Type 2 diabetes in adults

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.[1]Meigs JB, Muller DC, Nathan DM, et al. The natural history of progression from normal glucose tolerance to type 2 diabetes in the Baltimore Longitudinal Study of Aging. Diabetes. 2003 Jun;52(6):1475-84. https://diabetes.diabetesjournals.org/content/52/6/1475.full http://www.ncbi.nlm.nih.gov/pubmed/12765960?tool=bestpractice.com 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.