Type 2 diabetes

Question 1

T2D is most often diagnosed following what?

Answer 1

Routine screening.

Question 2

Define T2D.

Answer 2

· Progressive disorder defined by deficits in insulin secretion and action that lead to abnormal glucose metabolism.

· Leads to hyperglycaemic state.

Question 3

What is the epidemiology of T2D?

Answer 3

· Prevalence is rising, along with obesity.
· Accounts for over 90% of all diabetes cases.
· Common in older people but incidence rising in younger people.
· African, Hispanic and Native Americans have an increased risk.

Question 4

T2D is often preceded by a state of what?

Answer 4

Pre-diabetes.

Question 5

What is the pathophysiology of T2D?

Answer 5

· Uncontrolled BP and glucose increase the risk of complications.

· Metabolic syndrome that predisposes to CAD, stroke and PAD:

• Diabetes.
• HTN.
• Dyslipidaemias.
• Obesity.

Question 6

What is the aetiology of T2D?

Answer 6

· Background genetic predisposition.

· Insulin resistance:

• Aggravated by aging, physical inactivity and being overweight/obese.
• Weight loss reduces the degree of insulin resistance.

Question 7

List the common risk factors that predispose to T2D.

Answer 7

· Older age. 
· Overweight/Obesity. 
· Gestational diabetes. 
· Pre-diabetes. 
· FH of type 2 diabetes. 
· Physical inactivity. 
· Polycystic ovary syndrome. 
· HTN. 
· Dyslipidaemia. 
· CVD.

Question 8

What are the typical presenting signs and symptoms of T2D?

Answer 8

· Commonly asymptomatic. 
· Candida infections: most commonly vaginal, penile or in skin folds.
· Skin infections.
· UTI's. 
· Fatigue. 
· Blurred vision.
· Polydipsia and polyuria. 
· Acanthosis nigricans.

Question 9

What investigations would you request if you thought a patient was pre-diabetic?

Answer 9

· Single fasting plasma glucose of 5.6-6.9.

· HbA1c of 39-46.

Question 10

What investigations would you request to diagnose T2D?

Answer 10

· Fasting plasma glucose >6.9.
· HbA1c of 48 or greater.
· Abnormal glucose tolerance tests.
· Random plasma glucose of >11.1 plus symptoms of hyperglycaemia.

Question 11

List some differentials.

Answer 11

· Pre-diabetes.
· Type 1 diabetes.
· Latent autoimmune diabetes in adults (LADA).

Question 12

What is the treatment option at initial diagnosis?

Answer 12

· 1st line - Lifestyle changes.
· Plus - Glycaemic management. 
· Plus - BP management. 
· Plus - Lipid management. 
· Adjunct - Antiplatelet therapy.

Question 13

What is the main treatment for T2D?

Answer 13

Metformin.

Question 14

What complications can arise?

Answer 14

· Diabetic kidney disease. 
· Blindness.
· Amputation. 
· CVD.
· CHF. 
· Stroke.