Type 2 Diabetes
What type 2 diabetes is, the HbA1c numbers used to diagnose it, and what treatment involves.
Last revised
A condition in which blood glucose runs persistently high because the body responds poorly to insulin and, over time, produces less of it. It develops gradually and often causes no symptoms for years, which is why it is frequently found on a routine blood test.
How it differs from type 1
Type 1 is an autoimmune condition in which the pancreas stops producing insulin, usually presenting rapidly and often in childhood or early adulthood. Type 2 is a combination of insulin resistance and declining insulin production, develops over years, and accounts for around nine in ten diabetes diagnoses in the UK. They are different diseases that share a name and a symptom.
How it is diagnosed
Usually on an HbA1c blood test, which reflects average blood glucose over the preceding two to three months. A result of 48 mmol/mol (6.5 per cent) or above on two occasions, or once with symptoms, is diagnostic. A result between 42 and 47 mmol/mol indicates non-diabetic hyperglycaemia — often called prediabetes — which carries a substantially raised risk of progression and is the point at which intervention is most effective.
What treatment involves
Structured education, diet and activity come first and remain central throughout. Metformin is usually the first medicine offered. Further medicines are added according to individual factors, with several newer classes now used earlier where there is cardiovascular or kidney disease. Substantial weight loss can put type 2 diabetes into remission in some people, particularly within the first few years of diagnosis.
The checks that come with it
Annual retinal screening, an annual foot check, blood pressure and cholesterol monitoring, kidney function tests and HbA1c reviews. These exist because the complications of diabetes — to eyes, nerves, kidneys, heart and circulation — develop silently, and are largely preventable when found early.
At a glance
| Term | Detail |
|---|---|
| Diagnostic HbA1c | 48 mmol/mol (6.5%) or above |
| Non-diabetic hyperglycaemia | 42-47 mmol/mol |
| Share of UK diabetes cases | roughly 90 per cent are type 2 |
| Usual first medicine | metformin |
| Routine annual checks | eyes, feet, kidneys, blood pressure, cholesterol, HbA1c |
| Remission | possible with substantial weight loss, especially early after diagnosis |
When to get help
See a GP promptly if you are unusually thirsty, passing much more urine than normal, losing weight without trying, or notice blurred vision or slow-healing wounds. Seek urgent medical help for vomiting with abdominal pain, deep or rapid breathing, breath smelling of pear drops, or drowsiness and confusion, which can indicate diabetic ketoacidosis — a medical emergency that is more common in type 1 but does occur in type 2.
Where to go next
Where this comes from
- NICE - Type 2 diabetes in adults: management
- NHS - Type 2 diabetes
- Diabetes UK - diagnosis and remission
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.
