Disease Description (Causes and Symptoms)
- Definition: Non-insulin-dependent diabetes mellitus = type 2 diabetes mellitus, a disease in which blood glucose levels chronically rise due to insufficient insulin secretion and/or insulin resistance in peripheral tissues.
- Main pathophysiology: Genetic predisposition combined with environmental factors such as obesity, insufficient physical activity, and stress causes insulin resistance. Initially, compensatory insulin secretion increases, but later insulin secretion decreases due to impaired beta-cell function → persistent hyperglycemia.
- Main symptoms: Polyuria, polydipsia (excessive thirst), polyphagia, weight loss (as the disease progresses), fatigue, blurred vision, numbness·abnormal sensation in the hands and feet, vulvar itching (women). Many cases are asymptomatic in the early stages.
- Diagnostic criteria (main indicators):
- Fasting blood glucose ≥ 126 mg/dL, or
- 2-hour postprandial blood glucose (after a 75-g oral glucose tolerance test) ≥ 200 mg/dL, or
- Random blood glucose (with accompanying symptoms) ≥ 200 mg/dL.
- Supplementary indicator: Glycated hemoglobin (HbA1c) ≥ 6.5% is used to support diagnosis (repeat testing is recommended).
Treatment Methods
- Lifestyle management (basic): Weight loss (in cases of obesity), regular aerobic and strength exercise, dietary therapy (total calorie control, carbohydrate distribution), smoking cessation, and limiting alcohol consumption.
- Pharmacological treatment (general principles):
- First-line medication: Metformin (start after checking kidney function).
- Second-line/additional medications (selected according to patient characteristics and cardiovascular and kidney status): SGLT2 inhibitors (cardiovascular and kidney protective effects), GLP-1 receptor agonists (weight loss and cardiovascular benefits), DPP-4 inhibitors, sulfonylureas (blood glucose-lowering effects), thiazolidinediones, insulin (when necessary), etc.
- Patients with a history of cardiovascular disease or impaired kidney function should consult a specialist when selecting medications (e.g., consider SGLT2 or GLP-1 agents).
- Monitoring and targets: In general, an HbA1c target of <7% is usually recommended, but it should be individualized according to the patient’s age, comorbidities, risk of hypoglycemia, and other factors. Blood pressure and lipids (LDL-C) should also be managed together (e.g., a BP target of <130/80, tailored to the patient).
- Treatment of acute complications: Ketoacidosis, hyperosmolar coma, and similar conditions require emergency treatment (hospitalization, intravenous fluids, and insulin treatment).
- Vaccination: Consider vaccination against influenza, pneumococcus, and hepatitis B (for recommended 대상).
- Precautions (self-management): Recognize symptoms of hypoglycemia (hyperventilation·tremor·sweating·confusion, etc.) and learn how to immediately consume fast-acting carbohydrates; monitor kidney and liver function and medication side effects; undergo regular eye, nerve, and kidney examinations and foot checks.
Checklist Before an Outpatient Visit (Including Example Questions)
Items/materials to prepare or submit:
- List of currently used medications (including blood glucose-lowering drugs and blood pressure and lipid medications), and supplements (such as vitamins)
- Recent blood glucose levels (self-monitoring records), glycated hemoglobin (HbA1c) test results (if available), and recent blood test results (creatinine·electrolytes·lipids)
- Urinalysis results (urine albumin), if possible
- Records of changes in weight·blood pressure·lifestyle (diet·exercise)
- Records of symptom changes (polyuria·polydipsia·vision changes·delayed wound healing, etc.) and hypoglycemic episodes
Information to tell the doctor in advance before the consultation (examples):
- Whether you have recently experienced symptoms of hypoglycemia or hyperglycemia
- Whether you have other diseases (heart·kidney·liver), allergies, or are pregnant
General Example Questions to Ask the Doctor
- "What are the side effects and precautions for this medication?"
- "What should my target HbA1c be? What are the criteria for changing treatment?"
- "Are there any additional tests I should undergo to prevent cardiovascular disease?"
- "How should I respond immediately if hypoglycemia occurs?"
Examples of Condition-Specific Questions
- "Based on my recent HbA1c (or fasting blood glucose·self-monitoring records), should my medication be added to or changed?"
- "Considering my kidney function (creatinine/urine albumin), which blood glucose-lowering medication would be safe and effective?"
Additional information:
- Regular ophthalmologic examinations (for retinopathy), kidney tests (urine albumin·glomerular filtration rate), and nerve and foot examinations (ulcer risk assessment) are recommended.