Understanding Diabetes Type 2

NCBI Bookshelf. A service provided by the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

StatPearls [Internet].

Rajeev Goyal; Mayank Singhal; Ishwarlal Jialal.

Authors

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Last Revision: June 23, 2023.

Continuing Education Activity

Diabetes mellitus (DM) is a persistent metabolic disorder characterized by high blood sugar levels. It can result from a lack of insulin secretion, insulin resistance, or both. Prolonged hyperglycemia, along with other metabolic issues, in individuals with DM can lead to organ damage, causing severe health complications, especially microvascular and macrovascular problems that increase the risk of cardiovascular diseases. This article explores the pathophysiology of DM and emphasizes the crucial role of an interprofessional team in managing the condition.

Examine the need to enhance care coordination among interprofessional team members to enhance outcomes for individuals with type 2 diabetes mellitus.

Effective care coordination is essential for individuals with type 2 diabetes mellitus in order to optimize their management and improve health outcomes. Interprofessional collaboration among healthcare providers, including physicians, nurses, dietitians, pharmacists, and other specialists, is crucial for providing comprehensive care for patients with diabetes. By working together as a team, healthcare professionals can ensure that patients receive the appropriate treatment, education, and support needed to effectively manage their condition.

Introduction

DM is a persistent metabolic disorder marked by elevated blood sugar levels, which can arise from insulin deficiency, insulin resistance, or a combination of both. According to the International Diabetes Federation (IDF), approximately 415 million adults aged 20 to 79 had DM in 2015. The number is expected to surge by another 200 million by 2040, reflecting a growing global health crisis. This review provides insight into the causes, diagnosis, symptoms, and treatment principles of diabetes.

Etiology

DM is divided into three main types based on etiology and clinical features: type 1 diabetes, type 2 diabetes, and gestational diabetes. Less common types include monogenic diabetes and secondary diabetes.

Type 1 Diabetes Mellitus (T1DM)

Type 1 DM results from an autoimmune attack on insulin-producing beta cells in the pancreas, leading to insulin deficiency. It is often triggered by a combination of genetic and environmental factors, commonly affecting children and adolescents.

Type 2 Diabetes Mellitus

Type 2 DM constitutes most diabetes cases and is characterized by insulin resistance. It primarily affects adults over 45, but rising rates of obesity have led to its occurrence in younger age groups.

Gestational Diabetes Mellitus

GDM, or diabetes detected during pregnancy, can lead to various complications for both the mother and child.

Monogenic Diabetes

Monogenic diabetes stems from a single genetic mutation and includes conditions like MODY and neonatal diabetes.

Secondary Diabetes

Secondary diabetes arises as a complication of other medical conditions or drug treatments.

Epidemiology

Diabetes is a global epidemic, with increasing prevalence attributed to lifestyle changes and rising obesity rates. In 2017, the global prevalence of DM was 425 million, and approximately 10% of Americans had diabetes in 2015, a substantial portion of which was undiagnosed.

It is estimated that by 2045, over 600 million people worldwide will have diabetes if current trends continue. This staggering rise in numbers underscores the urgent need for prevention and management strategies to curb the impact of this disease on public health.

Pathophysiology

In T1DM, the immune system attacks pancreatic beta cells, leading to insulin deficiency. Genetic factors play a significant role in T1DM development, with specific gene polymorphisms contributing to disease susceptibility.

T2DM, characterized by insulin resistance and beta-cell dysfunction, is often linked to obesity and sedentary lifestyles. Various physiological mechanisms contribute to the pathogenesis of T2DM.

In addition to genetic and lifestyle factors, environmental triggers such as viral infections or exposure to certain toxins may also play a role in the development of both types of diabetes. It is important for individuals with diabetes to manage their condition through a combination of medication, diet, exercise, and regular monitoring of blood sugar levels.

History and Physical

Common symptoms of diabetes include increased thirst, frequent urination, fatigue, infections, and slow wound healing. Proper diagnosis and monitoring are essential for managing the condition effectively.

Evaluation

Annual diabetes screenings are recommended for individuals over 40 years of age, with more frequent screenings for those at higher risk, such as certain ethnic groups or individuals with obesity.

Women with a gestational diabetes diagnosis should undergo regular testing every three years for life. Other patients should start testing at age 45, with subsequent tests every three years if results are normal.
The same tests are used for both screening and diagnosing diabetes, as well as detecting prediabetes. Diabetes can be diagnosed using either hemoglobin A1C criteria or plasma glucose concentration (fasting or 2-hour plasma glucose).
– **Fasting Plasma Glucose (FPG)**
A blood sample is taken after an 8-hour fast. An FPG level over 126 mg/dL (7.0 mmol/L) suggests a diabetes diagnosis.
– **Two-Hour Oral Glucose Tolerance Test (OGTT)**
This test measures plasma glucose levels before and 2 hours after ingesting 75g of glucose. A DM diagnosis is made if the 2-hour sample shows a glucose level over 200 mg/dL (11.1 mmol/L). This test requires preparation with a high-carb diet and avoiding certain medications.
– **Glycated Hemoglobin (Hb) A1C**
This test provides an average of blood glucose levels over 2-3 months. A Hb A1C level exceeding 6.5% (48 mmol/mol) indicates DM. Hb A1C is a reliable and standardized test but may be affected by certain conditions.
For all tests, if the person is asymptomatic, testing should be repeated for a DM diagnosis. In symptomatic patients, random plasma glucose over 200 mg/dL is sufficient for a DM diagnosis.
Various testing methods can diagnose gestational diabetes in pregnant women using a one-step or two-step approach.
The mainstay of diabetes therapy involves diet, exercise, and medication like metformin. Different therapies are available based on patient needs and conditions. Maintaining optimal glycemic control and other health parameters is crucial to reducing complications and improving outcomes.
The interprofessional team takes charge of diagnosing and treating type 2 diabetes mellitus. Patients need appropriate referrals to various specialists such as ophthalmologists, cardiologists, nephrologists, and vascular surgeons. Moreover, they must be educated on lifestyle modifications to reduce blood sugar levels, including weight loss, physical activity, and a balanced diet. It is vital for diabetic individuals to stop smoking and abstain from alcohol. The complications of diabetes mellitus can be severe, impacting both quality of life and limb preservation.
Some publications on diabetes and its complications include:
– Global causes and epidemiology of type 2 diabetes mellitus and its complications by Zheng Y, Ley SH, Hu FB.
– Diabetes and Ramadan: A multicenter study in the Algerian population by Malek R, Hannat S, Nechadi A, Mekideche FZ, Kaabeche M.
– Type 2 diabetes mellitus and bone fragility: with a special emphasis on bone imaging by Choi YJ, Chung YS.
– Recent developments on how type 2 diabetes mellitus affects bone metabolism and material properties by Picke AK, Campbell G, Napoli N, Hofbauer LC, Rauner M.
– The mortality risk among individuals with type 2 diabetes in Latin America by Carrillo-Larco RM, Barengo NC, Albitres-Flores L, Bernabe-Ortiz A.
There are numerous other publications covering related topics such as comorbidities, hypertension management, dietary habits, diagnostic criteria, quality of life, arterial rigidity, bariatric surgery, medication safety, and personalized treatment approaches.