Type 2 diabetes

Question 1

What causes type II diabetes?

Answer 1

A mixture of genetic, environmental and epigenetic factors

Question 2

When does T2DM usually occur?

Answer 2

In middle or old age

Question 3

What are some environmental factors that can cause T2DM?

Answer 3

• Obesity
• Age
• Pregnancy
• Calorie-dense diet
• Sedentary lifestyle

Question 4

If someone has 1 parent with T2DM, what is their lifetime risk?

Answer 4

40%

Question 5

If someone has 2 parents with T2DM, what is their lifetime risk?

Answer 5

80%

Question 6

Describe the pathophysiology of T2DM in obesity

Answer 6

1. Obesity increases adiposity
2. Exceeds the fat store threshold, increasing FFA and adipokines
3. Causes insulin resistance in liver and muscle
4. Genetics causes vulnerable ß-cells
5. ß-cells try to keep up with demand, increasing insulin levels
6. ß-cells fail and stop producing insulin

Question 7

How is T2DM a spectrum of disease?

Answer 7

It can range from predominant ß-cell deficiency to predominant insulin resistance

Question 8

Why are those of Asian descent more at risk of T2DM?

Answer 8

Those of Asian descent have a lower threshold for fat storage

Question 9

How does T2DM cause symptoms?

Answer 9

Through hyperglycaemia

Question 10

What are some symptoms of T2DM?

Answer 10

• Polyuria
• Enuresis in children (Bedwetting)
• Thirst
• Polydipsia (Drinking lots of water)
• Blurred vision (High blood glucose causes lense shrinking)
• Genital thrush
• Fatigue
• Weight loss

Question 11

What are the stages of T2DM management?

Answer 11

1. Diagnosis
2. Therapeutic lifestyle change
3. Mono-therapy
4. Combination therapy
5. Insulin + Combination therapy

Question 12

What are the aims of treatment in T2DM?

Answer 12

Treat symptoms
Prevent complications

Question 13

What is some dietary advice given to those with diabetes?

Answer 13

• Normal intake of unrefined carbohydrate foods
• Reduced refined sugar intake
• Reduce fat intake
• Increase fruit and vegetable intake
• Reduce salt intake
• Safe and sensible alcohol consumption

Question 14

What is the HbA1c target for T2DM management?

Answer 14

<53mmol/mol (7%)

Question 15

What are the 3 categories of pharmacological diabetes management?

Answer 15

Insulin secretagogues
Insulin sensitisers
Others

Question 16

What are some examples of insulin secretagogues used in T2DM management?

Answer 16

• Sulphonylureas
• DPP4 inhibitors
• GLP-1 receptor agonists

Question 17

What are some examples of insulin sensitisers used in T2DM management?

Answer 17

• Thiazolidinediones
• Metformin

Question 18

What are some examples of other drugs used in T2DM management?

Answer 18

• Insulin
• SGLT-2 inhibitors

Question 19

What is meant by remission?

Answer 19

Remission is a period of time in which an illnesses symptoms and signs are less severe

Question 20

What level of weight loss is thought to increase chance of T2DM remission?

Answer 20

10-15kg

Question 21

What management trial has shown to be effective in inducing T2DM remission?

Answer 21

1. Complete diet replacement (12-20 weeks)
2. Stepped food reintroduction + exercise programme (2-8 weeks)
3. Weight loss maintenance (up to 1 year)
4. Relapse management