Diabetes mellitus type 2 (also known as type 2 diabetes ) is a long-term metabolic disorder characterized by high blood sugar, insulin resistance, and a relative lack of insulin. Common symptoms include increased thirst, frequent urination, and unexplained weight loss. Symptoms may also include increased hunger, fatigue, and a wound that does not heal. Often symptoms appear slowly. Long-term complications of high blood sugar include heart disease, stroke, diabetic retinopathy which can lead to blindness, kidney failure, and poor blood flow in the limbs that can lead to amputations. The sudden onset of hyperosmolar hyperglycemic conditions may occur; However, ketoacidosis is rare.
Type 2 diabetes mainly occurs as a result of obesity and lack of exercise. Some people are more at risk genetically than others. Type 2 diabetes makes about 90% of cases of diabetes, with another 10% mainly due to type 1 diabetes mellitus and gestational diabetes. In type 1 diabetes mellitus there is a lower total insulin level to control blood glucose, due to the loss of insulin-producing beta cells produced autoimmune in the pancreas. The diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or hemoglobin (A1C).
Type 2 diabetes can be partially prevented by maintaining normal weight, exercising regularly, and eating properly. Treatment involves exercise and dietary changes. If the blood sugar level is not sufficiently lowered, metformin drugs are usually recommended. Many people may end up needing insulin injections as well. In those who use insulin, routinely check blood sugar levels are recommended; However, this may not be necessary in those taking the pills. Bariatric surgery often improves diabetes in those who are obese.
The rate of type 2 diabetes has risen sharply since 1960 in parallel with obesity. By 2015 there were about 392 million people diagnosed with the disease compared with about 30 million in 1985. It usually begins in middle age or older, although the rate of type 2 diabetes increases in young people. Type 2 diabetes is associated with a shorter life expectancy of 10 years. Diabetes is one of the first illnesses described. The importance of insulin in the disease was determined in the 1920s.
Video Diabetes mellitus type 2
Signs and symptoms
The classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss. Other symptoms that commonly appear during diagnosis include a history of blurred vision, itching, peripheral neuropathy, recurrent vaginal infections, and fatigue. Many people, however, have no symptoms during the first few years and are diagnosed on routine testing. A small number of people with type 2 diabetes mellitus may develop hyperglycemic hyperosmolar (very high blood sugar conditions associated with decreased levels of consciousness and low blood pressure).
Complications
Type 2 diabetes is usually a chronic disease associated with a shorter life expectancy of 10 years. This is partly due to a number of associated complications, including: two to four times the risk of cardiovascular disease, including ischemic heart disease and stroke; a 20-fold increase in limb amputation, and an increase in hospitalization. In developed countries, and increasingly elsewhere, type 2 diabetes is the biggest cause of nontraumatic blindness and renal failure. It is also associated with an increased risk of cognitive dysfunction and dementia through disease processes such as Alzheimer's disease and vascular dementia. Other complications include acanthosis nigricans, sexual dysfunction, and frequent infections.
Maps Diabetes mellitus type 2
Cause
The development of type 2 diabetes is caused by a combination of lifestyle and genetic factors. While some of these factors are under personal control, such as diet and obesity, other factors are not, like age, female gender, and genetics. Sleep deprivation has been linked to type 2 diabetes. It is believed to act through its effects on metabolism. A mother's nutritional status during fetal development can also play a role, with one proposed mechanism being a change in DNA methylation. The intestinal bacteria Prevotella copri and Bacteroides vulgatus have been linked to type 2 diabetes.
Lifestyle
Lifestyle factors are important for the development of type 2 diabetes, including obesity and being overweight (defined by body mass index greater than 25), lack of physical activity, poor diet, stress, and urbanization. Excess body fat is associated with 30% of cases in Chinese and Japanese descent, 60-80% of cases in European and African descent, and 100% of cases in Pima Indians and Pacific Islanders. Among those who are not fat, high waist-hip ratios are often present. Smoking seems to increase the risk of type 2 diabetes mellitus.
Food factors also affect the risk of developing type 2 diabetes. Excessive consumption of sweet drinks is associated with increased risk. Essential fatty acids in foods, with saturated fats and trans fatty acids increase the risk, and polyunsaturated and monounsaturated fats reduce the risk. Eating lots of white rice seems to play a role in increasing the risk. Lack of exercise is believed to cause 7% of cases. Persistent organic pollutants may play a role.
