Diabetes Mellitus Type 2: NCLEX Priorities
T2DM: stepwise treatment, lifestyle, A1c targets, complications.
Type 2 diabetes is insulin resistance + relative insulin deficiency. NCLEX tests medication ladder and lifestyle.
Diagnosis
Same as T1: A1c ≥6.5, fasting ≥126, random ≥200 with symptoms.
Treatment ladder
Lifestyle + metformin first. Add SGLT2 inhibitor (cardio-renal benefits) or GLP-1 (weight loss). Sulfonylureas, DPP-4. Insulin if uncontrolled.
Goals
A1c <7% typically. Individualized (less strict in elderly, severe comorbidity). BP <130/80. Statin per ASCVD risk.
Complications screening
Annual eye exam, foot exam, urine microalbumin, A1c quarterly. Smoking cessation. ASA in established CVD.
Frequently asked
Metformin first-line, why?
Effective, weight-neutral or weight-loss, low hypoglycemia risk, cheap. Cardio-protective.
When start insulin in T2DM?
A1c >9 at diagnosis, symptomatic hyperglycemia, or inadequate control on multiple orals.
Quick check
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