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Medical Emergencies · patient case question

Which statement about type 2 diabetes is correct?

Patient case: Two chronic conditions and a set of labs

Patient: Male, 47 years old

Chief Complaint: Presents for extraction of a non-restorable molar.

Background: HIV diagnosed nine years ago, on antiretroviral therapy. Type 2 diabetes for six years, on metformin. BMI 34.

Laboratory: CD4+ count 302 cells/µL · HbA1c 9.0% · Viral load undetectable

Vital Signs: BP 138/86 mmHg · HR 80 bpm

  1. Insulin is required from the moment of diagnosis
  2. It results from autoimmune destruction of pancreatic beta cells
  3. The majority of people with the condition are overweight or obese
  4. It presents most often in childhood with ketoacidosis
Show answer and explanation

Correct answer: C. The majority of people with the condition are overweight or obese

  • A. Type 2 is managed first with lifestyle change and oral agents such as metformin. Insulin may be added later as beta-cell function declines, but it is not required at diagnosis.
  • B. Autoimmune destruction of beta cells defines TYPE 1 diabetes, with anti-GAD and islet-cell antibodies.
  • C. CORRECT. Excess adiposity, particularly visceral fat, is the dominant modifiable risk factor for type 2 diabetes — the large majority of patients are overweight or obese at diagnosis, and adipose-driven insulin resistance is the central mechanism. This patient's BMI of 34 fits the pattern. Weight loss can meaningfully improve or even remit early type 2 diabetes.
  • D. Childhood onset with ketoacidosis is the classic type 1 presentation. Type 2 usually presents in adulthood and is often found on screening in an asymptomatic patient.

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