Type 2 diabetes

Question 1

What is T2DM

Answer 1

Chronic, progressive metabolic disorder characterised by deficits in insulin secretion and action that lead to hyperglycaemia and related metabolic derangements.

Question 2

What are risk factors for T2DM

Answer 2

obesity and inactivity
BAME
Older age
Inactivity
Pre-diabetes
PCOS
CV: hypertension, dyslipidaemia

Question 3

What are Sx of T2DM?

Answer 3

Same as for T1DM (thirst, polyuria, fatigue), but with insidious onset or asymptomatic

Infections e.g. skin, candia, UTI common

Question 4

What are DDx for T2DM?

Answer 4

Other diabetes

Diabetes insipidus

Question 5

What Ix for T2DM

Answer 5

FBG

OGT

Random blood glucose

HbA1c

At least one abnormal with symptoms, or 2 abnormal.

Question 6

What is pre-diabetes?

Answer 6

A single fasting plasma glucose of 5.6-6.9 mmol/L (100-125 mg/dL) or a HbA1c of 39-46 mmol/mol (5.7% to 6.4%) in the absence of diabetes.

Question 7

What is Rx of T2DM?

Answer 7

Lifestyle: diet with low glycaemic index, weight loss, exercise

Vascular risk: statin and BP lowering with ACEi or ARB, and aspirin for patients who have CVD

If lifestyle doesn’t work, oral hypoglycaemic drugs

Question 8

What is algorithm for oral hypoglycaemic drugs

Answer 8

Usually start with metformin (or sulphonylurea if CI)

If HbA1c rises, add in either:

• + DPP4 inhibitor (sitagliptin)
• + thiazolidinediones (pioglitazone)
• + sulphonylurea (gliclazide)  \+ SGLT2 inhibitor (dapagliflozin) 

May need insulin