Diabetes Management Guidelines for RACGP Exams: Key Points for AKT & KFP Preparation

Diabetes mellitus is one of the most common chronic conditions encountered in Australian general practice, making it a high-yield topic for the RACGP exams. Whether you’re preparing for the Applied Knowledge Test (AKT) or the Key Feature Problem (KFP), a strong grasp of diabetes management is essential.

The RACGP Guidelines for General Practice Management of Type 2 Diabetes outline current best practices in diagnosis, treatment, and long-term care. This article highlights the essential areas of diabetes management that every exam candidate should know.

 

RACGP Exam Prep

 

Epidemiology & Importance in General Practice

Diabetes affects approximately 1 in 20 Australians, with type 2 diabetes representing over 85% of all cases. As GPs are often the first point of contact for diagnosis and ongoing management, understanding the disease’s natural progression, risk factors, and evidence-based interventions is central to both clinical practice and RACGP assessment scenarios.

 

Diagnosis of Diabetes Mellitus

The RACGP diabetes management guidelines align closely with Australian Diabetes Society (ADS) criteria for diagnosis. Candidates should remember the following diagnostic thresholds:

  • Fasting plasma glucose ≥7.0 mmol/L
  • 2-hour plasma glucose ≥11.1 mmol/L following an oral glucose tolerance test
  • HbA1c ≥6.5% (48 mmol/mol)
  • Random plasma glucose ≥11.1 mmol/L in a symptomatic patient

For the AKT exam, understanding when to confirm results, how to manage borderline cases, and when to repeat testing is crucial.

 

AKT and KFP Q Bank

 

Initial Management of Type 2 Diabetes

Early management focuses on lifestyle modification and patient education. Candidates should be familiar with the following principles:

  • Diet and Exercise: Encourage a balanced diet following the Australian Dietary Guidelines and at least 150 minutes of moderate physical activity per week.
  • Weight Management: Aim for a 5–10% weight reduction in overweight patients, which can significantly improve glycaemic control.
  • Smoking Cessation & Alcohol Limitation: Addressing these modifiable risks is an important part of long-term management.

For exam scenarios, always consider the whole-patient approach, including cultural and socioeconomic factors.

 

Pharmacological Management

The RACGP guidelines recommend a stepwise approach to pharmacotherapy:

1.    Metformin (first-line): Unless contraindicated, metformin remains the initial therapy for most patients.

2.    Second-line Agents:

o   SGLT2 inhibitors or GLP-1 receptor agonists for patients with cardiovascular disease or high cardiovascular risk.

o   Sulfonylureas or DPP-4 inhibitors as alternatives based on tolerance and cost.

3.    Insulin Therapy: Introduced when HbA1c targets are not met despite oral therapy.

For KFP exam preparation, focus on selecting appropriate add-on therapy based on comorbidities, renal function, and hypoglycaemia risk.

 

Glycaemic Targets

The RACGP recommends an HbA1c target of ≤7.0% (53 mmol/mol) for most adults, but this may vary:

  • Tighter control (≤6.5%) for younger patients without comorbidities.
  • Looser targets (≤8%) for elderly or frail patients to reduce hypoglycaemia risk.

Understanding individualized targets is essential for clinical reasoning questions in both AKT and KFP exams.

 

FRACGP Exam Course

 

Monitoring and Complication Screening

GPs play a vital role in ongoing monitoring. The RACGP guidelines recommend:

  • HbA1c every 6 months (every 3 months if changing therapy).
  • Annual renal function tests and urinary albumin:creatinine ratio.
  • Annual foot and eye examinations.
  • Cardiovascular risk assessment every 2 years or more frequently if indicated.

These preventive measures often appear in RACGP exam scenarios, testing how well candidates integrate chronic disease management and preventive care.

 

Patient Education & Team-Based Care

Successful diabetes management requires a multidisciplinary approach. Candidates should recognize the value of involving:

  • Diabetes educators
  • Dietitians
  • Podiatrists
  • Optometrists or ophthalmologists
  • Endocrinologists (for complex or refractory cases)

In exam cases, demonstrating understanding of referral pathways and chronic disease management plans (CDMPs) often earns additional marks.

For RACGP candidates, mastering diabetes management guidelines is essential for success in both the AKT and KFP exams. Focus on diagnostic criteria, individualized treatment goals, pharmacological steps, and long-term monitoring strategies.

Incorporating the RACGP exam timing tips, practicing AKT-style questions, and applying clinical reasoning to KFP case scenarios will help solidify your understanding. Strong command of diabetes care not only boosts exam performance but also forms the foundation of effective general practice in Australia.