Type 2 Diabetes: Disease Summary

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Questions and Answers

What is the primary characteristic that defines diabetes mellitus?

Elevated serum lipid concentrations

Chronic hypoglycemia

Chronic hyperglycemia (correct)

Acute hyperglycemia

How many distinct causes of diabetes mellitus have been identified?

30 (correct)

What is the primary feature of diabetes mellitus that distinguishes it from other diseases?

Lipid metabolism abnormalities

Insulin sensitivity

Insulin availability (correct)

Glucose intolerance

What is required for Type 2 diabetes to be present?

Both insulin resistance and pancreatic insulin secretion defects Signup and view all the answers

What percentage of patients with diabetes mellitus will develop retinopathy 15 years after diagnosis?

80% Signup and view all the answers

What is the leading cause of end-stage renal disease in the US?

Diabetes Signup and view all the answers

What is a common symptom of diabetes mellitus?

Excessive thirst Signup and view all the answers

What is the term for diabetes mellitus that should no longer be used?

Maturity-onset diabetes Signup and view all the answers

What is a common characteristic of the onset of type 2 DM?

Slow and progressive Signup and view all the answers

Which of the following is NOT a pathophysiologic mechanism involved in type 2 DM?

Gluconeogenesis sufficient conversion of glucose to glycogen Signup and view all the answers

What may be noted in patients with diabetes mellitus 2 who are experiencing respiratory distress?

High bicarbonate level; K+ shift from intracellular to intravascular (ECF) Signup and view all the answers

Which of the following is a symptom that is unlikely to be present in a patient with type 2 DM?

Weight loss, increased appetite, and nocturnal enuresis Signup and view all the answers

What is a common method of detecting type 2 DM?

Random or fasting blood glucose determination Signup and view all the answers

What is a complication of lower extremeity sensory neuropathy in type 2 DM?

Increased risk of both a foot infection and amputation Signup and view all the answers

How is a diagnosis of DM established?

If any one of the following three conditions is satisfied Signup and view all the answers

What is the minimum fasting glucose concentration required for a diagnosis of DM?

125 mg/dL Signup and view all the answers

When is insulin therapy instituted in patients with type 2 DM?

When combinations of medications fail to restore normal blood glucose levels Signup and view all the answers

What is the goal of dietary restrictions in non-obese patients with type 2 diabetes?

To restrict saturated fats and cholesterol Signup and view all the answers

What is the indication for exenatide therapy in patients with type 2 DM?

As an adjunctive therapy to improve glycemic control in patients taking metformin, an SFU, or a combination of both Signup and view all the answers

What is the next step in therapy when a patient's fasting blood glucose concentration remains above 140 mg/dL despite taking the maximum dose of an SFU?

Adding metformin or a TZD to the treatment regimen Signup and view all the answers

In non-obese patients with type 2 diabetes, what is the primary goal of diet therapy?

To restore a normoglycemic state Signup and view all the answers

What is the role of weight reduction interventions in patients with type 2 DM?

To improve insulin sensitivity Signup and view all the answers

When is a trial of an SFU often successful in non-obese patients with type 2 diabetes?

When diet therapy is insufficient to correct hyperglycemia Signup and view all the answers

What is the main difference in treating obese and non-obese patients with type 2 DM?

The emphasis on weight reduction interventions Signup and view all the answers

What is the estimated increase in probability of developing type 2 diabetes for every 20% increase over desirable body weight?

Doubles Signup and view all the answers

What is the term used to describe the combination of obesity and type 2 diabetes?

Diabesity Signup and view all the answers

What is the primary reason for the alarming number of children diagnosed with type 2 diabetes?

Poor eating habits, lack of exercise, and increasing body weight Signup and view all the answers

What is the risk factor for type 2 diabetes that is associated with a seven times higher risk of developing the disease later in life?

Polycystic ovarian syndrome Signup and view all the answers

What is the pathophysiologic process that causes a relative lack of insulin in type 2 diabetes?

Insulin resistance Signup and view all the answers

What is the outcome when type 2 diabetes develops in an identical twin older than 40 years of age?

