Type 2 diabetes in adults

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Diabetes Mellitus Type 2Published by: Domus Medica | SSMGLast published: 2017Diabète sucré de type 2Published by: SSMG | Domus MedicaLast published: 2017

Lifestyle factors (e.g., overweight/obesity and stress) seem to be the main drivers of the current type 2 diabetes epidemic. Particular conditions can increase the risk of type 2 diabetes. These include cardiovascular disease, hypertension, dyslipidaemia, obesity, stroke, polycystic ovary syndrome, a history of gestational diabetes, and mental health problems.[27][34]

The National Institute for Health and Care Excellence (NICE) in the UK recommends a two-stage strategy to identify people at high risk of type 2 diabetes (and those with undiagnosed type 2 diabetes): a risk assessment and, if necessary, a confirmatory blood test.[27] NICE recommends that general practitioners (primary care physicians) use a validated computer-based risk-assessment tool to identify people on their practice register who may be at high risk of type 2 diabetes.[27] In addition, it recommends that pharmacists, opticians, occupational health nurses, and community leaders should offer a validated self-assessment questionnaire or validated web-based tools to:[27]

All adults aged 40 and above (except pregnant women)
People aged 25 to 39 of South Asian, Chinese, African-Caribbean, and black African ethnicity (except pregnant women)
Adults with any other condition that increases the risk of type 2 diabetes.

Those with a high risk score should be advised to contact their GP or practice nurse for a fasting plasma glucose or HbA1c test.[27] In addition, a blood test should also be considered regardless of risk score for those aged 25 years and over of South Asian or Chinese descent whose body mass index (BMI) is greater than 23 kg/m².[27] People identified as being at high risk of progression to type 2 diabetes, that is, having non-diabetic hyperglycaemia, NDH (defined as fasting plasma glucose of 5.5 to 6.9 mmol/L [99.0 to 124.2 mg/dL] or HbA1c of 42 to 47 mmol/mol [6.0% to 6.4%]) should be offered a referral to an evidence-based, quality-assured intensive lifestyle-change programme.[27][44]

In England, one such programme is the NHS Diabetes Prevention Programme (DPP), also called the ‘Healthier You’ programme.[44] It identifies people at risk of developing type 2 diabetes and enrolls them onto a 9-month, evidence-based lifestyle change programme, which is available as a face-to-face group service or as a digital service.[44] Specific eligibility criteria for the programme are adults (aged 18-80 years) with NDH, or people with a history of previous gestational diabetes mellitus and normoglycaemia (HbA1c <42 mmol/mol; fasting plasma glucose <5.5 mmol/l).[44] People on the programme receive personalised support to manage their weight, eat more healthily, and be more physically active, with the digital service utilising tools such as wearable technologies, apps where users can access health coaches, online peer-support groups, and the ability to set and monitor goals electronically.[44] This programme has reduced the risk of developing type 2 diabetes by more than a third for people completing the course.[44]

Research shows that a combination of low-risk lifestyle behaviours, such as maintaining a healthy body weight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption, is associated with a lower risk of incident type 2 diabetes.[45][46][47][48] Further, with aggressive prevention of obesity in all age groups, type 2 diabetes is potentially preventable.[49][50] Several clinical trials have shown that weight loss is associated with delayed or decreased onset of type 2 diabetes in high-risk adults, and the European Association for the Study of Diabetes recommends that people with overweight or obesity should aim for at least a 5% weight loss by adopting an intensive lifestyle intervention.[31][45][51][52][53][54][55] Progression to diabetes from NDH can be reduced by 50% over 3-4 years through modest weight loss (7% of body weight) using diet and regular physical activity.[51] [ ] In addition, several pharmacological agents, including metformin, alpha-glucosidase inhibitors, orlistat, glucagon-like peptide-1 (GLP-1) receptor agonists, and thiazolidinediones, have been shown to reduce progression from NDH to type 2 diabetes.[56][57][58][59][60] [ ] [ ] [ ] Lifestyle change and/or metformin are preferred for most patients.[61][62][63][64] More aggressive multi-agent pharmacological approaches remain controversial.[65] Screening for NDH and cardiovascular risk reduction appropriate to the needs of the individual are also very important.[66][67]

Secondary prevention

The risk of macrovascular and microvascular complications can be reduced by about 50% using effective multifactorial interventions.[330]

Other preventative measures currently recommended for people with type 2 diabetes in the UK include:

Annual influenza immunisations for those who require insulin or oral hypoglycaemic drugs, or with diet-controlled diabetes[331]
Vaccination against pneumococcal disease for those with diabetes requiring insulin or antidiabetic medication (not those with diabetes that is diet controlled).[332]
Vaccination against COVID-19. Patients with any diabetes, including diet-controlled diabetes and current gestational diabetes, are considered to be in a 'clinical risk group', and should be offered vaccination/booster vaccinations.[293]
Regular dental care
Structured, tailored diabetes education, with annual reinforcement and review.[36]

Use of this content is subject to our disclaimer

Type 2 diabetes in adults

Primary prevention

Your Organisational Guidance

Secondary prevention