Type 2 Diabetes Mellitus

Definition

Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterised by hyperglycaemia due to insulin resistance and relative insulin deficiency.

Etiology
  • Old age
  • Overweight/obesity
  • Hypertension
  • Dyslipidaemia
  • Increased waist circumference
  • Hyperglycaemia
Clinical Features
  • Classic triad:
    • Polyuria
    • Polydipsia
    • Loss of weight/ fatigue
  • Suspect diabetes in patients with recurrent infections (e.g. cellulitis, UTIs)
Investigations
  • Positive for 2 separate tests (or same test repeated twice) if asymptomatic; or positive for 1 test if symptomatic:
    • Fasting plasma glucose >7 mmol/L
    • Random plasma glucose >11 mmol/L
    • HbA1c >6.5%
    • 2-hour 75g OGTT >11 mmol/L
  • Fasting lipid profile
  • Urine albumin to creatinine ratio (ACR)
  • UEC
  • eGFR
  • Baseline ECG to screen for ischaemia
  • ABPI to screen for PVD (<0.9 intermittent claudication; <0.5 critical limb ischaemia)
  • Fundoscopy to screen for diabetic retinopathy
  • Diabetic foot exam to screen for ulcers, PVD and peripheral neuropathy
Management
  • Lifestyle changes: mnemonic SNAP
    • Smoking cessation
    • Balanced Nutritional intake
    • Alcohol reduction
    • Adequate Physical activity
  • Involve allied health such as a dietitian, physiotherapist, optometrist
  • All patients should be educated on (+ referral to Diabetic Nurse Educator):
    • Alcohol increases the risk of hypoglycaemia (<2 standard drinks per day)
    • Driving requirements (“BSL above 5 to drive”)
    • Sick day management
    • Hypoglycaemic awareness and management of hypoglycemia
  • Target measurements:
    • Fasting blood sugar in community 4-8
    • HbA1c <6.5%
Author