Type 2 diabetes in adults

The cornerstone of therapy for all patients with diabetes is a personalised self-management programme, usually developed with the patient by a diabetes education nurse or nutritionist.

Lifestyle changes plus metformin are initial antihyperglycaemic therapy for most patients. Glycaemic goals and treatment choices are individualised.

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).

Selected glucose-lowering drugs reduce all-cause and cardiovascular mortality.

Type 2 diabetes mellitus is a progressive disorder defined by deficits in insulin secretion and action 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. http://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. Type 2 diabetes is most often diagnosed following routine screening. It is preceded by a state of pre-diabetes, which is defined by a single fasting plasma glucose of 5.6-6.9 mmol/L (100-125 mg/dL) or an HbA1c of 39-46 mmol/mol (5.7% to 6.4%) in the absence of diabetes. Diabetes diagnosis is based on 2 confirmed values of: fasting plasma glucose >6.9 mmol/L (125 mg/dL); HbA1c of 48 mmol/mol (6.5%) or greater; or (less commonly) abnormal glucose tolerance test results, or a random plasma glucose of ≥11.1 mmol/L (≥200 mg/dL) plus symptoms of hyperglycaemia. [2] American Diabetes Association. Standards of medical care in diabetes - 2018. Diabetes Care. 2018 Jan; 41(suppl 1): S1-159. http://care.diabetesjournals.org/content/41/Supplement_1/S1