Type 2 Diabetes

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and relative insulin deficiency. Management focuses on glycaemic control to prevent micro- and macrovascular complications.

🎯 Key Learning Objectives

1. Diagnose T2DM using HbA1c (>= 48 mmol/mol) or fasting glucose.
2. Implement the NICE pharmacological algorithm (Metformin first-line).
3. Identify when to add SGLT2 inhibitors for cardiovascular/renal protection.
4. Screen for complications (retinopathy, neuropathy, nephropathy).
5. Manage cardiovascular risk factors (BP, Statins).
6. Recognize and treat Hyperglycaemic Hyperosmolar State (HHS).

🔬 Pathophysiology

A combination of genetic predisposition and lifestyle factors leads to insulin resistance in peripheral tissues (muscle, liver). Initially, beta-cells compensate with hyperinsulinaemia, followed by gradual beta-cell failure.

🩺 Clinical Features

🔬 Investigations

💊 Management

⚠️ Complications

⭐ High-Yield Pearls

• Metformin side effects are mainly GI; start with a slow-release formulation.
• SGLT2 inhibitors carry a risk of euglycaemic DKA and thrush.
• HbA1c target for most is 48 mmol/mol (53 if on drugs causing hypos).
• Gliclazide (sulfonylurea) is the most common cause of drug-induced hypoglycaemia in T2DM.
• HHS is characterized by high glucose (>30), high osmolality, and absence of significant ketosis.

❓ Practice Questions