Around the globe 2.2 million deaths were attributable to high blood glucose in 2012, and in 2019 estimated 1.5 million deaths were directly caused by diabetes. Type 2 diabetes is a more common form of Diabetes.
Type II form of Diabetes mellitus is known to be caused due to Progressive loss of βcell insulin secretion leading to Insulin deficiency due to inflammation, metabolic and genetic factors. Usually present in patients with > 30 years of age who are overweight, obese with positive family history. Pathophysiology of Diabetes:
It presents with symptoms of hyperglycemia, nephropathy, neuropathy and retinopathy, polyuria, polydipsia, polyphagia, weight loss, weakness, fatigue.
Laboratory diagnosis is made by plasma glucose >=200 mg/dL or fasting glucose>=126 mg/d L or 2 hr plasma glucose>=200mg/dL with oral glucose tolerance test with 75 gm load.
Complications due to diabetes effect on arterial walls, peripheral neuropathy, proliferative retinopathy, nephropathy and chronic renal failure, Atherosclerotic cardiovascular and peripheral vascular disease, hyperosmolar coma, gangrene of extremities, blindness, glaucoma, cataracts, skin ulceration, in pregnant female leading to fetal wasting
For treatment the recommended goal include A1c goal <6.5 %, reduce risk of hyperglycemia, facilitate weight loss in obese patient and prevent additional weight gain. Another major goal is to prevent appearance of Chronic vascular disease and other comorbidities affecting major organs.
Once diagnosed, the patient counselled for home monitoring of blood glucose, for change of life style modification, physical activities, sufficient sleep, prevent smoking, limit alcohol consumption and reduce stress on psychosocial issues.
Dietary modification according to international guidelines include balanced diet of protein, carbohydrate and saturated and unsaturated fatty acids.
The treatment as first line of drug is Metformin, however its contraindicated in renal insufficiency, radiocontrast reagents, surgery or acute illness like liver disease, cardiogenic shock, pancreatitis, hypoxia, with tetracycline.
Alternate agents in intolerant to Metformin can be used Alpha-glucosidase inhibhitors(AGI ),dipeptidyl peptidase -4 (DPP-4) , Glucagon like peptide-1 agonists, thiazolidineiones, sulponylureas, sodium-glucose linked transporter -2 (SGLT-2)inhibhitors.
Two drug combination therapy is given in patient with HbA1c>=9. For Patient with severe hyperglycemia >=300-350 mg /dL) or HbA1c >=10-12% with or without catabolic features of weight loss, ketoacidosis combination injectable therapy with oral drug is given.
If required single drug therapy is changed to two drug therapy and again asked to review after 3 months. If still the goal is not achieved one oral drug and injectable insulin is started.
Assessment and follow up of the glycemic control is done every 2-3 months depending upon compliance and degree of metabolic control Review of symptoms and home blood glucose level is done.
Follow up laboratory investigations and physical investigation consist of Haemoglobon A1c, fundoscopy, cardiopulmonary examination, foot exam for ulcers ,arterial insufficiency, neuropathy.