Diabetes Mellitus, Type 2
Diabetes mellitus (DM) type 2 is due to a progressive insulin secretory defect in the setting of insulin resistance.
Monitor for hypoglycemia; adjust doses for renal/hepatic dysfunction and cognitive function; less aggressive glucose targets than younger patients
Incidence is increasing and parallels obesity epidemic.
- Diet, metformin, glyburide, and insulin are all options for treatment of gestational diabetes.
- In gestational diabetes, screen for diabetes/prediabetes with oral glucose tolerance test (OGTT) 6 to 12 weeks postpartum and every 3 years.
1.5 million new cases in the United States each year
Estimated 37.3 million Americans (11.3% of the population); 90–95% are likely type 2.
Etiology and Pathophysiology
- Peripheral insulin resistance and defective insulin secretion with increased hepatic gluconeogenesis
- Obesity and visceral adiposity
- Associated with dyslipidemia, hypertension, and gut microbiome changes
- Drug or chemical induced (e.g., glucocorticoids, antiretroviral therapy, atypical antipsychotics, organ transplant immunosuppressants)
- Family history is strongly predictive of risk.
- Polygenic; rarely monogenic (e.g., peroxisome proliferator–activated receptor [PPAR] γ and insulin gene mutations)
- Parental history of type 2 diabetes
- Gestational diabetes or history of baby with birth weight ≥4 kg (9 lb)
- Polycystic ovarian syndrome (PCOS)
- Hypertriglyceridemia or low high-density lipoprotein (HDL)
- Ethnicity: African American, Latino, Native American, Asian, and Pacific Islander
- Sedentary lifestyle, visceral obesity
- Maintenance of normal weight, or weight loss of 7% body weight, decrease intake of carbohydrates and overall calories; moderate-intensity exercise (150 min/week).
- Metformin, α-glucosidase inhibitors, thiazolidinediones (TZDs), and glucagon-like peptide-1 receptor agonist (GLP-1 RA) in prediabetes
Commonly Associated Conditions
Hypertension, dyslipidemia, metabolic syndrome, fatty liver disease, PCOS, acanthosis nigricans, hemochromatosis
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