Diabetes Mellitus (DM) Type 2 Flashcards
What is type 2 diabetes mellitus (T2DM)?
T2DM is a chronic metabolic disorder characterised by insulin resistance and progressive pancreatic beta-cell dysfunction, leading to hyperglycaemia.
What are the common symptoms of type 2 diabetes?
Increased thirst, polyuria, fatigue, recurrent infections, blurred vision, and weight loss in severe cases.
What are the main risk factors for T2DM?
Obesity, physical inactivity, family history, age over 40, ethnicity (e.g., South Asian or African-Caribbean), and history of gestational diabetes.
What is the pathophysiology of T2DM?
Insulin resistance leads to impaired glucose uptake in tissues, and pancreatic beta-cell dysfunction reduces insulin production, causing hyperglycaemia.
How is T2DM diagnosed?
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.
What is the role of HbA1c in diagnosing T2DM?
HbA1c reflects average blood glucose levels over 2-3 months and is used for both diagnosis and monitoring of T2DM.
What are the key differences between type 1 and type 2 diabetes?
Type 1 diabetes is autoimmune with absolute insulin deficiency, whereas T2DM involves insulin resistance and relative insulin deficiency.
What are the potential long-term complications of T2DM?
Microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (cardiovascular disease, stroke, peripheral vascular disease) complications.
What is diabetic retinopathy?
A microvascular complication of diabetes affecting the retina, leading to vision impairment or blindness.
How does T2DM affect the kidneys?
It can cause diabetic nephropathy, leading to proteinuria, reduced kidney function, and eventually chronic kidney disease (CKD).
What are the goals of T2DM management?
To achieve good glycaemic control, prevent complications, and improve quality of life through lifestyle changes and pharmacological therapy.
What is the first-line pharmacological treatment for T2DM?
Metformin is the first-line treatment, particularly in overweight or obese patients.
How does metformin work?
Metformin reduces hepatic glucose production, increases peripheral insulin sensitivity, and lowers intestinal glucose absorption.
What are the side effects of metformin?
Gastrointestinal upset (nausea, diarrhoea) and, rarely, lactic acidosis in patients with significant renal impairment.
What are the second-line medications for T2DM if metformin alone is insufficient?
Sulfonylureas (e.g., gliclazide), DPP-4 inhibitors (e.g., sitagliptin), SGLT2 inhibitors (e.g., dapagliflozin), or GLP-1 agonists (e.g., liraglutide).
What is the mechanism of action of SGLT2 inhibitors?
They reduce glucose reabsorption in the renal proximal tubules, increasing glucose excretion in urine and lowering blood glucose levels.
What are the benefits of GLP-1 receptor agonists in T2DM?
They improve glycaemic control, promote weight loss, and may reduce cardiovascular risk.
What lifestyle modifications are recommended for managing T2DM?
A balanced diet, regular physical activity, weight loss, smoking cessation, and limiting alcohol intake.
What is diabetic ketoacidosis (DKA), and is it common in T2DM?
DKA is a life-threatening complication of hyperglycaemia due to insulin deficiency; it is rare in T2DM but can occur in severe cases.
What is the role of blood glucose monitoring in T2DM?
It helps assess glycaemic control, especially for patients on insulin or those at risk of hypoglycaemia.
What is hypoglycaemia, and how is it managed in T2DM?
Hypoglycaemia is a blood glucose level <4 mmol/L, managed with oral glucose (e.g., sugary drinks) or intravenous glucose in severe cases.
What are the diagnostic criteria for prediabetes?
HbA1c of 42–47 mmol/mol (6.0–6.4%) or fasting plasma glucose of 5.5–6.9 mmol/L.
What are the cardiovascular benefits of SGLT2 inhibitors in T2DM?
SGLT2 inhibitors reduce the risk of heart failure, cardiovascular events, and progression of renal disease.
How is T2DM managed in patients with renal impairment?
Use renal-dose-adjusted medications such as reduced-dose metformin or DPP-4 inhibitors, and avoid SGLT2 inhibitors if contraindicated.
What is the long-term prognosis for patients with T2DM?
Prognosis depends on glycaemic control and management of complications; effective treatment can significantly improve quality of life and reduce morbidity.
