Type 2 Diabetes Flashcards
what is the pathophysiology of T2DM
genetic disposition + obesity lifestyle factors
insulin resistance
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compensatoy beta cell hyperplasia (normoglycemia)
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early beta cell failure (impaired glucose tolerance- pre diabetes)
=
beta cell failure late (diabetes)
can also be caused by primary beta cell failure (rare)
what are the components of the ominous octet that contribute to hyperglycaemia in T2DM
decreased insulin secretion (pancreas) increased glucagon secretion (pancreas) decreased incretin effect (gut peptide) increased hepatic glucose production (liver) neurotransmitter dysfunction increased lipolysis increased glucose reabsorption (kidneys) decreased glucose uptake (muscles)
why is the prevalence of T2DM increasing more than the incidence
as people are living longer
what ethnic group has a higher risk of diabetes
eastern Asian
insulin resistance is more assocaited with micro/macro vascular disease
macro
hyperglycaemia is more associated with micro/macro vascular disease
micro
how is CVD risk most effectively treated
statins/ anti-hypertensives
when is one blood test diagnostic for diabetes
when its over diagnostic limit and patient is symptomatic
what is the treatment areas for T2DM
lifestyle changes
glycaemic management- metformin (most), insulin (last line)
blood pressure management
lipid management- statin
antiplatelet therapy- aspirin, clopidogrel
what is the treatment for acute T2DM
basal bolus insulin
metformin
what is the first line treatment give to most people for glycaemic control
metformin
what is the mechanism of metformin
decreases hepatic gluconeogenesis
increased peripheral glucose uptake
what outcomes does metformin usually have
decreases HbA1c
weight neutral
no hypoglycaemia control when used as monotherapy
decreased Cancer and CHD risk
what are some adverse effects of metformin
GI, lactic acidosis
what can metformin be combined with as a second step
SGLT2 glitazone gliptin GLP-1R SU basal insulin