Endocrinology20 UKMLA questions
Type 2 Diabetes Mellitus — UKMLA Revision Notes
Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterised by insulin resistance and relative insulin deficiency, leading to hyperglycaemia. It is the most common form of diabetes and a major risk factor for cardiovascular disease, nephropathy, retinopathy, and neuropathy.
Key Facts
- Diagnosis: HbA1c ≥48 mmol/mol (6.5%) on two occasions, or fasting glucose ≥7.0 mmol/L
- Metformin is first-line pharmacotherapy (unless contraindicated)
- HbA1c target: 48 mmol/mol (6.5%) on lifestyle/metformin; 53 mmol/mol on additional agents
- SGLT-2 inhibitors reduce cardiovascular and renal events in T2DM
- Annual review: HbA1c, BP, lipids, eGFR, urine ACR, retinal screening, foot examination
Investigations
- HbA1c: diagnosis and monitoring
- Fasting plasma glucose or OGTT if HbA1c inconclusive
- Urine ACR: screen for diabetic nephropathy
- eGFR: renal function monitoring
- Lipid profile, BP, retinal photography, foot examination
Management
- Lifestyle: weight loss, dietary modification, exercise — can achieve remission
- Metformin: first-line; reduce dose if eGFR 30–45, stop if <30
- Add SGLT-2 inhibitor (empagliflozin, dapagliflozin) if CVD/CKD/HF present
- GLP-1 agonist (semaglutide, liraglutide): for weight management or CVD risk
- Insulin: if HbA1c uncontrolled on oral agents
NICE Guideline: NICE NG28 — Type 2 diabetes in adults: management (updated 2022)
Related UKMLA Conditions
HypertensionHeart FailureCKDDiabetic RetinopathyPeripheral Neuropathy