Type 2 Diabetes

“Approximately 90% of all cases of Diabetes worldwide are of this type.”

Type 2 Diabetes is the most common type of Diabetes Mellitus, it is highly related to the lifestyle of the patient and approximately 90% of all cases of Diabetes worldwide are of this type.

Comparison of Type 1 and Type 2 Diabetes
Type 1 Type 2
Onset Sudden Gradual
Age at onset Mostly in children Mostly in adults
Body size Thin or normal Often obese
Ketoacidosis Common Rare
Autoantibodies Usually present Absent
Endogenous insulin Low or absent Normal, decreased

or increased

Concordance in identical twins 50 % 90 %
Prevalence ~10% ~90%

The major difference between Type 1 Diabetes is that the pancreas is still working, so the organ never stopped producing insulin.

It can happen that the body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance), but still the organ, the pancreas is working.

Also it is an important difference that Type 2 Diabetes generally appears later on in life, compared to Type 1 Diabetes.

A person with Type 2 Diabetes either
  • Does not produce enough insulin, or
  • Suffers from ‘insulin resistance’, which means that the insulin is not working properly.

What is happening is that the defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However the specific defects are not known. Diabetes Mellitus cases due to a known defect are classified separately.

The World Health Organization definition of Diabetes (both Type 1 Diabetes and Type 2 Diabetes) is for a single raised glucose reading with symptoms, otherwise raised values on two occasions, of either:

Symptoms of Diabetes either
  • fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl)

or

  • with a glucose tolerance test, two hours after the oral dose a plasma glucose ≥ 11.1 mmol/l (200 mg/dl)

Some people may be able to control their Type 2 Diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels.

However, Type 2 Diabetes is typically a progressive disease – it gradually gets worse – and the patient will probably end up have to take insulin, usually in tablet form.

Previously seen mainly in middle-aged and elderly people, Type 2 Diabetes occurs increasingly frequently in children and young people.

Type 2 Diabetes is often undiagnosed and studies to assess the number of newly occurring cases are complicated and consequently there are almost no data on true incidence. World Health Organization’s recent review of data from seven countries found that between 24% and 62% of people with Diabetes were undiagnosed and untreated. This is a shockingly high number.

Overweight and obese people have a much higher risk of developing Type 2 Diabetes compared to those with a healthy body weight. People with a lot of visceral fat, also known as central obesity, belly fat, or abdominal obesity, are especially at risk.

Being overweight/obese causes the body to release chemicals that can destabilize the body’s cardiovascular and metabolic systems.

But being overweighted might be a parental responsibility as well. A simple blood test could predict whether children as young as five are at risk of becoming obese in later life.

The test, which looks at a fat storage gene, will enable parents to change the lifestyles of children before the pounds pile on.

Although the risk of Type 2 Diabetes is determined by an interplay of genetic and metabolic factors, by being overweight, physically inactive and eating the wrong foods all contribute to our risk of developing Type 2 Diabetes. Ethnicity, family history of Diabetes, and previous gestational Diabetes combined with older age, overweight and obesity, unhealthy diet, physical inactivity and smoking increase risk.

Drinking just one can of (non-diet) soda per day can raise our risk of developing Type 2 Diabetes by 22%, researchers from Imperial College London reported in the journal Diabetologia.

Scientists believe that the impact of sugary soft drinks on Diabetes risk may be a direct one, rather than simply an influence on body weight.

The fundings were so serious that in January 2014 Mexico implemented a nationwide tax on drinks containing added sugar.

The risk of developing Type 2 Diabetes is also greater as we get older. Experts are not completely sure why, but they say that as we age we tend to put on weight and become less physically active.

Those with a close relative who have/had Type 2 Diabetes, people of Middle Eastern, African, or South Asian descent also have a higher risk of developing the disease.

Also the older you are the higher your risk is, especially if you are over 40 (for white people), and over 25 (for black, South Asian and some minority groups). It has been found in the UK that black people and people of South Asian origin have five times the risk of developing Type 2 Diabetes compared to white people.

