Diabetes Mellitus Type 2 Flashcards
What is T2DM
Progressive disorder due to insulin secretion deficits and increased insulin resistance
Some macrovascular complications of hyperglycaemia
Coronary heart disease, cerebrovascular amd peripheral artery disease
Some microvascular complications of hyperglycaemia
Retinopathy, nephropathy, neuropathy
Pathophysiology of T2DM
Genetic predisposition background with insulin secretion deficits and insulin resistance. Environmental factors such as ageing, BMI, diet can exacerbate resistance
How does T2DM present
Can be asymptomatic and an accidental finding
Polydipsia, polyuria, candidal infections, skin infections, UTIs, fatigue and blurred vision
Risk factors for T2DM
Older age, overweight, family history, non white amcestry, PCOS, hypertension, dyslipidaemia, CVD and stress
1st line investigations for diagnosing T2DM
Fasting plasma glucose, HbA1c, OGTT (2 hour glucose test) and random plasma glucose
Initial treatment of T2DM at initial diagnosis
Lifestyle changes (diet, weight, exercise, education)
HbA1c target,
If symptomatic hyperglycaemia, give insulin or sulphonylurea
First line treatment T2DM
Metformin
Plus lifestyle changes and cardiovascular risk reduction
If HbA1c is still above goal after metformin mono therapy what do you give
Metformin PLUS 1 or 2 anti hyperglycaemic agents and lifestyle changes.
Or insulin or SGLT2 inhibitors or GLP1 agonist
Or bariatric surgery
If someone can’t tolerate metformin or can’t take it what do you give
DPP4 inhibitor or pioglitazone or sulphonylurea or SGLT2 inhibitor
If still HbA1c above goal, do dual therapy or bariatric surgery as 3rd line
Treatment of T2DM in pregnant women
Low dose aspirin or metformin or insulin.
Aspirin reduces risk of preeclampsia
Prognosis of T2DM
Macro and microvascular conditions
