T2DM

• What is Type 2 Diabetes Mellitus characterized by?

  Pancreatic beta-cell insufficiency and insulin resistance
• What are the symptoms of chronic hyperglycaemia in Type 2 DM?


  Symptoms include polyuria, polydipsia, and potential complications
• What key investigations are used for diagnosing Type 2 DM?


  Random and fasting blood glucose, 2-hour glucose tolerance, and HbA1C tests
• How is the diagnosis of Type 2 DM established?


  Based on test results and/or symptoms
• What is the primary management strategy for Type 2 DM?


  Lifestyle modifications, hypoglycaemic agents, and insulin therapy when necessary
• What are some complications associated with chronic hyperglycaemia?


  Complications include issues in the gastrointestinal system, nervous system, and cardiovascular system
• In which population is Type 2 DM generally found?


  Generally in adults
• What is the familial predisposition for Type 2 DM?


  There is a strong familial predisposition
• What percentage of all diagnosed cases of diabetes does Type 2 DM account for?


  90-95%
• What factors contribute to the aetiology of Type 2 DM?


  A combination of genetic and environmental factors, poor dietary habits, lack of physical activity, and obesity
• What are common presentations of Type 2 DM?


  May be asymptomatic, polyuria, polydipsia, unexplained weight loss, blurry vision, and fatigue
• How does Type 1 Diabetes Mellitus differ from Type 2 DM?


  Type 1 typically presents with early onset and ketoacidosis, requiring insulin therapy from diagnosis
• What are the characteristics of MODY (Maturity Onset Diabetes of the Young)?


  • MODY 3: Mutation in HNF1A, high blood sugar (10-20), sensitive to sulphonylureas
  • MODY 2: Glucokinase mutation, blood sugars rarely above 7-8, often diet-controlled
  • MODY 5: HNF1 beta mutation, pancreatic atrophy, renal cysts, and other complications
• What is Secondary Diabetes Mellitus often associated with?


  Other signs of pancreatic disease or certain medications
• What fasting blood glucose level indicates diabetes?


  Fasting ≥7.0 mmol/L
• What random blood glucose level indicates diabetes?

  Random ≥11.1 mmol/L
• What is the HbA1c level that indicates diabetes?


  HbA1c ≥48 mmol/mol (6.5%)
• What dietary advice is recommended for Type 2 DM management?


  Encourage high fiber, low glycaemic index carbohydrates, and control saturated fats
• What is the initial target weight loss for an overweight person with Type 2 DM?


  1. 10%
• What is the first-line pharmacological treatment for Type 2 DM?


  Metformin
• What should be done if metformin is contraindicated or not tolerated?


  Consider SGLT-2 inhibitors or other agents like DPP-4, Pioglitazone, or Sulfonylurea
• What is the recommended action for patients with cardiovascular risk?

  Start SGLT-2 inhibitors after confirming metformin tolerability
• What should be done if monotherapy is ineffective?

  Add DPP-4, Pioglitazone, Sulfonylurea, or SGLT-2 inhibitor
• What is the next step if dual therapy is ineffective?


  Try three drug classes or start insulin
• What conditions warrant considering a GLP-1 receptor agonist?


  BMI ≥ 35 kg/m² with obesity-related problems or significant implications from insulin therapy
• What is the requirement for continuing GLP-1 receptor agonist therapy?


  Reduction of at least 11 mmol/mol [1.0%] in HbA1c and weight loss of at least 3% in 6 months
• What are the blood pressure targets for patients with Type 2 DM?


  Same as for patients without Type 2 DM
• What is the first-line treatment for hypertension in Type 2 DM?


  ACE inhibitors or angiotensin II receptor blockers (ARB)
• What is the preferred treatment for hypertension in patients of African or African-Caribbean origin?


  An ARB is preferred
• When should antiplatelets be offered to patients with Type 2 DM?


  Only if the patient has existing cardiovascular disease
• What is the criteria for offering statins to patients with Type 2 DM?


  Only patients with a 10-year cardiovascular risk > 10% should be offered a statin
• What is the first-line statin of choice for Type 2 DM?

  Atorvastatin 20mg
• What are the macrovascular complications of Type 2 DM?


  • Cardiac Complications: Increased risk of cardiovascular disease
  • Peripheral Arterial Disease (PAD): Symptoms include foot discoloration and absent peripheral pulses
  • Cerebrovascular disease: Increased risk of TIAs and stroke
• What are the microvascular complications of Type 2 DM?


  • Diabetic retinopathy: Leading cause of visual loss in adults
  • Diabetic nephropathy: Characterized by proteinuria, leading to chronic kidney disease
  • Diabetic neuropathy: Includes autonomic neuropathy and gastrointestinal complications
• What is diabetic retinopathy characterized by?


  Vascular occlusion and leakage in the retinal capillaries
• What is diabetic nephropathy a leading cause of?


  Chronic kidney disease
• What histological changes are associated with diabetic nephropathy?


  Kimmelstiel-Wilson nodules characteristic of nodular diabetic glomerulosclerosis
• What is the primary causative factor of diabetic neuropathy?


  Chronic hyperglycaemia
• What are the symptoms of autonomic neuropathy?


  Postural hypotension, dizziness, falls, and loss of consciousness
• What is gastroparesis and its relation to diabetes?


  Delayed gastric emptying due to nerve damage from poor glycaemic control