From the Guidelines
Type 2 diabetes is a chronic condition characterized by hyperglycemia, insulin resistance, and relative insulin deficiency, with a pathogenesis that begins with insulin resistance in muscle, liver, and fat cells, and is accelerated by genetic and environmental factors, such as obesity, sedentary lifestyle, and poor diet, leading to long-term complications including microvascular and macrovascular disease. The chronic conditions associated with type 2 diabetes include:
- Hyperglycemia
- Insulin resistance
- Relative insulin deficiency
- Microvascular damage (retinopathy, nephropathy, neuropathy)
- Macrovascular disease (cardiovascular disease, stroke)
The pathogenesis of type 2 diabetes is complex and involves multiple factors, including:
- Insulin resistance in muscle, liver, and fat cells
- Pancreatic beta cell dysfunction
- Genetic predisposition
- Environmental factors, such as obesity, sedentary lifestyle, and poor diet
- Inflammatory cytokines and free fatty acids released by excess visceral fat, which worsen insulin resistance 1
According to the most recent and highest quality study, the management of type 2 diabetes requires a multifaceted approach, including lifestyle modifications, such as diet, exercise, and weight loss, as well as oral medications, such as metformin, SGLT2 inhibitors, and GLP-1 receptor agonists, and eventually insulin therapy as the disease progresses 1. Early intervention is crucial to prevent the progressive beta cell failure that characterizes advanced disease.
The diagnosis and classification of diabetes is based on criteria that define prediabetes and diabetes, including fasting plasma glucose, 2-hour plasma glucose during an oral glucose tolerance test, and A1C levels 1. The risk of developing type 2 diabetes increases with age, obesity, and lack of physical activity, and is more frequent in certain racial/ethnic subgroups and in individuals with a strong genetic predisposition or family history of diabetes 1.
In terms of morbidity, mortality, and quality of life, type 2 diabetes is a significant public health burden, with long-term complications that can be prevented or delayed with early diagnosis and treatment 1. Therefore, it is essential to prioritize early intervention and management of type 2 diabetes to prevent the development of long-term complications and improve quality of life.
From the Research
Chronic Conditions of Type 2 Diabetes
- Type 2 diabetes is a common metabolic disorder characterized by chronic hyperglycaemia 2
- It is associated with a reduced life expectancy owing to a greater risk of heart disease, stroke, peripheral neuropathy, renal disease, blindness, and amputation 2
- The disease is defined in a 'negative' sense, with hyperglycaemia occurring in the absence of evidence of autoimmune destruction of islet cells 2
Pathogenesis of Type 2 Diabetes
- Insulin resistance is a general term meaning that insulin does not exert its normal effects in insulin-sensitive target tissues, such as skeletal muscle, adipose tissue, and liver 3
- Insulin resistance promotes cardiovascular disease via multiple mechanisms, including changes in classic cardiovascular risk factors and downregulation of the insulin signaling pathways in different tissues 3
- The two major pathophysiological abnormalities in type 2 diabetes are insulin resistance and impaired insulin secretion 3
- Hyperglycemia manifests in various forms with a varied presentation and results in carbohydrate, fat, and protein metabolic dysfunctions 4
- Long-term hyperglycemia often leads to various microvascular and macrovascular diabetic complications, which are mainly responsible for diabetes-associated morbidity and mortality 4
Key Factors in the Development of Type 2 Diabetes
- Visceral obesity and dyslipidaemia characterized by low levels of high-density lipoprotein cholesterol, hypertriglyceridaemia, and raised small dense low-density lipoprotein particle levels 5
- Changes in adipose tissue mass and metabolism may link insulin resistance and visceral obesity, a condition that is common in type 2 diabetes 5
- Weight reduction, increased physical activity, metformin, and acarbose have been shown to reduce the development of type 2 diabetes in genetically predisposed subjects and may decrease the high cardiovascular risk of patients with diabetes 5