Excess body fat, overweight and obesity, together with physical inactivity, are estimated to cause a large proportion of the global Diabetes burden. Higher waist circumference and higher Body Mass Index (BMI) are associated with increased risk of Type 2 Diabetes.

Of course this may vary in different populations for example populations in South-East Asia develop Diabetes at a lower level of Body Mass Index than populations of European origin.

Several dietary practices are linked to unhealthy body weight and/or Type 2 Diabetes risk, including high intake of saturated fatty acids, high total fat intake and inadequate consumption of dietary beverages.

High intake of sugar-sweetened beverages, which contain considerable amounts of free sugars, increases the likelihood of being overweight or obese, particularly among children.

Early childhood nutrition affects the risk of Type 2 Diabetes later in life. Factors that appear to increase risk include poor fetal growth, low birth weight (particularly if followed by rapid postnatal catch-up growth) and high birth weight.

Active (as distinct from passive) smoking increases the risk of Type 2 Diabetes, with the highest risk among heavy smokers. Risk remains elevated for about 10 years after smoking cessation, falling more quickly for lighter smokers.

Men whose testosterone levels are low have been found to have a higher risk of developing Type 2 Diabetes. Researchers from the University of Edinburgh, Scotland, say that low testosterone levels are linked to insulin resistance.

However when you are getting older and you experience that your eyesight and hearing might not be as sharp as they were in your youth, Type 2 Diabetes can be the underlying reason.

It is always worth to check yourself for Diabetes Mellitus if you experience any of these five symptoms:

  • You find it tougher to see or hear clearly
  • You feel tired and grouchy
  • You are experiencing odd symptoms
  • You feel hungry all the time
  • You urinate frequently and always feel thirsty

These symptoms are not necessarily present only because of your age. For example hearing loss is twice as common in people with diabetes as in those who do not have the disease.

Even if you are always tired can mean that your body is not effectively converting glucose to energy. Or a dry skin or tingling and numbness of the hands and feet can be the first warning sign.

Luckily Type 2 Diabetes is preventable. Regular physical activity reduces the risk of Type 2 Diabetes and raised blood glucose, and is an important contributor to overall energy balance, weight control and obesity prevention – all risk exposures linked to future Diabetes prevalence.

In the early stage of Type 2 Diabetes, the predominant abnormality is reduced insulin sensitivity. At this stage, high blood sugar can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce the liver’s glucose production.

However, the prevalence of physical inactivity globally is of increasing concern.

In 2010, (the latest year for which data are available) just under a quarter of all adults aged over 18 years did not meet the minimum recommendation for physical activity per week and were classified as insufficiently physically active.

Being overweight or obese is strongly linked to Type 2 Diabetes. Physical inactivity is alarmingly common among adolescents, with 84% of girls and 78% of boys not meeting minimum requirements for physical activity for this age.

Also women were more overweight or obese than men.

The prevalence of obesity was highest in the World Health Organization region of the Americas and lowest in the World Health Organization South-East Asian region.

Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 60–80% of cases in those of European and African descent, and 100% of Pima Indians and Pacific Islanders.

Overall, despite the global voluntary target to halt the rise in obesity by 2025, being overweight or obese has increased in almost all countries.

The proportion of people who are overweight or obese increases with country income level.

High- and middle-income countries have more than double the overweight and obesity prevalence of low-income countries.

Management of Type 2 Diabetes focuses on lifestyle interventions, lowering other cardiovascular risk factors, and maintaining blood glucose levels in the normal range.

As for medications the patient will usually be prescribed orally administered anti-diabetic drugs. As a person with Type 2 Diabetes does produce his/her own insulin, a combination of oral medicines will usually improve insulin production, regulate the release of glucose by the liver, and treat insulin resistance to some extent.

If the beta cells become further impaired the patient will eventually need insulin therapy in order to regulate glucose levels.

No major Diabetes organization recommends universal screening for Diabetes as there is no evidence that such a program improve outcomes.

Also screening can be recommended among those whose blood pressure is less, who are overweight and between the ages of 40 and 70.


Researched, collected and written by Zsolt Szemerszky

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