Clinical Features: Type 2 Diabetes

The presentation of Type 2 diabetes

The patient:
- Usually has a slow-onset of symptoms developing over years/months
  - Many patients are asymptomatic and only found via routine screening/investigation of other conditions
- Typically older patients (often >50 y/o)
  - Although is beginning to affect youngsters (see MODY)
- Related conditions – several conditions are seen more in T2 than T1 DM
  - Metabolic syndrome and obesity
  - NAFLD
  - PCOS

T2DM usually presents in one of 4 ways
1. Most often, these patients will actually be asymptomatic
  - May be picked up on screening or incidental findings
  - May have non-specific complaints like fatigue/malaise
2. Hyperglycaemia
  - Often incidental – e.g. if patient has had a urine dip for a suspected UTI this may show glycosuria
3. HHS
4. Long-term complications
  - Macrovascular
  - Microvascular

Symptoms of T2DM

Hyperglycaemic symptoms
- Onset is much slower and the symptoms are less marked than in Type 1
  - However, the same symptoms as Type 1 can develop including:
    - Increased infection risk
    - Osmotic diuresis
    - CNS
    - Weight loss
  - NB hyperglycaemia is often detected in asymptomatic patients with a routine dipstick for other conditions
- HHS – See Separate
  1. Increased blood osmolality
    1. Significant hyperglycaemia symptoms
    2. Coma
  2. This is a rare presentation as the patient has to have been extremely hyperglycaemic

Long-term complications – See separate
- Macrovascular –
  - Angina/MI
  - Stroke
  - PVD – Claudications and diabetic foot ulcers
- Retinopathy –
  - Blurred vision
  - Shows up on opthalmoscopy which may be done for other conditions (e.g. at optician)
- Neuropathy –
  - Symmetric foot pain, tingling, and numbness in all modalities
  - Increased trauma to feet
- Nephropathy –
  - Microalbuminuria – ACR = >30mg/ml

Note that symptoms of gluconeogenesis are very rare in T2DM