From the Guidelines
Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and impaired insulin secretion, requiring a comprehensive management approach that includes lifestyle modifications and pharmacological interventions.
Pathophysiology
The pathophysiology of T2DM involves a complex interplay of genetic, environmental, and lifestyle factors, including insulin resistance, impaired insulin secretion, and ectopic fat accumulation in the liver, pancreas, and muscle, leading to hyperglycemia, hypertension, and dyslipidemia 1.
Clinical Management
The clinical management of T2DM should focus on promoting healthy behaviors, including healthy nutrition, regular physical activity, adequate sleep, and smoking cessation 1.
- Weight management is a crucial aspect of T2DM management, with a target weight loss of at least 5% to achieve clinical benefits, and substantial weight loss (>10%) increasing the chance of disease remission 1.
- Medications should be used to achieve glycemic targets, with a proactive approach to combining agents with complementary mechanisms of action, and considering fixed-dose combination preparations to improve medication adherence 1.
- Lifestyle interventions, such as moderate physical activity and weight management, can delay or prevent the progression to T2DM among people with impaired glucose tolerance (IGT) 1.
Screening and Diagnosis
Screening for prediabetes and T2DM is recommended using an informal assessment of risk factors or an assessment tool, such as the ADA risk test, to guide providers on whether to perform a diagnostic test 1.
- The diagnostic criteria for T2DM include a fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher, a 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during an oral glucose tolerance test (OGTT), or an A1C level of 6.5% (48 mmol/mol) or higher 1.
Prevention
Primary prevention of T2DM includes health education and promoting a healthy lifestyle, with lifestyle interventions shown to delay or prevent the progression to T2DM among people with IGT 1.
From the Research
Pathophysiology of Type 2 Diabetes Mellitus (T2DM)
- T2DM is a complex, multifactorial disease characterized by insulin resistance and decreased β-cell function 2, 3, 4
- The disease is associated with hyperglycemia, which becomes manifest once insulin secretion is no longer adequate for the metabolic demands of the individual 2
- Oxidative stress, mitochondrial dysfunction, endoplasmic reticulum stress, and inflammation are closely correlated with insulin resistance and β-cell dysfunction 3
- The pathogenesis of T2DM involves a combination of genetic and environmental factors, including obesity, lifestyle, and aging 3, 4
Clinical Management of T2DM
- The approach to glycemic management of T2DM should be individualized, considering the psycho-socio-economic condition of each patient, and glycemic targets should reflect the presence of comorbid conditions, age of the patient, and stage of the disease 2
- Early diagnosis and timely intervention are crucial to improve outcomes and prevent complications, such as microvascular and macrovascular diseases 5
- Lifestyle intervention and medication can prevent or manage T2DM, and holistic and personalized management should be taken as soon as possible through timely detection and diagnosis 4
- Emerging treatment options, such as sodium-glucose cotransporter 2 inhibitors, provide an additional tool to treat patients with T2DM, improving glycemic control independently of insulin and promoting weight reduction 6
Complications and Burden of T2DM
- T2DM is a major cause of early mortality due to atherosclerosis and cardiovascular disease, and is the leading cause of blindness, leg amputations, and chronic renal disease 2
- The disease represents a significant burden on the healthcare system, with a high risk of cardiovascular disease, heart failure, cerebrovascular accidents, and peripheral artery disease 5
- The estimated number of individuals suffering from diabetes mellitus is expected to rise, making it a major healthcare condition of the 21st century 5