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Diabetes Type 2 - Coggle Diagram
Diabetes Type 2
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Management: Adults
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Advise that HbA1c should be measured at 3–6 monthly intervals initially until stable on unchanging antidiabetic treatment, and then every 6 months to ensure adequate blood glucose control.
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If HbA1c levels are not adequately controlled by a single drug and rise to 58 mmol/mol (7.5%) or higher: reinforce advice on lifestyle, assess adherence to drug treatment, support to aim for HbA1c of 53 mmol/l and intensify antidiabetic drug treatment.
ifestyle including diet combined with a single drug not associated with hypoglycaemia (such as metformin) — 48 mmol/mol
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Targets should be individualised according to duration of diabetes, co-morbidities, age, adverse affects from treatment and unlikely to achieve longer-term risk-reduction benefits.
Do not routinely recommend self-monitoring of blood glucose levels unless they are using insulin therapy, have evidence of hypoglycaemic episodes, are taking drugs which increase the risk of hypoglycaemia while driving/operating machinery, pregnant or planning pregnancy.
If routine self monitoring required support to learn skills, quality and frequency of testing, how to interpret results and what action to take. Review annually.
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Advise about sexual health, contraception, and the importance of pre-pregnancy counselling, if appropriate.
Advise that screening for complications will be arranged at diagnosis and then annually thereafter. Screen for retinopathy, foot problems, diabetic kidney disease, cardiovascular risk factors, peripheral and autonomic neuropathy. Manage risks appropriately.
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Provide advise on lifestyle measures such as diet, exercise, alcohol and weight loss.
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Offer referral to a structured group education programme such as the DESMOND (Diabetes Education for Self-Management for Ongoing and Newly Diagnosed) programme, for the person and their family/carers.
Ensure an individualised care plan is in place, taking into account their age, preferences, co-morbidities, and risk of adverse affects from polypharmacy and likelihood of benefiting from long-term interventions.
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Sick day Rules
If self-monitoring of blood glucose levels is indicated (for example on insulin therapy), advise: an increase in frequency may be required.
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If on insulin therapy, do not stop treatment.
Advise to maintain their normal meal pattern (including fluids and carbohydrate intake) where possible if appetite is reduced.
Advise to temporarily stop some drug treatments during acute illness. Medication may be restarted once the person is feeling better and eating and drinking for 24–48 hours, unless there is concern about renal function.
Advise to seek urgent medical advice if the person:unable to eat or drink, is dehydrated or at risk of dehydration, has persistent vomiting or has hypoglycaemia that cannot be managed in primary care.
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Diagnosis: Adults
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Clinical features
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Acanthosis nigricans (skin condition causing dark pigmentation in skin folds) which suggests insulin resistance
When confirming the diagnosis, be aware type 2 diabetes is more likely if there are no additional features of type 1 diabetes and no clinical features of other types of diabetes.
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Diagnosis: Children
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A diagnosis of type 2 diabetes is more likely if there are no additional features of type 1 diabetes and no clinical features of other types of diabetes.
If suspected in child or young person arrange immediate same day referral to a multidisciplinary paediatric diabetes team to confirm diagnosis and provide immediate care.
Hyperglycaemic Emergency
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Precipitating factors
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Drugs (corticosteroids, diuretics, atypical antipsychotics, sympathomimetic drugs such as salbutamol)
Management
After recovery: discuss precipitating factors, consider non-adherence and provide information on managing illness and sick day rules
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Antidiabetic Drugs
Offer standard-release metformin as initial treatment, unless it is contraindicated.
Based on this cardiovascular risk assessment for the person with type 2 diabetes: If they have chronic heart failure or established atherosclerotic cardiovascular disease, offer an SGLT-2 inhibitor with proven cardiovascular benefit in addition to metformin or If they are at high risk of developing cardiovascular disease, consider an SGLT-2 inhibitor with proven cardiovascular benefit in addition to metformin. Introduce drugs sequentially to check tolerability.
If first-line treatment is ineffective, consider one of the following second-line treatment options: Metformin plus a DPP-4 inhibitor, or Metformin plus pioglitazone, or Metformin plus a sulfonylurea Metformin plus an SGLT-2 inhibitor may be considered if a sulfonylurea is contraindicated or not tolerated, or the person is at significant risk of hypoglycaemia or its consequences.
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Diabetes mellitus is a group of metabolic disorders in which persistent hyperglycaemia (random plasma glucose more than 11.1 mmol/L) is caused by deficient insulin secretion, resistance to the action of insulin, or both. Type 2 diabetes — insulin resistance and a relative insulin deficiency result in persistent hyperglycaemia.