Type 2 diabetes

Question 1

How common is it?

Answer 1

3.5 Million in the UK. 31,500 children with it.

Question 2

What causes it?

Answer 2

Combination of insulin resistance/insensitivity and insulin deficiency. This balance of the two varies between people.

Question 3

What risk factors are there?

Answer 3

Obesity and inactivity: accounts for 80-85% of the overall risk

Family history

Ethnicity: people of Asian, African, and black communities.

History of gestational diabetes (mothers and baby)

Poor dietary habits – low fibre, high glycaemic index food.

Drugs: statins, corticosteroids, thiazide+beta blocker

Metabolic syndrome

Low birthweight

Question 4

How does it present?

Answer 4

Persistent hyperglycaemia (HbA1c more than 48mmol/mol (6.5%) or random plasma glucose more than 11mmol/L)

Characteristic features of T1DM (thirst, polyuria, blurred vision, weight loss, recurrent infections, and tiredness) are not usually severe and may be absent.

Can also present as insulin resistance (acanthosis nigricans).

In an asymptomatic patient you need two separate HbA1cs.
Type 2 diabetes is more likely in a person with: No additional features of type 1 diabetes (such as rapid onset, often in childhood, insulin dependence, or ketoacidosis).

Question 5

Signs on examination?

Answer 5

Diabetic neuropathy. Diabetic retinopathy

Question 6

Investigations?

Answer 6

HbA1c

plasma glucose levels

Question 7

Treatment

Answer 7

Lifestyle advice and drugs.

Standard release metformin for all new diagnoses. If metformin is contraindicated: A Gliptin, Pioglitazone or a Sulfonylurea.

Second line: Metformin plus a gliptin, pioglitazone or a sulfonylurea. But if metformin is contraindicated then: A Gliptin plus pioglitazone or sulfonylurea OR pioglitazone plus a sulfonylurea

Third line: Metformin, a gliptin/pioglitazone and a sulfonylurea. Or start insulin based treatment

Question 8

Conditions that would present similarly

Answer 8

T1DM