Genetics
Most cases of diabetes involve multiple genes, with each becoming a small contributor to the increased likelihood of becoming a type 2 diabetic. If one identical twin has diabetes, the likelihood of developing another diabetes in its lifetime is greater than 90%, while the rate for siblings nonidentis is 25-50%. In 2011, more than 36 genes have been found that contribute to the risk of type 2 diabetes. All of these genes together still account for only 10% of the total component of inherited diseases. The TCF7L2 allele, for example, increases the risk of developing diabetes by 1.5 times and is the greatest risk of a common genetic variant. Most of the genes associated with diabetes are involved in beta cell function.
There are a number of rare cases of diabetes arising from abnormalities in a single gene (known as monogenic forms of diabetes or "other specific types of diabetes"). These include younger-onset diabetes (MODY), Donohue syndrome, and Rabson-Mendenhall syndrome, among others. Maturity onset of young diabetes is 1-5% of all cases of diabetes in young people.
Medical condition
There are a number of medications and other health problems that can affect diabetes. Some medications include: glucocorticoids, thiazides, beta blockers, atypical antipsychotics, and statins. Those who previously had gestational diabetes had a higher risk of developing type 2 diabetes. Other associated health problems include: acromegaly, Cushing's syndrome, hyperthyroidism, pheochromocytoma, and certain cancers such as glucagonomas. Lack of testosterone is also associated with type 2 diabetes.
Pathophysiology
Type 2 diabetes is caused by insufficient insulin production from beta cells in the regulation of insulin resistance. Insulin resistance, which is the inability of cells to respond adequately to normal insulin levels, occurs mainly in the muscles, liver, and fat tissues. In the liver, insulin usually suppresses glucose release. However, in the setting of insulin resistance, the liver does not precisely release glucose into the blood. The proportion of insulin resistance versus beta-cell dysfunction differs among individuals, with some having mainly insulin resistance and only minor defects in insulin secretion and others with little insulin resistance and especially lack of insulin secretion.
Other potentially important mechanisms associated with type 2 diabetes and insulin resistance include: increased lipid damage in fat cells, resistance and lack of incretin, high glucagon in blood, increased salt and water retention by the kidney, and inappropriate regulation. metabolism by the central nervous system. However, not everyone with insulin resistance develops diabetes, because impaired insulin secretion by pancreatic beta cells is also necessary.
Diagnosis
The definition of diabetes The World Health Organization (both type 1 and type 2) is for a single increase in glucose readings with symptoms, on the contrary increasing the value on two occasions:
- fasting plasma glucose> = 7.0 mmol/l (126 mg/dl)
- or
- with a glucose tolerance test, two hours after the oral dose of plasma glucose> = 11.1 mmol/l (200 mg/dl)
A random blood sugar of more than 11.1 mmol/l (200 mg/dl) in relation to typical symptoms or hemoglobin (HbA 1c ) >> = 48 mmol/mol (> = 6.5 DCCTÃ, %) is another method for diagnosing diabetes. In 2009 the International Committee of Experts which included representatives of the American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) recommended that a threshold of> 48 mmol/mol (> = 6.5 DCCT% ) should be used to diagnose diabetes. This recommendation was adopted by the American Diabetes Association in 2010. A positive test should be repeated unless the person comes with typical symptoms and blood sugar & gt; 11.1 mmol/l (& gt; 200 mg/dl).
The threshold for the diagnosis of diabetes is based on the relationship between glucose tolerance test results, fasting glucose or HbA 1c and complications such as retinal problems. A fasting or random blood sugar is preferred over the glucose tolerance test, because it is easier for people. HbA 1c has the advantage that fasting is not needed and the results are more stable but have the disadvantage that the test is more expensive than the measurement of blood glucose. It is estimated that 20% of diabetics in the United States are unaware that they have the disease.
Type 2 diabetes mellitus is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. This is in contrast to type 1 diabetes mellitus where there is absolute insulin deficiency due to the destruction of islet cells in the pancreas and gestational diabetes mellitus which is a new beginning of high blood sugar associated with pregnancy. Type 1 and type 2 diabetes can usually be distinguished by the circumstances. If antigen diagnosis is doubtful it may be useful to confirm type 1 diabetes and C-peptide levels may be useful for confirming type 2 diabetes, with normal or high levels of C-peptide in type 2 diabetes, but low type 1 diabetes.