The other twin develops type 2 diabetes within 1 year more than 70% of the time Signup and view all the answers

What is the gene on chromosome 2 that has been linked to type 2 diabetes?

Calpain 10 Signup and view all the answers

What is the characteristic of type 2 diabetes that distinguishes it from type 1 diabetes?

Relative insulin deficiency followed by an absolute lack of insulin Signup and view all the answers

What is the minimum plasma glucose concentration required to diagnose diabetes mellitus?

200 mg/dL Signup and view all the answers

What is the percentage of people with prediabetes that progress to diabetes mellitus each year?

3-7% Signup and view all the answers

What is the reduction in risk for developing complications of diabetes mellitus with a 1% reduction in glycosylated hemoglobin levels?

25% Signup and view all the answers

What is the decrease in life expectancy for people diagnosed with type 2 diabetes mellitus in their 40s?

5-10 years Signup and view all the answers

What is the primary goal of treatment for obese type 2 diabetes patients?

Weight reduction Signup and view all the answers

What is the minimum amount of weight loss required to improve control of diabetes?

5-10% of total body weight Signup and view all the answers

What is the first-line therapy for obese patients with mild type 2 diabetes?

Monotherapy with metformin Signup and view all the answers

What is the diagnostic criterion for metabolic syndrome?

Triglycerides greater than 150 Signup and view all the answers

Study Notes

Type 2 Diabetes: Definition and Characteristics

Diabetes mellitus refers to a group of clinically heterogeneous endocrine/metabolic disorders with glucose intolerance in common.
Type 2 diabetes (T2D) is a chronic medical condition characterized by chronic hyperglycemia, abnormalities in carbohydrate, lipid, and protein metabolism, and defects in insulin availability.
T2D is a disorder of insulin availability, resulting from defects in insulin production or utilization.

Pathophysiology

T2D is characterized by insulin resistance and pancreatic b-cell dysfunction, leading to a relative insulin deficiency and ultimately an absolute lack of insulin.
Insulin resistance is the major pathophysiologic process causing a relative lack of insulin.
Pancreatic b-cell dysfunction with impaired production of insulin is the major pathophysiologic process resulting in an absolute insulin deficiency.

Clinical Manifestations

Symptoms of T2D may include lack of energy, excessive thirst, frequent urination, slow healing of infections and wounds, generalized pruritus, and blurry vision.
Retinopathy affects 80% of all patients with DM 15 years after diagnosis.
Diabetes is the leading cause of end-stage renal disease and non-traumatic lower limb amputations.

Risk Factors

Obesity is a significant risk factor for T2D, with a direct relationship between the degree of obesity and the risk for developing T2D.
The probability of developing T2D doubles every 20% increase over desirable body weight.
Polycystic ovarian syndrome is also a risk factor for T2D.

Diagnosis

Onset of T2D is typically slow and progressive.
Many persons with T2D are completely asymptomatic or have few complaints at the time of diagnosis.
Diagnosis is established if any one of the following three conditions is satisfied:
- Fasting glucose concentration ≥ 125 mg/dL.
- Two hours after 75 mg oral glucose, plasma glucose concentration ≥ 200 mg/dL.
- A random plasma glucose concentration ≥ 200 mg/dL combined with symptoms of increased thirst, increased appetite, and complaints of frequent urination and voiding of unusually large volumes of urine.

Treatment and Prognosis

Treatment of T2D involves a broad-based focus on glucose control, nutrition, exercise, lipids, hypertension, and smoking cessation.
A reduction in glycosylated hemoglobin levels by even 1% can decrease the risk for developing complications by 25%.
Medications that provide more than one benefit (lowering both blood sugar and low-density lipoprotein concentrations) are preferred.
The life expectancy of people diagnosed with T2D in their 40s decreases by 5-10 years, and cardiovascular disease is the leading cause of death.

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Description

Learn about the definition, causes, and characteristics of diabetes mellitus, a group of metabolic disorders with glucose intolerance. Understand chronic hyperglycemia, metabolic abnormalities, and more.