Type 2 diabetes should be managed with a personalised self-management programme, with a focus on diet and lifestyle interventions.
Glycaemic goals and treatment choices should be individualised. Initial antihyperglycaemic therapy is with metformin, although sodium-glucose co-transporter 2 (SGLT2) inhibitors or glucagon-like peptide-1 (GLP-1) agonists are increasingly preferred for high-risk patients because of their cardiovascular and renal benefits. Dual therapy, triple therapy, and/or insulin may be needed to achieve good glycaemic control.
Selected glucose-lowering drugs reduce all-cause and cardiovascular mortality.
Blood pressure control, lipid management, smoking cessation, and glycaemic management reduce the risk of macrovascular complications such as heart attack and stroke. Glycaemic control and blood pressure management reduce the risk of microvascular complications (neuropathy, nephropathy, retinopathy).
Type 2 diabetes mellitus is a progressive disorder defined by deficits in insulin secretion and increased insulin resistance that lead to abnormal glucose metabolism and related metabolic derangements. Although the aetiologies of type 1 and type 2 diabetes differ dramatically, both lead to hyperglycaemic states, and both share common macrovascular (coronary heart, cerebrovascular, and peripheral vascular disease) and microvascular (retinopathy, nephropathy, and neuropathy) complications.
History and exam
Amar Puttanna, MBChB, MRCP
Diabetes and Endocrinology Consultant
Good Hope Hospital
University Hospitals Birmingham NHS Trust
AP has received honoraria from Napp, Novo Nordisk, Sanofi, Lilly-Boehringer Ingelheim, Daiichi-Sankyo, and AstraZeneca for presentation at meetings, conference registration or participating in advisory boards.
Partha Kar, OBE, MBBS MD, FRCP
Portsmouth Hospitals University NHS Trust
National Specialty Advisor, Diabetes, NHS England
PK has sat on advisory boards and attended events reimbursed by Novo Nordisk, Eli Lilly, and Sanofi.
Dr Amar Puttanna and Dr Partha Kar would like to gratefully acknowledge Dr Patrick J. O'Connor and Dr JoAnn M. Sperl-Hillen, the previous contributors to this topic.
PJO receives research funding from the National Institutes of Health on multiple projects and is an author of a number of references cited in this topic. JMS-H is an author of a number of references cited in this topic and is an inventor on a US patent for Disease Treatment Simulation, a simulation-based technology developed without commercial support to educate health providers on chronic disease management in a virtual environment.
Vinod Patel, MD, FRCP, FHEA, MRCGP, DRCOG, MBChB, BSc (Hons), RCPathME
Professor, Diabetes and Clinical Skills
Warwick Medical School
University of Warwick
Hon Consultant in Endocrinology and Diabetes, Acute Medicine, Medical Obstetrics
Diabetes and Endocrinology Centre
George Eliot Hospital NHS Trust
Clinical Director for Diabetes West Midlands Clinical Networks & Clinical Senate
NHS England and NHS Improvement - Midlands
VP declares he has worked with most of the large pharmaceutical industry groups over the years with the majority of the work being in education of healthcare professionals in diabetes care. This includes Novo Nordisk, Eli Lily, MSD, BI, Sanofi, Napp, Internis, Takeda, and AZ. VP has been part of advisory board work on occasions. VP has received conference arrangements and lecture fees. VP is a trustee of the charity South Asian Health Foundation.
Gregory Lip, MD, FRCP, DFM, FACC, FESC, FEHRA
Price-Evans Professor of Cardiovascular Medicine
University of Liverpool
National Institute for Health Research
Faculty of Medicine
GL has acted as a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo.
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