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Type 2 diabetes

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**Type 2 Diabetes Overview:**
– Signs and symptoms: frequent urination, increased thirst, increased hunger, weight loss, blurred vision, itchiness, peripheral neuropathy, recurrent infections, fatigue.
– Complications: ten-year-shorter life expectancy, increased risk of cardiovascular disease, higher rates of lower limb amputations, leading cause of nontraumatic blindness and kidney failure, associated with cognitive dysfunction and dementia.
– Causes: lifestyle and genetic factors, including diet, obesity, age, sex, genetics, alcohol consumption, maternal nutrition during fetal development.

**Risk Factors and Prevention:**
– Lifestyle factors: obesity, lack of physical activity, poor diet, psychological stress, urbanization, smoking, lack of sleep, dietary factors like sugar-sweetened drinks.
– Genetics: multiple genes contribute to diabetes risk, estimated 72% of diabetes is inherited, specific genes like TCF7L2 allele increase risk, involvement of genes in pancreatic beta cell functions.
– Prevention strategies: maintain healthy weight, regular physical activity, balanced diet low in sugar and processed foods, regular medical check-ups, avoid smoking and excessive alcohol consumption.

**Diagnosis and Treatment:**
– Diagnosis: WHO criteria, HbA1c levels, fasting glucose, 2h glucose levels, ADA diagnostic criteria.
– Treatment options: lifestyle changes, medications like metformin, sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, insulin therapy, bariatric surgery, regular monitoring of blood sugar levels and complications.
– Prevention strategies: onset delay through nutrition and exercise, intensive lifestyle measures, high physical activity levels, dietary changes, medications like Metformin.

**Management and Screening:**
– Management focus: lifestyle interventions, cardiovascular risk reduction, blood glucose level maintenance, self-monitoring, managing cardiovascular risk factors, treatment goals.
– Screening: not universally recommended, recommended for high-risk adults, consideration of age, overweight, obesity, high blood pressure, inconclusive evidence on benefits.

**Additional Considerations:**
– Medical conditions associated with diabetes: medications predisposing to diabetes, gestational diabetes, health problems like acromegaly, Cushing’s syndrome, hyperthyroidism, pheochromocytoma, certain cancers.
– Pathophysiology: insufficient insulin production, insulin resistance, mechanisms like lipid breakdown, incretin resistance, high glucagon levels, kidney function, central nervous system regulation.
– Lifestyle considerations: proper diet, regular exercise, impact of exercise on blood sugar control, blood lipid levels, calorie restriction, various effective diets, dietary interventions, stress management, medication options, blood pressure management, other treatments like aspirin use.

Type 2 diabetes (Wikipedia)

Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, fatigue and unexplained weight loss. Symptoms may also include increased hunger, having a sensation of pins and needles, and sores (wounds) that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

Type 2 diabetes
Other namesDiabetes mellitus type 2;
adult-onset diabetes;
noninsulin-dependent diabetes mellitus (NIDDM)
A blue circle is the universal symbol of diabetes.
SymptomsIncreased thirst, frequent urination, unexplained weight loss, increased hunger
ComplicationsHyperosmolar hyperglycemic state, diabetic ketoacidosis, heart disease, strokes, diabetic retinopathy, kidney failure, amputations
Usual onsetMiddle or older age
DurationLong term
CausesObesity, lack of exercise, genetics
Diagnostic methodBlood test
PreventionMaintaining normal weight, exercising, healthy diet
TreatmentDietary changes, metformin, insulin, bariatric surgery
Prognosis10 year shorter life expectancy
Frequency392 million (2015)

Type 2 diabetes primarily occurs as a result of obesity and lack of exercise. Some people are genetically more at risk than others.

Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to type 1 diabetes and gestational diabetes. In type 1 diabetes there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas. Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin (A1C).

Type 2 diabetes is largely preventable by staying at a normal weight, exercising regularly, and eating a healthy diet (high in fruits and vegetables and low in sugar and saturated fats). Treatment involves exercise and dietary changes. If blood sugar levels are not adequately lowered, the medication metformin is typically recommended. Many people may eventually also require insulin injections. In those on insulin, routinely checking blood sugar levels (such as through a continuous glucose monitor) is advised; however, this may not be needed in those who are not on insulin therapy. Bariatric surgery often improves diabetes in those who are obese.

Rates of type 2 diabetes have increased markedly since 1960 in parallel with obesity. As of 2015 there were approximately 392 million people diagnosed with the disease compared to around 30 million in 1985. Typically it begins in middle or older age, although rates of type 2 diabetes are increasing in young people. Type 2 diabetes is associated with a ten-year-shorter life expectancy. Diabetes was one of the first diseases ever described, dating back to an Egyptian manuscript from c. 1500 BCE. The importance of insulin in the disease was determined in the 1920s.

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