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CONTINUING PROFESSIONAL DEVELOPMENT
As the prevalence of diabetes continues
to increase in Australia, the need for
pharmacists to assist patients to be
adherent to management plans will
be of growing importance. This case
illustrates how a patient’s simple
misconception may potentially have
profound effects on their health
outcomes and quality of life, and how
a patient‐centred approach is key to
optimising treatment plans.
1. Australian Bureau of Statistics. Diabetes mellitus. In:
4364.0 .55 .001 – National Health Survey: First Results,
2014–15. 2016. At: www.abs.gov.au/ausstats/abs@.nsf/
Lookup/by%20Subject/4364.0 .55 .001~2014-15~Main%20
2. Diabetes Australia. Diabetes in Australia. 2016. At: www.
3. The Royal Australian College of General Practitioners.
General practice management of type 2 diabetes –
2014–15. Melbourne, Victoria: RACGP and Diabetes
Australia; 2014. At: www.racgp.org.au/your-practice/
4. Munshi MN, Pandya N, Umpierrez GE, et al. Contributions of
basal and prandial hyperglycemia to total hyperglycemia
in older and younger adults with type 2 diabetes mellitus. J
Am Geriatr Soc 2013;61(4):535–41.
5. Lipska KJ, Krumholz H, Soones T, Lee SJ. Polypharmacy in
the aging patient: a review of glycemic control in older
adults with type 2 diabetes. JAMA 2016;315(10):1034–45.
6. Corriere M, Rooparinesingh N, Kalyani RR. Epidemiology
of diabetes and diabetes complications in the elderly:
an emerging public health burden. Curr Diab Rep
7. Miller ME, Bonds DE, Gerstein HC, et al. The effects of
baseline characteristics, glycaemia treatment approach,
and glycated haemoglobin concentration on the risk of
severe hypoglycaemia: post hoc epidemiological analysis
of the ACCORD study. BMJ 2010;340:b5444.
8. Huang W, Castelino RL, Peterson GM. Metformin usage in type
2 diabetes mellitus: are safety guidelines adhered to? Intern
Med J 2014;44(3):266–72.
9. International Diabetes Federation. IDF global guideline
for managing older people with type 2 diabetes. Brussels,
Belgium: International Diabetes Federation; 2013. At: www.idf.
10. Malanda UL, Welschen LMC, Riphagen II, et al. Self-monitoring
of blood glucose in patients with type 2 diabetes mellitus
who are not using insulin. Cochrane Database of Systematic
Reviews 2012, Issue 1.
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1. The prevalence of diabetes in
Australia is highest in which ONE of
the following age groups?
a) 18 to 55 years.
b) 55 to 65 years.
c) 65 to 75 years.
d) 75 years and over.
2. Which ONE of the following
statements regarding diabetes
in older people is the MOST
a) Their risk of cardiovascular events is the
same as that of younger people with
b) Fasting hyperglycaemia is comparatively
less common in older people with
diabetes than younger people.
c) Older people have fewer complications
arising from hypoglycaemia than
d) The threshold HbA1c level for a
diagnosis of diabetes in older people is
higher than that in younger people.
3. Which ONE of the following
statements regarding diabetes
management is the MOST
a) Intensive glycaemic control has not
been shown to decrease the risk of
b) Clear glycaemic treatment targets for
older people have been established via
large randomised controlled trials.
c) Polypharmacy is associated with an
increased risk of severe hypoglycaemia
in older people.
d) Intensive glycaemic control is
associated with a reduced risk of
myocardial infarction within two years
of commencing treatment.
4. Which ONE of the following
statements regarding the choice of
diabetes therapy in older people is
the LEAST appropriate?
a) Metformin is usually the first-line choice,
although contraindications are more
common in older people.
b) Glibenclamide should be avoided in
older people due to a comparatively
high risk of hypoglycaemia.
c) There is evidence that metformin use
may be safe in people with a creatinine
clearance <30 mL/min.
d) Long-acting insulins should always be
avoided in older people due to a high
risk of prolonged hypoglycaemia.
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