Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterised by insulin resistance and impaired insulin secretion leading to hyperglycaemia.
It peaks between 60 and 70 years and is more common in men.
Screening for type 2 diabetes
| Diagnosis | HbA1C | Fasting glucose (mmol/L) | Glucose Tolerance (mmol/L) |
|---|---|---|---|
| No diabetes | < 5.7% | ≤ 5.6 | ≤ 7.8 |
| Pre-diabetes (Impaired glucose regulation) | 5.7 – 6.5 | 5.6 – 6.9 (impaired fasting glucose) | 7.8 – 11.0 (impaired glucose tolerance) |
| Diabetes | ≥ 6.5% | ≥ 7.0 | ≥ 11.1 |
- Risk factors
- Family history of T2DM
- Obesity
- Sedentary lifestyle
- High caloric intake
- Increasing age
- Smoking
- Sleep disorders
- History of gestational diabetes
- Polycystic ovarian syndrome (PCOS)
- Pathophysiology
- Signs and symptoms
- Asymptomatic (70%)
- Polyuria
- Polydipsia
- nocturia
- Fatigue
- Blurry vision
- Weight loss
- Due to fluid depletion and accelerated breakdown of fat and muscle
- Pruritus vulvae or balanitis
- Differentials
- Maturity-Onset Diabetes of the Young (MODY)
- Treatment
- Dietary modifications
- High fibre, low glycaemic index source of carbohydrates
- Low-fat dairy products and oily fish
- Limit saturated fats and trans fatty acids
- Discourage the use of foods marketed specifically at people with diabetes
- Target weight loss of 5 – 10%
- Monitor HbA1C every 3 – 6 months until stable, then 6-monthly. Targets include
- 48 mmol/mol (6.5%) if lifestyle management only or lifestyle + metformin
- 53 mmol/mol (7.0%) if treatment includes any drug that can cause hypoglycaemia
- ACEi or ARBs for hypertension
- Atorvastatin if there is a 10-year cardiovascular risk of > 10% (using QRISK2)
- Drug therapy for diabetes mellitus
- Metformin (first line)
- DPP-4 inhibitor
- Pioglitazone
- Sulfonylurea
- SGLT-2 inhibitor
- Insulin
- Dietary modifications