Type 2 Diabetes Flashcards
What percentage of people with diabetes have type 2?
89%
Is T2DM mono or polygenic?
Polygenic
If your parent has diabetes what is your lifetime risk?
40%
If you identical twin has diabetes what is your 15 year risk?
76%
What is the main risk factor associated with T2DM?
Obesity
What percent of people with T2DM are overweight/obese?
90%
Describe the pathology of diabetes in relation to obesity
Obesity –> adiposity & free fatty acids & adiopkines
–> insulin resistance –> lipotoxicity in addition to genetic vulnerability of beta cells leads to an inability to produce insulin and thus diabetes
What is insulin resistance syndrome associated with?
- hypertension
- hyperlipidaemia
- hyperglycaemia
- polycystic ovarian syndrome
- high risk of metabolic syndrome
State three ways of which a patient with T2DM could present
- with symptoms
- after screening
- due to concurrent illness e.g. CVD
What are typical symptoms of T2DM?
blurred vision, polyuria, recurrent UTIs, tiredness
What values must the following tests be to indicate diabetes: HbA1c Fasting glucose 2-hr glucose Random glucose?
HbAc1 - >48
Fasting glucose >7
2-hr/random glucose >11
State four aims of diabetes management
- treat symptoms
- prevent microvascular complications
- prevent cardiovascular complications
- screen for complications & treat complications early
What is the most important aspect of diabetes management?
LIFESTYLE
In T2DM what is the target HbA1?c
<53 but anywhere between 48-58 may be adequate
Is gradual or intensive therapy better?
Gradual
What are risk factors for failure to reach HbA1c target?
Female, younger, obese, no BP/lipid target, complex therapies, human factors
Name a class of drugs that are harmful to cardiovascular health
Thiazolidinediones
What is the risk of DDP4 inhibitors and Thhiazolindinediones?
Increase risk of heart failure and fluid retention
What drugs are beneficial to cardiovascular health?
SGLT2 inhibitors, pioglitazone (alpha glucoside inhibitor), liraglutide (GLP1 inhibitor)
What is the difference between basal and bolus insulin?
basal - slow acting
bolus - fast acting
Name the first line treatment for diabetes
Metformin
What drugs have a risk of hypoglycaemia?
Sulfonylureas & insulin
Name two drugs that cause weight gain
- sulfonylureas
- thiazolidinedione
Name two drugs that cause weight loss
- SGLT2 inhibitors
- GLP 1 receptor agonist
How long is each drug tried for before a step up?
3 months
What other medication should also be given to diabetics in addition to anti-diabetic drugs?
- blood pressure medication (target 130/80)
- cholesterol mediation in >40yo as primary prevention (aim for less than 4 total)
When should metformin dose be reduced?
eGFR of <30 = stop
eGFR 30-45 = reduce from 1g BD to 500mg
What are the side effects of SGLT 1 inhibitors and GLP1 receptor agonists
GI upset
Why is there an increased risk for diabetics in pregnancy?
Increased risk of pre-eclampsia & foetal malformation may lead to termination if blood sugars are not well controlled
