE Endocrinology MCQ

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EasyDiabetesHypoglycaemia in type 2 diabetesSCE Endocrinology

A 77-year-old man with type 2 diabetes, frailty and recurrent falls has HbA1c 53 mmol/mol while taking gliclazide 160 mg daily and metformin. He reports two early-morning capillary glucose readings below 3.5 mmol/L in the last month. What is the most appropriate management?

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Correct answer: B — Reduce or stop gliclazide and individualise the HbA1c target

Recurrent hypoglycaemia in a frail older adult should prompt de-intensification, especially of sulfonylurea therapy, and an individualised target. Adding insulin or increasing gliclazide would worsen hypoglycaemia risk. A clinical pearl is that low HbA1c is not automatically beneficial in frailty when achieved at the cost of hypoglycaemia.

Reference: NICE NG28; BNF