Type 2 diabetes in adults
Summary
Definition
History and exam
Other diagnostic factors
- candidal infections
- skin infections
- urinary tract infections
- fatigue
- blurred vision
- polyphagia
- unintentional weight loss
- paraesthesias
- acanthosis nigricans
Risk factors
- older age
- overweight/obesity
- gestational diabetes
- non-diabetic hyperglycaemia (NDH)
- family history of type 2 diabetes
- non-white ancestry
- polycystic ovary syndrome (PCOS)
- hypertension
- dyslipidaemia
- cardiovascular disease
- stress
- smoking
- suboptimal sleep
- low levels of testosterone/hypogonadism in men
- mental illness
Diagnostic investigations
1st investigations to order
- HbA1c
- fasting plasma glucose
- 2-hour post-load glucose after 75 g oral glucose
- random plasma glucose
Investigations to consider
- fasting lipid profile
- urine ketones
- urinary albumin to creatinine ratio (ACR)
- serum creatinine and estimated GFR (eGFR)
- dilated retinal examination
- ECG
- ankle-brachial pressure index (ABPI)
- random C-peptide
- autoantibody testing
- liver function tests (LFTs)
- platelet count
- non-invasive tests of liver elasticity
Treatment algorithm
Contributors
Authors
Sarah N. Ali, BM, BCh (Oxon), BSc (Hons), FRCP, FRSA
Consultant Physician
Department of Diabetes and Endocrinology
Royal Free London NHS Foundation Trust
London
UK
Disclosures
SNA is a trustee for Diabetes UK and the South Asian Health Foundation (both registered charities), and is principal investigator for the SMART study in type 1 diabetes (funded by the Steven Morgan Foundation charity).
Acknowledgements
Dr Sarah N. Ali would like to gratefully acknowledge Dr Surya Rajeev, Dr Partha Kar, Dr Amar Puttanna, Dr Patrick J. O'Connor, and Dr JoAnn M. Sperl-Hillen, the previous contributors to this topic.
Disclosures
SR has received reimbursement from Novo Nordisk for conferences, and has presented paid lectures. PK has sat on advisory boards and attended events reimbursed by Novo Nordisk, Eli Lilly, and Sanofi. 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. PJO receives research funding from the National Institutes of Health on multiple projects and is an author of several references cited in this topic. JMS-H is an author of several 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.
Peer reviewers
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
Nuneaton
Clinical Director for Diabetes West Midlands Clinical Networks & Clinical Senate
NHS England and NHS Improvement - Midlands
UK
Disclosures
VP declares that 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 Lilly, 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
Senior Investigator
National Institute for Health Research
UK
Distinguished Professor
Faculty of Medicine
Aalborg University
Denmark
Adjunct Professor
Yonsei University
Seoul
South Korea
Declarações
GL has acted as a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
National Institute for Health and Care Excellence. Type 2 diabetes in adults: management. Jun 2022 [internet publication].Texto completo
American Diabetes Association. Standards of care in diabetes. Diabetes Care. 2026 Jan;49(Suppl_1):S1-S371.Texto completo
Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022 Nov 1;45(11):2753-86.Texto completo Resumo
Marx N, Federici M, Schütt K, et al. 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023 Oct 14;44(39):4043-140.Texto completo Resumo
National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. Dec 2020 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível aqui.
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