Type 2 diabetes Flashcards
Causes include a combination of environmental and […] factors, poor […], lack of […] and […].
Causes include a combination of environmental and genetic factors, poor diet, lack of exercise and obesity.
Diagnosis
If […] one of the following results is sufficient:
Random blood glucose =[…]/l
Fasting plasma glucose =[…]/l
2 hour glucose tolerance =11.1mmol/l
HbA1C =[…]/mol ([…]%)
If the patient is asyptomatic […] results are required from different days.
Diagnosis
If symptomatic one of the following results is sufficient:
Random blood glucose =11.1mmol/l
Fasting plasma glucose =7mmol/l
2 hour glucose tolerance =11.1mmol/l
HbA1C =48mmol/mol (6.5%)
If the patient is asymptomatic two results are required from different days.
Conditions where HbA1c may not be used for diagnosis:
haemoglobinopathies
[…] anaemia
untreated […] […] anaemia
suspected gestational diabetes
[…]
[…]
chronic […] disease
people taking medication that may cause […] (for example […])
Conditions where HbA1c may not be used for diagnosis:
haemoglobinopathies
haemolytic anaemia
untreated iron deficiency anaemia
suspected gestational diabetes
children
HIV
chronic kidney disease
people taking medication that may cause hyperglycaemia (for example corticosteroids)
Impaired glucose tolerance (IGT) is defined as fasting plasma glucose between […] and 7.0 mmol/l and OGTT 2-hour value greater than or equal to […] mmol/l but less than 11.1 mmol/l
6.1, 7.8
Mx
Conservative
- […] modification
Pharmacological
1st line –> […] +/- SGLT-2i
If HbA1c rises to […] mmol/mol (7.5%) despite uptitrating metformin and lifestyle, consider:
2nd line therapy
- […] therapy: metformin + ([…], […], […]
3rd line therapy
- […] therapy
metformin + DPP-4 inhibitor + sulfonylurea
metformin + pioglitazone + sulfonylurea
metformin + (pioglitazone or sulfonylurea or DPP-4 inhibitor) + SGLT-2 if certain NICE criteria are met
[…]-based treatment
Mx
Conservative
- lifestyle modification
Pharmacological
1st line –> Metformin +/- SGLT-2i
If HbA1c rises to 58 mmol/mol (7.5%) despite metformin and lifestyle, consider:
2nd line therapy
- Dual therapy: metformin + (pioglitazone, DPP4, sulfonylurea
3rd line therapy
- Triple therapy
metformin + DPP-4 inhibitor + sulfonylurea
metformin + pioglitazone + sulfonylurea
metformin + (pioglitazone or sulfonylurea or DPP-4 inhibitor) + SGLT-2 if certain NICE criteria are met
insulin-based treatment
Further therapy
If triple therapy is not effective or tolerated consider switching one of the drugs for a […]-[…] mimetic:
- BMI ≥ […] kg/m² OR insulin therapy would have significant […] implications OR […] […] would benefit other significant obesity-related comorbidities
Only continue if there is a reduction of at least […] mmol/mol [1.0%] in […] and a weight loss of at least […] % of initial body weight in […] months
If triple therapy is not effective or tolerated consider switching one of the drugs for a GLP-1 mimetic:
BMI ≥ 35 kg/m² and specific psychological or other medical problems associated with obesity or
BMI < 35 kg/m² and for whom insulin therapy would have significant occupational implications or weight loss would benefit other significant obesity-related comorbidities
only continue if there is a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body weight in 6 months
Dietary advice
encourage […] fibre, low […] […] sources of […]
include low-fat dairy products and […] fish
control the […] of foods containing […] fats and […] […] acids
discourage the use of foods marketed specifically at people with diabetes
initial target weight loss in an overweight person is […]-[…]%
encourage high fibre, low glycaemic index sources of carbohydrates
include low-fat dairy products and oily fish
control the intake of foods containing saturated fats and trans fatty acids
discourage the use of foods marketed specifically at people with diabetes
initial target weight loss in an overweight person is 5-10%
Hypertension targets
blood pressure targets are the […] as for patients […] type 2 diabetes
[…] […] or […] […] […] […] (ARB) are first-line
an ARB is preferred if the patient has a black African or African–Caribbean family origin
Age < […] years
Clinic: […]/90 mmHg
ABPM: […]/85 mmHg
Age > […] years
Clinic: […]/90 mmHg
ABPM: […]/85 mmHg
Hypertension targets
blood pressure targets are the same as for patients without type 2 diabetes (see table below)
ACE inhibitors or angiotensin II receptor blockers (ARB) are first-line
an ARB is preferred if the patient has a black African or African–Caribbean family origin
Age < 80 years
Clinic: 140/90 mmHg
ABPM: 135/85 mmHg
Age > 80 years
Clinic: 150/90 mmHg
ABPM: 145/85 mmHg
Antiplatelets
should not be offered unless a patient has existing cardiovascular disease
Lipids
Lipids
Offer atorvastatin 20mg if QRISK >10%
When to use SGLT2
if any of the following apply:
the patient has a high risk of developing cardiovascular disease (CVD, e.g. QRISK ≥ […]%)
the patient has established […]
the patient has chronic […] failure
if any of the following apply:
the patient has a high risk of developing cardiovascular disease (CVD, e.g. QRISK ≥ 10%)
the patient has established CVD
the patient has chronic heart failure