Screening
No major organization recommends universal screening for diabetes because there is no evidence that such a program improves results. Screening is recommended by the United States Preventive Services Task Force (USPSTF) in asymptomatic adults whose blood pressure is greater than 135/80 mmHg. For those whose blood pressure is lacking, evidence is insufficient to recommend or oppose screening. There is no evidence that it alters the risk of death in this group of people. They also recommend examination among those overweight and between the ages of 40 and 70 years.
The World Health Organization recommends testing of high-risk groups and by 2014 the USPSTF is considering similar recommendations. High-risk groups in the United States include: those over the age of 45 years; those with first-degree relatives with diabetes; several ethnic groups, including Hispanics, African-Americans, and Native Americans; history of gestational diabetes; polycystic ovary syndrome; overweight; and conditions associated with metabolic syndrome. The American Diabetes Association recommends screening those with a BMI above 25 (in Asian screening guys recommended for a BMI over 23).
Prevention
The onset of type 2 diabetes can be delayed or prevented through proper nutrition and regular exercise. Intensive lifestyle measures can reduce the risk by half. The benefits of exercise occur regardless of one's initial weight or subsequent weight loss. A high level of physical activity reduces the risk of diabetes by about 28%. The evidence for the benefits of dietary changes alone, however, is limited, with some evidence for a diet high in green leafy vegetables and some to limit the intake of sugary beverages. In those with impaired glucose tolerance, diet and exercise either alone or in combination with metformin or acarbose may lower the risk of developing diabetes. Lifestyle interventions are more effective than metformin. Review 2017 found that, long-term, lifestyle changes lowered risk by 28%, while treatment did not reduce the risk after withdrawal. While low vitamin D levels are associated with an increased risk of diabetes, improving levels by adding vitamin D3 does not increase that risk.
Management
Type 2 diabetes management focuses on lifestyle intervention, lowers other cardiovascular risk factors, and maintains blood glucose levels within the normal range. Self-monitoring of blood glucose for people with newly diagnosed type 2 diabetes can be used in combination with education, but the benefits of self-monitoring in those who do not use multi-dose insulin are questioned. In those who do not want to measure blood levels, measuring urine levels can be done. Managing other cardiovascular risk factors, such as hypertension, high cholesterol, and microalbuminuria, increases one's life expectancy. A decrease in systolic blood pressure to less than 140 mmHg was associated with a lower risk of death and better outcomes. Intensive blood pressure management (less than 130/80 mmHg) compared with standard blood pressure management (less than 140/85-100 mmHg) resulted in a slightly lower risk of stroke but no effect on overall risk of death.
The decrease in intensive blood sugar (HbA 1c & lt; 6%) compared with a standard blood sugar decrease (HbA 1c 7-7.9%) did not appear to alter mortality. The goal of treatment is usually HbA 1c from 7 to 8% or fasting glucose less than 7.2 mmol/L (130 mg/dl); This goal, however, can be changed after professional clinical consultation, taking into account the risks of hypoglycemia and life expectancy. Although the guidelines recommend that intensive blood sugar control is based on a direct hazard balance with long-term benefits, many people - for example people with a life expectancy of less than nine years who will not benefit, are too untreated.
It is recommended that everyone with type 2 diabetes get regular eye exams. There is weak evidence suggesting that treating gum disease with scaling and root planing can result in a small short-term increase in blood sugar levels for diabetics. There is no evidence to suggest that elevated blood sugar levels are maintained for more than 4 months. There is also not enough evidence to determine whether a cure for gum disease effectively lowers blood sugar levels.
Lifestyle
Proper diet and exercise are the foundation of diabetes care, with a greater amount of exercise producing better results. Aerobic exercise leads to a decrease in HbA 1c and increases insulin sensitivity. Endurance exercises are also useful and a combination of both types of exercises may be most effective.
A diabetic diet that promotes weight loss is important. While the best types of diet to achieve this are controversial, low glycemic index diets or low-carbohydrate diets have been found to improve blood sugar control. A very low calorie diet, starting immediately after the onset of type 2 diabetes, may result in forgiveness of the condition.
The vegetarian diet has generally been linked to lower risk of diabetes, but does not offer any benefits compared to a diet that allows moderate amounts of animal products. There is not enough evidence to show that cinnamon increases blood sugar levels in people with type 2 diabetes.
Cultural education can help people with type 2 diabetes control their blood sugar levels, up to 24 months. If lifestyle changes in those with mild diabetes do not result in improved blood sugar within six weeks, drugs should be considered. There is not enough evidence to determine whether lifestyle intervention affects death in those who already have DM2.
