417.2 📚 國考版醫垫國考 / PGY OSCE

417.2.0.1 📌 Cram Sheet

417.2.0.1.1 🔥 高 yield 18
  1. HbA1c < 7% 倚敞成人個人化
  2. 9 藥類: metformin / SU / glinide / TZD / DPP-4 / SGLT2 / GLP-1 / GIP+GLP-1 / insulin
  3. Metformin 1st line (陀非 eGFR < 30)
  4. CVD/HF/CKD → SGLT2 or GLP-1 1st-line addition
  5. HFrEF/HFpEF → SGLT2 mandatory (even non-DM)
  6. CKD eGFR > 20 + proteinuria → SGLT2 mandatory
  7. Obesity priority → GLP-1 (semaglutide) or tirzepatide
  8. Tirzepatide HbA1c -2.5% + weight -20% (best class)
  9. Insulin when HbA1c > 9% + symptomatic
  10. SGLT2 SE: GU infection, eu-DKA, vol depletion, Fournier
  11. GLP-1 SE: nausea, pancreatitis, MTC risk (CI MEN2)
  12. TZD CI: HF NYHA III-IV, fracture, bladder CA
  13. DPP-4 saxagliptin HF risk
  14. SU SE: hypoglycemia + weight gain
  15. Glyburide 老人 + CKD 避甚 (long-acting metabolite)
  16. TIR > 70% for T1DM CGM
  17. AID (hybrid closed-loop) = revolutionary for T1DM
  18. Once-weekly icodec (22E phase 3 / EU approved)
417.2.0.1.2 🔢 必背
項目 æ•žå­—
HbA1c general < 7%
HbA1c stricter < 6.5%
HbA1c lenient < 8%
BP DM < 130/80
LDL ASCVD < 70
LDL other < 100
Metformin eGFR > 30 (full); 30-45 reduced; < 30 stop
SGLT2 eGFR > 20 for CKD; > 30 for glycemic
TIR target T1DM > 70%
CV death NNT EMPA-REG ~ 39 over 3 yr
GLP-1 weight loss 5-15%
Tirzepatide weight loss 15-20%
Insulin starting basal 0.1-0.2 U/kg/d

417.2.0.2 ⭐ 高 yield

417.2.0.2.1 Drug Class Summary
Class HbA1c ↓ Weight Hypo CV Renal äž» SE
Metformin 1-2% ↔ No Neutral OK >30 GI, B12
SU 1-1.5% ↑ Yes Neutral Adjust Hypo
Glinide 0.5-1% ↑ Yes Neutral OK Hypo
TZD 1% ↑↑ No Mixed OK HF, fracture
DPP-4 0.5-0.8% ↔ No Neutral Mostly OK Joint, pancreatitis
SGLT2 0.5-1% ↓ No Benefit Benefit GU, eu-DKA
GLP-1 1-1.5% ↓↓ No Benefit Benefit GI, MTC, gallstone
GIP+GLP-1 2-2.5% ↓↓↓ No Trial TBD GI
Insulin varies ↑ Yes Neutral OK Hypo
417.2.0.2.2 Trials Quick
Trial Drug Population Outcome
EMPA-REG Empagliflozin T2DM + CV CV ↓
LEADER Liraglutide T2DM + CV CV ↓
SUSTAIN-6 Semaglutide T2DM + CV CV ↓
REWIND Dulaglutide T2DM CV ↓
DAPA-HF Dapagliflozin HFrEF HF ↓
EMPEROR-Reduced Empagliflozin HFrEF HF ↓
EMPEROR-Preserved Empagliflozin HFpEF HF ↓
DAPA-CKD Dapagliflozin CKD Renal ↓
EMPA-KIDNEY Empagliflozin CKD Renal ↓
CREDENCE Canagliflozin DM + CKD Renal ↓
FLOW Semaglutide DM + CKD Renal ↓ (22E)
SURPASS Tirzepatide T2DM HbA1c -2.5%
SURMOUNT Tirzepatide Obesity Weight -20%
SOUL Oral semaglutide T2DM + CV CV ↓ (22E NEJM)
QWINT-1 Once-weekly icodec T2DM Non-inferior (22E)
ESSENCE Semaglutide NASH Histology ↓ (22E)
SUMMIT Tirzepatide HFpEF + obesity HF ↓ (22E)
417.2.0.2.3 Insulin Quick
Type Onset Peak Duration
Lispro/aspart/glulisine 5-15 min 1-2 h 4-6 h
Faster aspart < 5 min 1 h 4-5 h
Regular 30 min 2-4 h 6-8 h
NPH 1-2 h 4-10 h 12-18 h
Glargine U-100 1-2 h flat ~ 24 h
Glargine U-300 6 h flat 36 h
Detemir 1-2 h mild 18-22 h
Degludec 1 h flat 42 h
Once-weekly icodec 24 h flat 7+ d
417.2.0.2.4 CGM + AID
  • CGM accuracy (MARD): Dexcom G7 ~ 8%, Libre 3 ~ 8%, Medtronic Guardian ~ 11%
  • TIR target: > 70% (70-180 mg/dL); > 50% for elderly
  • TBR (time below range < 70): < 4%; < 1% for severe
  • AID systems: Tandem t:slim X2 + Control-IQ, Medtronic 780G, Omnipod 5

417.2.0.3 🎯 自我檢枬

  1. HbA1c general goal? → < 7%
  2. Metformin eGFR cutoff? → < 30 stop
  3. SGLT2 mandatory in? → HF + CKD
  4. GLP-1 best in? → Obesity, CVD
  5. Tirzepatide HbA1c effect? → -2.5%
  6. Tirzepatide weight in obesity? → -15-20%
  7. Glyburide avoid in? → 老人 + CKD
  8. TZD CI? → HF NYHA III-IV
  9. Saxagliptin warning? → HF (SAVOR-TIMI 53)
  10. SGLT2 unique SE? → eu-DKA (rare)
  11. GLP-1 CI? → MEN2 / family Hx MTC
  12. Once-weekly icodec? → 22E ultra-long basal
  13. AID systems names? → t:slim+Control-IQ / 780G / Omnipod 5
  14. TIR target T1DM? → > 70%
  15. Basal insulin starting? → 0.1-0.2 U/kg/d
  16. Honeymoon period? → T1DM early partial remission
  17. C-peptide use? → β-cell function
  18. EMPA-REG NNT CV death? → ~ 39 over 3 yr

⚠ AI 草皿。