Diabetes Type 2 - Lab

10/22/24, 9:21 PM OneNote Diabetes Type 2 Friday, October 11, 2024 11:46 PM Topic Discussion: Diabetes Type 2 1. Background/Introduction a. Introduction: Type 2 diabetes (T2DM) is a chronic metabolic disorder characterized by insulin resistance and relative insulin deficiency, leading to hyperglycemia. b. Epidemiology: T2DM is the most common form of diabetes, accounting for 90-95% of cases globally. It has an increasing prevalence due to rising obesity rates and sedentary lifestyles. c. Classifications: Type 2 diabetes differs from Type 1, where there is absolute insulin deficiency, and from gestational diabetes, which occurs during pregnancy. d. Risk Factors: Obesity, sedentary lifestyle, family history, advanced age, hypertension, dyslipidemia, and certain ethnicities (e.g., African American, Hispanic). 2. Pathophysiology/Etiology Insulin resistance in peripheral tissues (muscle, liver) leads to decreased glucose uptake. Over time, pancreatic β-cell dysfunction occurs, resulting in inadequate insulin production to overcome resistance. 3. Signs and Symptoms a. Pertinent Labs: Fasting plasma glucose (FPG) ≥ 126 mg/dL, HbA1c ≥ 6.5%, 2-hour plasma glucose ≥ 200 mg/dL during an OGTT. b. Presenting Symptoms: Polyuria, polydipsia, polyphagia, fatigue, blurred vision, slow-healing sores, unexplained weight loss (in some cases). c. Diagnostic Criteria/Tools: HbA1c, fasting glucose, oral glucose tolerance test (OGTT). 10/22/24, 9:21 PM OneNote 4. Treatment a. Approach to Therapy: i. Pharmacological: First-Line Agent: Metformin is typically the first-line therapy due to its effectiveness in lowering blood glucose and favorable safety profile. 2nd-Line Agents: • Sulfonylureas: Promote insulin secretion (e.g., glipizide). • DPP-4 inhibitors: Prolong incretin action (e.g., sitagliptin). • SGLT2 inhibitors: Promote glucose excretion (e.g., empagliflozin). • GLP-1 agonists: Enhance insulin secretion (e.g., liraglutide). 1. First-Line Agent: • Metformin: This is the first-line treatment for T2DM due to its effectiveness in lowering blood glucose levels, favorable safety profile, and potential cardiovascular benefits. Metformin primarily works by decreasing hepatic glucose production and improving insulin sensitivity. 2. Second-Line Agents: • Sulfonylureas (e.g., glipizide): These stimulate insulin secretion from pancreatic beta cells and are often used when metformin alone does not achieve adequate glycemic control. • DPP-4 Inhibitors (e.g., sitagliptin): These enhance incretin levels, which help regulate insulin secretion and lower blood glucose levels. • SGLT2 Inhibitors (e.g., empagliflozin): These promote glucose excretion through the urine and are beneficial for patients with heart failure or chronic kidney disease. • GLP-1 Agonists (e.g., liraglutide): These enhance insulin secretion and slow gastric emptying, leading to weight loss, making them suitable for overweight patients. Rationale for General Approach: Metformin is preferred as the initial therapy due to its effectiveness, low risk of hypoglycemia, and weight neutrality. It is also associated with cardiovascular benefits, which is crucial given the high cardiovascular risk in diabetic patients. Second-line agents are introduced based on individual patient factors, such as the presence of cardiovascular disease, renal function, and patient preferences regarding side effects and administration routes. For example, SGLT2 inhibitors are particularly beneficial for patients with heart failure or those at risk for renal disease, while GLP-1 agonists are favored for patients needing weight loss. 10/22/24, 9:21 PM OneNote ii. Non-pharmacological: Weight loss through diet, increased physical activity, smoking cessation, and glucose monitoring. b. Unique Aspects/Counseling Points: ○ Metformin: GI upset is common; take with meals. Monitor renal function. ○ SGLT2 inhibitors: Can cause urinary infections, dehydration. ○ Sulfonylureas: Hypoglycemia risk, weight gain. 5. Bonus: Clinical Guideline American Diabetes Association (ADA) Standards of Care 2024