Drugs
There are several classes of anti-diabetic drugs available. Metformin is generally recommended as first-line treatment because there is some evidence that it lowers mortality; However, this conclusion is questionable. Metformin should not be used on those with severe kidney or liver problems.
Another second class oral agent or insulin may be added if metformin is not enough after three months. Other classes of drugs include: sulfonylureas, thiazolidinedione, dipeptidyl peptidase-4 inhibitors, SGLT2 inhibitors, and peptide-1 analogs such as glucagon. By 2015 there is no significant difference between these agents. Overview 2018 found that SGLT2 inhibitors may be better than peptide-1 analogs such as glucagon or dipeptidyl peptidase-4 inhibitors.
Rosiglitazone, thiazolidinedione, has not been found to improve long-term outcomes despite raising blood sugar levels. In addition it is associated with increased rates of heart disease and death. Angiotensin-converting enzyme inhibitors (ACEIs) prevent kidney disease and improve outcomes in those with diabetes. Drugs similar to angiotensin receptor blockers (ARBs) do not. A 2016 review is recommended for treating systolic blood pressure of 140 to 150 mmHg.
Insulin injections can be added to oral medication or used alone. Most people initially do not need insulin. When used, long-acting formulations are usually added at night, with oral medications being continued. The dose is then increased for the effect (blood sugar levels are well controlled). When insulin is not sufficient every night, insulin twice a day can achieve better control. Long acting insulin glargine and detemir are equally safe and effective, and do not look much better than insulin protamine Hagedorn (NPH) neutral, but because they are significantly more expensive, they are not cost effective in 2010. In those who are insulin pregnant generally is the treatment of choice.
Vitamin D supplements for people with type 2 diabetes may increase insulin resistance markers and HbA1c.
Surgery
Weight loss surgery in those who are obese is an effective way to treat diabetes. Many are able to maintain normal blood sugar levels with little or no treatment after surgery and long-term mortality decreases. However there are some short-term mortality risks of less than 1% of surgery. Body mass index cuts for when the surgery is correct are not yet clear. It is recommended that this option be considered in those who can not lose their weight and blood sugar.
Epidemiology
Globally by 2015 it is estimated there are 392 million people with type 2 diabetes who constitute about 90% of cases of diabetes. This is equivalent to about 6% of the world's population. Diabetes is common in developed and developing countries. However, this is rare in an undeveloped world.
Women appear to have greater risks such as certain ethnic groups, such as South Asia, Pacific Islands, Latinos and Native Americans. This may be due to increased sensitivity to Western lifestyles in certain ethnic groups. Traditionally regarded as an adult disease, type 2 diabetes is increasingly diagnosed in children in parallel with increasing levels of obesity. Type 2 diabetes is now diagnosed as often as type 1 diabetes in adolescents in the United States.
The diabetes rate in 1985 is estimated at 30 million, rising to 135 million in 1995 and 217 million in 2005. This increase is believed to be primarily due to the aging of the global population, the decrease in exercise, and the increase in obesity rates. The five countries with the highest number of diabetics in 2000 were India with 31.7 million, China 20.8 million, United States 17.7 million, Indonesia 8.4 million and Japan 6.8 million. It is recognized as a global epidemic by the World Health Organization.
History
Diabetes is one of the first illnesses described with Egyptian script from c. 1500 BC which mentions "emptying urine too big." The first case described is believed to be type 1 diabetes. Indian doctors around the same time identify the disease and classify it as madhumeha or honey urine noting that urine will attract ants. The term "diabetes" or "pass through" was first used in 230 BC by Apollonius Of Memphis, Greece. The disease rarely occurred during the Roman empire with Galen commenting that he only saw two cases during his career.
Type 1 and type 2 diabetes were identified as a separate condition for the first time by Indian doctors Sushruta and Charaka in 400-500 AD with type 1 associated with youth and type 2 with overweight. The term "mellitus" or "from honey" was added by British rider John Rolle in the late 1700s to separate the condition of diabetes insipidus which was also associated with frequent urination. Effective treatment was not developed until the early 20th century when Canadian Frederick Banting and Charles Best discovered insulin in 1921 and 1922. This was followed by the development of long-acting NPH insulin in the 1940s.
References
External links
- Diabetes mellitus type 2 in Curlie (based on DMOZ)
- IDF Diabetes Atlas 2015
- National Diabetes Information Center
- Centers for Disease Control (endocrine pathology)
Source of the article : Wikipedia
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