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Diabetes mellitus type 2

Background knowledge ๐Ÿง 

Definition

  • Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and relative insulin deficiency
  • Leads to hyperglycemia and associated complications
  • Most common form of diabetes
  • Usually develops in adulthood but increasingly seen in younger populations

Epidemiology

  • Prevalence: approximately 3.8 million people diagnosed in the UK
  • Accounts for 90-95% of all diabetes cases
  • More common in older adults, but incidence is rising in younger age groups
  • Higher prevalence in certain ethnic groups (e.g., South Asians, African-Caribbeans)
  • Strong association with obesity and sedentary lifestyle

Aetiology and Pathophysiology

  • Insulin resistance in peripheral tissues (muscle, fat, liver)
  • Beta-cell dysfunction leading to impaired insulin secretion
  • Genetic predisposition
  • Environmental factors: diet, physical inactivity, obesity
  • Pathophysiology: chronic hyperglycemia leads to glucotoxicity and lipotoxicity, exacerbating beta-cell dysfunction

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Polyuria (frequent urination)
  • Polydipsia (excessive thirst)
  • Polyphagia (increased hunger)
  • Weight loss (unintentional)
  • Fatigue
  • Blurred vision
  • Recurrent infections (e.g., urinary tract infections, candidiasis)
  • Slow healing of cuts and wounds
  • Acanthosis nigricans (darkened skin patches)

Signs

  • Elevated blood glucose levels
  • Hypertension
  • Central obesity
  • Acanthosis nigricans
  • Peripheral neuropathy (reduced sensation in extremities)
  • Retinopathy (fundoscopic examination)
  • Presence of ketones in urine (if severe)
  • Signs of cardiovascular disease

Investigations ๐Ÿงช

Tests

  • Fasting blood glucose (โ‰ฅ7.0 mmol/L)
  • Random blood glucose (โ‰ฅ11.1 mmol/L with symptoms)
  • HbA1c (โ‰ฅ48 mmol/mol)
  • Oral glucose tolerance test (OGTT)
  • Lipid profile (to assess cardiovascular risk)
  • Urinalysis (glucosuria, proteinuria)
  • Renal function tests
  • Blood pressure monitoring
  • ECG (if cardiovascular risk is suspected)
  • Fundoscopy (for diabetic retinopathy)

Management ๐Ÿฅผ

Management

  • Lifestyle modifications: diet, exercise, weight loss
  • Oral hypoglycemic agents (e.g., metformin, SGLT-2 inhibitors, sulfonylureas)
  • Insulin therapy (if necessary)
  • Monitoring of blood glucose levels
  • Management of comorbidities (e.g., hypertension, dyslipidemia)
  • Regular screening for complications (e.g., retinopathy, nephropathy)
  • Patient education and support
  • Psychological support and counselling
  • Smoking cessation
  • Foot care and regular podiatry reviews

Complications

  • Microvascular complications (retinopathy, nephropathy, neuropathy)
  • Macrovascular complications (cardiovascular disease, stroke)
  • Foot problems (ulcers, infections)
  • Diabetic ketoacidosis (DKA, although less common than in T1DM)
  • Hyperosmolar hyperglycemic state (HHS)
  • Infections (e.g., urinary tract infections, skin infections)
  • Depression and anxiety
  • Sexual dysfunction
  • Gastrointestinal problems (e.g., gastroparesis)
  • Dental problems (e.g., periodontal disease)

Prognosis

  • With proper management, patients can lead normal, healthy lives
  • Lifelong monitoring and treatment are necessary
  • Risk of complications increases with poor glycemic control
  • Early detection and management of complications improve outcomes
  • Support from a multidisciplinary team is crucial
  • Lifestyle modifications significantly impact prognosis
  • Advances in medication and technology have improved quality of life for patients

Key Points

  • Type 2 diabetes mellitus is characterized by insulin resistance and relative insulin deficiency
  • Management includes lifestyle modifications, medication, and monitoring for complications
  • Early recognition and treatment of complications are essential to prevent long-term morbidity
  • Patient education and support from a multidisciplinary team are crucial for optimal management
  • With appropriate management, patients can lead normal, healthy lives

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