Insulin resistance and progressive β-cell failure causing chronic hyperglycaemia.
Risk factors
- • Age
- • Obesity
- • Family history
- • Ethnicity (S Asian, Afro-Caribbean)
- • GDM history
- • PCOS
Clinical features
- • Often asymptomatic
- • Polyuria, polydipsia, weight loss
- • Recurrent infections
- • Blurred vision
Investigations
- • HbA1c ≥48 mmol/mol (6.5%)
- • Fasting glucose ≥7
- • OGTT 2-h ≥11.1
- • Random glucose ≥11.1 + symptoms
- • Annual: ACR, eGFR, lipids, BP, foot, retinal screen
Management
- • Lifestyle: diet, exercise, weight loss
- • Metformin first-line
- • Add SGLT2i if CV/CKD risk; GLP-1RA if obesity or CV risk
- • Sulfonylurea / DPP4i / insulin as adjunct
- • BP <140/90 (<130/80 if albuminuria)
- • Statin if QRISK ≥10%
Complications
- • Macro: CV, stroke, PAD
- • Micro: retinopathy, nephropathy, neuropathy
- • Foot ulcer / Charcot
- • DKA (T2DM with SGLT2i — euglycaemic)
Clinical pearls
- • SGLT2i CV + renal benefit
- • Remission possible with weight loss within 6 yr of diagnosis
Related in WardRound
Educational — verify locally.
