Type 2 Diabetes Flashcards

1
Q

T2DM

A

Due to progressive insulin secretory defect on the background of insulin resistance

Polygenic common complex disease

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2
Q

Epidemiology

A

predominantly present in >40

Greatest prevalence in low and middle income countries

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3
Q

Aetiology

A

Obesity
Chronic Pancreatitis
Peak age of onset: 50 years
Cushing’s syndrome

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4
Q

Genetics

A

40% lifetime risk in offspring

Over 400 genetic variants

Twin studies: Monozygotic concordance rate of 90%

Highly heritable

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5
Q

Pathophysiology

A

Combination of insulin resistance and inadequate production

  • beta cell destruction
  • Impaired secretion of insulin

Exceeding fat storage threshold

  • lipid overspill
  • lipotoxicity
  • vulnerable beta-cells

The adiposity exceeding fat storage threshold leads to lipotoxicity causing vulnerable beta-cells

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6
Q

Fat storage threshold

A

Insulin resistance occurs when fat can no longer be safely stored in subcutaneous adipose tissue causing spill over of FFA to. the viscera

People with ‘healthy’ obesity are able to safely store lots of fat; others have low fat storage threshold

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7
Q

insulin resistance associations

A

hypertension
hyperlipidaemia
hyperglycaemia
Polycystic ovarian syndrome

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8
Q

Signs

A

increased BMi
Retinopathy
Peripheral Neuropathy

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9
Q

Symptoms

A

Often with complications of diabetes
- e.g. peripheral vascular disease, CVA, MI

Hyperosmolar Non-Ketotic Coma (HONK)

Recurrent infection

Pruritus

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10
Q

Aims of Management

A

Treat Symptoms

Prevent microvascular complications

  • glucose control
  • aim for HbA1c <53mmol/L

Prevent CV complications

  • cholesterol control
  • BP control
  • Antiplatelet therapy

Screen for complications early

  • eye disease
  • neuropathy
  • kidney disease
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11
Q

Management pathway

A
  1. Diagnosis
  2. Therapeutic Lifestyle change
  3. Monotherapy
  4. Combination therapy (NOT insulin)
  5. Combination therapy with insulin
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12
Q

Therapeutic management

A

Diet and exercise

Aim for realistic targets with weight maintanence/ modest weight loss
- 5 to 10kg in one year

General guidance on healthy eating
- Increase veg and decrease fats

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13
Q

HbA1c Targets

A

Symptomatic control

Prevent complications
- HbA1c <53 mol/mol

Targets should be set with individuals in order to balance benefits with harm (in particular hypoglycaemia and weight gain)

For patients on triple oral therapy or insulin
- an HbA1c of 58 mol/L may be appropriate

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14
Q

Glycaemic Control

A

Initially treat with diet

If unsatisfactory control, consider oral hypoglycaemic

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15
Q

Complication Surveillance

A

Annual Review

  • Fundoscopy
  • Feet examination (neurological and vascular)

Check Insulin Sites

BP monitoring

Monitor renal function

Urine. protein dipstick

Thyroid function

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16
Q

Metformin

A

1st line pharmacological treatment
Improve sensitivity to insulin

It is a biguanide

17
Q

Sulphonylureas

A

Stimulate pancreatic insulin release

E.g. Gliclazide

Side effects

  • Risk of hypoglycaemia
  • Weight gain
18
Q

Thiazolidinediones

A

Improve sensitivity to insulin

PPAR(gamma) agonists

E.g. pioglitazone

Side effects

  • Weight gain
  • Fluid retention
  • Fracture risk