From the Guidelines
Diabetes Mellitus (DM) Type 2 is a metabolic disorder characterized by hyperglycemia due to a combination of insulin resistance and impaired insulin secretion.
Key Characteristics
- Insulin Resistance: decreased biological response to insulin, often associated with obesity and physical inactivity 1
- Impaired Insulin Secretion: defective glucose-stimulated insulin secretion, leading to hyperglycemia 1
- Risk Factors: increases with age, obesity, and lack of physical activity, and is more common in individuals with prior gestational diabetes mellitus, polycystic ovary syndrome, hypertension, dyslipidemia, and certain racial/ethnic subgroups 1
Diagnosis and Classification
- Classification: type 2 diabetes accounts for 90-95% of all diabetes cases, and is characterized by relative insulin deficiency and peripheral insulin resistance 1
- Diagnosis: can be made based on symptoms, plasma glucose levels, and A1C measurements, and may involve islet autoantibody testing to exclude type 1 diabetes in certain cases 1
Management and Complications
- Management: may involve weight reduction, exercise, oral glucose-lowering agents, and insulin therapy, with the goal of achieving adequate glycemic control and preventing macrovascular and microvascular complications 1
- Complications: includes retinopathy, nephropathy, peripheral neuropathy, autonomic neuropathy, and atherosclerotic cardiovascular disease, which can be prevented or delayed with proper management 1
From the Research
Definition and Pathophysiology of Diabetes Mellitus (DM) Type 2
- Diabetes Mellitus (DM) Type 2, also known as Type 2 Diabetes (T2D), is a complex multifactorial disease that emerges from the combination of genetic and environmental factors 2.
- The main metabolic feature of T2D is hyperglycemia, which is a consequence of insulin resistance and β-cell dysfunction 2, 3.
- Insulin resistance and impaired insulin secretion are the core defects in T2D, but at least six other pathophysiological abnormalities contribute to the dysregulation of glucose metabolism 4.
Risk Factors and Prevention
- Obesity, lifestyle, and aging are the most relevant risk factors for T2D 2.
- Excess adiposity is the most important risk factor for diabetes, and maintaining a healthy body weight and avoiding weight gain during adulthood is the cornerstone of diabetes prevention 5.
- Increasing physical activity and reducing sedentary behaviors, such as prolonged TV watching, are important for maintaining body weight and improving insulin sensitivity 5.
- A healthy diet, together with regular physical activity, maintenance of a healthy weight, moderate alcohol consumption, and avoidance of sedentary behaviors and smoking, could nearly eliminate type 2 diabetes 5.
Pathogenesis and Therapy
- The pathogenesis of T2D is not fully understood, with insulin resistance and β-cell dysfunction playing central roles in its pathophysiology 6.
- Dyslipidemia, hyperglycemia, along with other metabolic disorders, results in insulin resistance and/or islet β-cell dysfunction via some shared pathways, such as inflammation, endoplasmic reticulum stress, oxidative stress, and ectopic lipid deposition 6.
- There is currently no cure for T2D, but it can be prevented or put into remission by lifestyle intervention and/or some medication 6.