Diabetes Mellitus (DM) Type 2

Question 1

What is type 2 diabetes mellitus (T2DM)?

Answer 1

T2DM is a chronic metabolic disorder characterised by insulin resistance and progressive pancreatic beta-cell dysfunction, leading to hyperglycaemia.

Question 2

What are the common symptoms of type 2 diabetes?

Answer 2

Increased thirst, polyuria, fatigue, recurrent infections, blurred vision, and weight loss in severe cases.

Question 3

What are the main risk factors for T2DM?

Answer 3

Obesity, physical inactivity, family history, age over 40, ethnicity (e.g., South Asian or African-Caribbean), and history of gestational diabetes.

Question 4

What is the pathophysiology of T2DM?

Answer 4

Insulin resistance leads to impaired glucose uptake in tissues, and pancreatic beta-cell dysfunction reduces insulin production, causing hyperglycaemia.

Question 5

How is T2DM diagnosed?

Answer 5

Diagnosis is made with HbA1c ≥48 mmol/mol (6.5%), fasting plasma glucose ≥7.0 mmol/L, or 2-hour plasma glucose ≥11.1 mmol/L during an OGTT.

Question 6

What is the role of HbA1c in diagnosing T2DM?

Answer 6

HbA1c reflects average blood glucose levels over 2-3 months and is used for both diagnosis and monitoring of T2DM.

Question 7

What are the key differences between type 1 and type 2 diabetes?

Answer 7

Type 1 diabetes is autoimmune with absolute insulin deficiency, whereas T2DM involves insulin resistance and relative insulin deficiency.

Question 8

What are the potential long-term complications of T2DM?

Answer 8

Microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (cardiovascular disease, stroke, peripheral vascular disease) complications.

Question 9

What is diabetic retinopathy?

Answer 9

A microvascular complication of diabetes affecting the retina, leading to vision impairment or blindness.

Question 10

How does T2DM affect the kidneys?

Answer 10

It can cause diabetic nephropathy, leading to proteinuria, reduced kidney function, and eventually chronic kidney disease (CKD).

Question 11

What are the goals of T2DM management?

Answer 11

To achieve good glycaemic control, prevent complications, and improve quality of life through lifestyle changes and pharmacological therapy.

Question 12

What is the first-line pharmacological treatment for T2DM?

Answer 12

Metformin is the first-line treatment, particularly in overweight or obese patients.

Question 13

How does metformin work?

Answer 13

Metformin reduces hepatic glucose production, increases peripheral insulin sensitivity, and lowers intestinal glucose absorption.

Question 14

What are the side effects of metformin?

Answer 14

Gastrointestinal upset (nausea, diarrhoea) and, rarely, lactic acidosis in patients with significant renal impairment.

Question 15

What are the second-line medications for T2DM if metformin alone is insufficient?

Answer 15

Sulfonylureas (e.g., gliclazide), DPP-4 inhibitors (e.g., sitagliptin), SGLT2 inhibitors (e.g., dapagliflozin), or GLP-1 agonists (e.g., liraglutide).

Question 16

What is the mechanism of action of SGLT2 inhibitors?

Answer 16

They reduce glucose reabsorption in the renal proximal tubules, increasing glucose excretion in urine and lowering blood glucose levels.

Question 17

What are the benefits of GLP-1 receptor agonists in T2DM?

Answer 17

They improve glycaemic control, promote weight loss, and may reduce cardiovascular risk.

Question 18

What lifestyle modifications are recommended for managing T2DM?

Answer 18

A balanced diet, regular physical activity, weight loss, smoking cessation, and limiting alcohol intake.

Question 19

What is diabetic ketoacidosis (DKA), and is it common in T2DM?

Answer 19

DKA is a life-threatening complication of hyperglycaemia due to insulin deficiency; it is rare in T2DM but can occur in severe cases.

Question 20

What is the role of blood glucose monitoring in T2DM?

Answer 20

It helps assess glycaemic control, especially for patients on insulin or those at risk of hypoglycaemia.

Question 21

What is hypoglycaemia, and how is it managed in T2DM?

Answer 21

Hypoglycaemia is a blood glucose level <4 mmol/L, managed with oral glucose (e.g., sugary drinks) or intravenous glucose in severe cases.

Question 22

What are the diagnostic criteria for prediabetes?

Answer 22

HbA1c of 42–47 mmol/mol (6.0–6.4%) or fasting plasma glucose of 5.5–6.9 mmol/L.

Question 23

What are the cardiovascular benefits of SGLT2 inhibitors in T2DM?

Answer 23

SGLT2 inhibitors reduce the risk of heart failure, cardiovascular events, and progression of renal disease.

Question 24

How is T2DM managed in patients with renal impairment?

Answer 24

Use renal-dose-adjusted medications such as reduced-dose metformin or DPP-4 inhibitors, and avoid SGLT2 inhibitors if contraindicated.

Question 25

What is the long-term prognosis for patients with T2DM?

Answer 25

Prognosis depends on glycaemic control and management of complications; effective treatment can significantly improve quality of life and reduce morbidity.