Diabetes Mellitus, Type 2
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Diabetes mellitus (DM) type 2 is due to a progressive insulin secretory defect in the setting of insulin resistance.
Monitor elderly for hypoglycemia; adjust doses for renal/hepatic dysfunction and cognitive function; less aggressive glucose targets than in younger patients
Incidence is increasing and parallels obesity epidemic.
Diet, metformin, glyburide, and insulin are all options for treatment of gestational diabetes.
1.5 million new cases in 2015
- Estimated 23.1 million Americans (7.4% of the population); 90–95% are likely type 2.
- Higher education associated with lower prevalence
Etiology and Pathophysiology
- Peripheral insulin resistance and/or defective insulin secretion with increased hepatic gluconeogenesis
- Genetic factors: monogenic (e.g., PPARγ and insulin gene mutations) and polygenic
- Obesity (body mass index [BMI] ≥25 kg/m2) and visceral adiposity
- Gut microbiome changes
- Drug- or chemical-induced (e.g., glucocorticoids, highly active antiretroviral therapy [HAART], atypical antipsychotics, organ transplant immunosuppressants)
- Genome-wide association studies in progress to identify associated genes; 50% concordance in monozygotic twins
- Family history is strongly predictive of risk.
- Gestational diabetes or history of baby with birth weight ≥4 kg (9 lb)
- Polycystic ovary syndrome (PCOS)
- Hypertriglyceridemia or low high-density lipoprotein (HDL)—marker for insulin resistance
- Ethnicity: African American, Latino, Native American, Asian, and Pacific Islander
- Sedentary lifestyle
- Use of thiazides, antipsychotics, glucocorticoids, and statins
- Maintenance of normal weight, or weight loss of 7% body weight, exercise 150 min/week, and decrease in carbohydrates and overall caloric intake. Moderate-intensity exercise and resistance training are recommended.
- Higher intake of nuts, coffee, tea, and yogurt (1)[A]
- Use of metformin and thiazolidinediones (TZDs) in select patients with prediabetes (1)[A].
Commonly Associated Conditions
Hypertension, dyslipidemia, metabolic syndrome, fatty liver disease, infertility, PCOS, acanthosis nigricans, hemochromatosis