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Frailty and type 2 diabetes overtreatment — SCE Endocrinology MCQ

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EasyDiabetes mellitusFrailty and type 2 diabetes overtreatmentSCE Endocrinology

A 68-year-old man with type 2 diabetes and frailty has HbA1c 49 mmol/mol on gliclazide 160 mg twice daily. He has had two falls preceded by sweating and confusion; capillary glucose during one episode was 2.9 mmol/L. What is the most appropriate management?

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Correct answer: B — Relax the glycaemic target and reduce sulfonylurea exposure

Relax the glycaemic target and reduce sulfonylurea exposure is best because documented hypoglycaemia in frailty should prompt individualised targets and de-intensification of hypoglycaemia-provoking therapy. The alternatives are less appropriate because tighter targets increase harm; prandial insulin adds hypoglycaemia risk; diet change without medication review is unsafe; sulfonylurea escalation worsens the problem. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG28