Endocrinology and diabetes for the AMC exam
Diabetes, thyroid disease, adrenal and pituitary disorders, calcium and bone. The AMC loves diabetic emergencies and the Australian diabetes treatment algorithm.
High-yield points
Type 2 diabetes diagnosis: HbA1c 6.5% (48 mmol/mol) or higher, fasting glucose 7.0 mmol/L or higher, or 2-hour OGTT/random glucose 11.1 mmol/L or higher.
Metformin is first line; add an SGLT2 inhibitor or GLP-1 receptor agonist early when there is cardiovascular disease, heart failure or CKD.
General HbA1c target is 7.0% (53 mmol/mol) or less, individualised (looser in the frail elderly).
DKA: IV fluids first, then fixed-rate insulin infusion (0.1 units/kg/hr), monitor and replace potassium closely; SGLT2 inhibitors can cause euglycaemic DKA.
Hypoglycaemia: 15 g of fast-acting carbohydrate if conscious; IM glucagon or IV glucose if not.
Thyroid: TSH is the screening test; primary hypothyroidism is treated with levothyroxine (commonly called thyroxine in Australia).
Adrenal crisis: hydrocortisone 100 mg IV/IM immediately, do not wait for results; patients on steroids need sick-day rules.
Hypercalcaemia: most commonly primary hyperparathyroidism (outpatients) or malignancy (inpatients); treat severe cases with IV saline then bisphosphonate.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Units and diagnosis | Glucose in mg/dL (e.g. fasting 126 mg/dL). | Glucose in mmol/L (fasting 7.0 mmol/L); HbA1c 6.5% or 48 mmol/mol diagnoses diabetes. |
| Diabetes screening | Opportunistic, or population screening from 30 under the NCD program. | AUSDRISK from age 40 in general, and from 18 in Aboriginal and Torres Strait Islander people, who get diabetes more often and younger. |
| Drug choice after metformin | Sulfonylureas, DPP-4 inhibitors and fixed-dose combinations are common, partly on cost. | SGLT2 inhibitors or GLP-1 agonists favoured with CVD, heart failure or CKD. PBS criteria apply. Supplies via NDSS. |
| Iodine | Iodine-deficiency goitre is classic; universal salt iodisation. | Iodised salt in bread since 2009; pregnant and breastfeeding women are advised an iodine supplement (150 mcg daily). |
Units and diagnosis
India (MBBS)
Glucose in mg/dL (e.g. fasting 126 mg/dL).
Australia (AMC): what the exam expects
Glucose in mmol/L (fasting 7.0 mmol/L); HbA1c 6.5% or 48 mmol/mol diagnoses diabetes.
Diabetes screening
India (MBBS)
Opportunistic, or population screening from 30 under the NCD program.
Australia (AMC): what the exam expects
AUSDRISK from age 40 in general, and from 18 in Aboriginal and Torres Strait Islander people, who get diabetes more often and younger.
Drug choice after metformin
India (MBBS)
Sulfonylureas, DPP-4 inhibitors and fixed-dose combinations are common, partly on cost.
Australia (AMC): what the exam expects
SGLT2 inhibitors or GLP-1 agonists favoured with CVD, heart failure or CKD. PBS criteria apply. Supplies via NDSS.
Iodine
India (MBBS)
Iodine-deficiency goitre is classic; universal salt iodisation.
Australia (AMC): what the exam expects
Iodised salt in bread since 2009; pregnant and breastfeeding women are advised an iodine supplement (150 mcg daily).
The Australian context
Australia reports blood glucose in mmol/L and HbA1c in both % and mmol/mol, not mg/dL, so convert your Indian reference numbers. Type 2 diabetes is several times more common in Aboriginal and Torres Strait Islander people and starts younger; screening starts from 18 years in this group. The National Diabetes Services Scheme (NDSS) subsidises glucose monitoring and supplies.