T2 DM

Question 1

Insulin resistance

• Cause
• Associations

Answer 1

Causes- humans have become a lot more calorie excess
- Increase in visceral fat= production of FFA, proinflammatory cytokines, procoagulant factors.

Associations

• Age [>40]
• Obesity, especially central obesity
• Hypertension
• Hyperglycaemia
• Dyslipidaemia

Question 2

Main Aetiological causes of T2 DM

Answer 2

Decrease in beta-cell mass:

Polygenic factors
- Identical twins showed high incidence.

Maternal hyperglycaemia

Nutrient deficiency in utero–> Intrauterine growth retardation

Question 3

Other possible aetiological causes of T2 DM

Answer 3

Gut bacterial change

SOX-5 gene mutation–>Beta-cell regression

Autoimmune

Old age

Decreased incretin action
- Reduced GLP-1, GIP

Abnormal glucagon action

Glucotoxicity and lipotoxicity

Question 4

Glucose diagnosis of diabetes

Answer 4

Blood glucose

• > 11mmol/L + symptoms
• > 11mmol/ L x 2 without symptoms

Question 5

HbA1c diagnosis of diabetes

Answer 5

HbA1c= glycated haemoglobin

Diabetes if HbA1c> 48 mmol/ mol or 6.5%

Question 6

75 g glucose tolerance test

Answer 6

Method of diagnosing T2 DM.

1. Fasted period.
   - DM if blood glucose > 7mmol/L
   - Impaired fasting if blood glucose is 6-6.9 mmol/L.
2. Injection of 75g, 2 hrs weight
   - DM if blood glucose> 11.1 mmol/L
   - Impaired glucose tolerance if blood glucose is 7-11 mmol/L

Question 7

Epidemiology of T2 DM

Answer 7

Prevalence

• 4.6 million
• Further 12.3 M are at risk

Most prevalent in

• Older age, >45
• Overweight [70%]

Question 8

Pathology of T2 DM

Answer 8

Insulin resistance and inadequate insulin production.

Progression

• Increase in B-cell apoptosis
• Amyloid deposits from IAPP disrupts beta-cells.

Question 9

Dyslipidemia and T2 DM

Answer 9

In those with T2 DM, there can be high levels of LDL, chylomicrons, VLDL+ their catabolic remnants

• Proinflammatory
• Increases atherosclerotic formation

Leads to vascular pathologies
- Coronary heart disease

Question 10

Major consequences of T2 diabetes

Answer 10

Hyperglycaemia

Dysregulation of lipid metabolism

High proinflammatory cytokines + free radicals

Increased susceptibility to infection

Question 11

T2 DM morbidities

Answer 11

Maculopathy/ Retinopathy

Neuropathy

Foot ulcers

Peripheral vascular disease

Cataracts

Cheiroarthropathy

Increased fractures/ weaker bones

Nephropathy

Coronary heart disease/ MI

Question 12

Preventative treatment for T2 DM

Answer 12

Lifestyle modification
- Diet/ exercise, smoking cessation.

Screening

• Eyes
• Kidneys
• Feet: neuropathy and vascular disease.

Taking aspirin to prevent MI/ CV events

Question 13

Eye screening tests for T2 DM

Answer 13

Retinal photography
- Screen for maculopathy/ retinopathy

Using laser eye treatment when required.

Question 14

Kidney screening

Answer 14

Measuring urine albumin [EMU]

Blood pressure

Using ACEi/ ARBs

Question 15

T2 DM treatment goals

Answer 15

Modifying lifestyle and screening for complications

HbA1c+ 48-59 mmol/mol OR 6.5-7.5%

BP controlled= 12-140/180

LDL< 2.0 mmol/L