T2DM Flashcards
Definition?
Disorder defined by deficits in insulin secretion and action, leading to abnormal glucose metabolism and so metabolic pathologies.
90% of diabetes cases are T2
Risk factors?
- Older age
- Obesity
- Gestational diabetes
- Pre-diabetes
- Family history
- Non-white
- Physical inactivity
- POCS
- Hypertension
- Dyslipidaemia
- CVD
- Stress
- Low birth weight for gestational age
Differentials?
- Pre-diabetes-asymptomatic
- DM T1
- Latent autoimmune diabetes in adults-over 30’s, responsive to treatment, non-obese
- Monogenic diabetes-non-obese, young-family history
- Ketosis-prone diabetes-same as T1D-no evidence of autoimmunity
- Diabetes-gestational-after 24 wks?
Epidemiology?
• Age: Older
• Sex: Women
• Ethnicity: BAME
Prevalence: 3.5 million in UK
Aetiology?
Insulin resistance and insensitivity caused by exposure to risk factors
Clinical presentation?
- Risk factors
- Asymptomatic-screening
- Candidal infections
- Skin infections
- UTIs
- Fatigue
- Blurred vision
- Polydipsia->16.6 mmol/L (>300 mg/dL), HbA1c >95 mmol/mol (>11%).
- Polyphagia
- Polyuria
- Paraesthesias
- Nocturia
- Unintentional weight loss
- Acanthosis nigricans
Pathophysiology?
- Normal amount of insulin needed but insulin receptors not inserted into cell membrane
- Mechanisms not fully understood
- Adipokines -inflammation-linked to insulin resistance
- Genetics-twin studies
- More insulin produced via beta cell hyperplasia and hypertrophy
- Works in the short term
- Amylin aggregates in islets and so they become dysfunctional and die off-insulin levels die and pts develop hyperglycaemia
- But some circulating insulin available
Investigations-first line and findings?
- HbA1c-48 mmol/mol (6.5%) or greater
- Fasting plasma glucose->6.9 mmol/L (>125 mg/dL)
- Random plasma glucose-≥11.1 mmol/L (≥200 mg/dL)
- 2 hr post-load glucose after 75g oral glucose-≥11.1 mmol/L (≥200 mg/dL)
Investigations?-second line and findings?
- Fasting lipid profile
- Urine ketones
- Random C peptide
- Urinary albumin excretion
- Serum creatinine and eGFR
- ECG
- ABI
- Dilated retinal exam
Management-first line?
- Lifestyle changes
- Glycaemic management
- BP management
- Lipid management
- Antiplatelet therapy
Management-HG or symptomatic?
Basal-bolus insulin and CVD risk management
Metformin
Management-NHG-first line?
1-metformin and CVD risk reduction
Management-NHG-second line?
- SGLT2 inhibitor
- GLP-1 agonist
- DPP4 inhibitor
- Sulphonylurea or meglitinide
- Basal insulin
Management-NHG-third line?
- Alpha glucosidase inhibitor
* Thiazolidinedione
Management-NHG-fourth line?
- Individual regimen
- Switch to basal-bolus insulin
- Metformin
- Bariatric