T2DM

Question 1

What is the definition of diabetes?

Answer 1

HbA1c more than 48mmol or random plasma glucose of more than 11mmol/L

Question 2

What causes type 2 diabetes?

Answer 2

combination of insulin resistance and insulin deficiency

Question 3

What are the risk factors for type 2 diabetes?

Answer 3

obesity 
lack of physical activity 
history of gestational diabetes 
treatment with certain drugs 
FHx
HTN
dyslipidaemia 
south asian or afro caribbean ancestries

Question 4

What are the microvascular complications of T2 diabetes?

Answer 4

retinopathy
nephropathy
neuropathy

Question 5

What are the macrovascular complications of T2 diabetes?

Answer 5

CV disease
Cerebrovascular disease
Peripheral arterial disease

Question 6

What are the metabolic complications of T2 diabetes?

Answer 6

dyslipidaemia and diabetic ketoacidosis (uncommon)

Question 7

What are the other complications of T2 diabetes?

Answer 7

psychological complications - anxiety and depression
reduced quality of life
reduced life expectancy

Question 8

What is the first stage in managing diabetes?

Answer 8

lifestyle interventions are initially used to manage type 2 diabetes 
BP/Lipid control
provide education and information 
promote smoking cessation 
encourage weight loss
refer to diabetic clinic

Question 9

What is the first medication used to manage type 2 DM?

Answer 9

Metformin

Question 10

What other medications can be added after metformin?

Answer 10

• add insulin secretagogue
• add DPP-4 inhibitor
• add GLP-1 agonist
• add SGLT-2 inhibitor

Question 11

What are the next stages in managing diabetes?

Answer 11

• augmented individual pharmacological plan
• switch to basal bolus insulin dosages
• refer to endocrinology/pallative care