1. Introduction
Definition : Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterised by insulin resistance and a progressive decline in pancreatic beta-cell function, leading to hyperglycaemia.
Epidemiology : T2DM accounts for 90–95% of all diabetes cases, with rising prevalence worldwide due to increased obesity, sedentary lifestyles, and ageing populations.
Significance : A major cause of morbidity and mortality due to its complications, including cardiovascular disease, kidney disease, and neuropathy.
2. Causes and Risk Factors
Causes :
Insulin resistance in peripheral tissues, combined with insufficient compensatory insulin secretion by beta cells.
Risk Factors :
Modifiable : Obesity (especially central adiposity), physical inactivity, poor diet, and smoking.
Non-modifiable : Family history of diabetes, advancing age, ethnicity (higher risk in South Asians, African-Caribbeans, and Native Americans).
Gestational diabetes or polycystic ovary syndrome (PCOS).
3. Pathophysiology
Chronic hyperglycaemia results from insulin resistance in skeletal muscle, adipose tissue, and the liver, combined with beta-cell dysfunction. This leads to impaired glucose uptake, increased hepatic glucose production, and lipotoxicity, exacerbating metabolic disturbances.
4. Symptoms and Features
Early Symptoms :
Increased thirst (polydipsia) and frequent urination (polyuria).
Fatigue and unexplained weight loss.
Blurred vision and recurrent infections (e.g., urinary tract infections or thrush).
Advanced Features :
Poor wound healing and numbness or tingling in extremities (neuropathy).
Symptoms of complications like chest pain (cardiovascular disease) or swelling in the feet (nephropathy).
5. Complications
Acute :
Hyperosmolar Hyperglycaemic State (HHS): Life-threatening severe hyperglycaemia without significant ketosis.
Chronic :
Microvascular : Retinopathy, nephropathy, neuropathy.
Macrovascular : Cardiovascular disease, stroke, peripheral vascular disease.
6. Diagnosis
Diagnostic Criteria (any one of the following) :
Fasting plasma glucose ≥7.0 mmol/L (126 mg/dL).
Random plasma glucose ≥11.1 mmol/L (200 mg/dL) with classic symptoms.
HbA1c ≥6.5%.
2-hour plasma glucose ≥11.1 mmol/L (200 mg/dL) during an oral glucose tolerance test (OGTT).
Additional Tests :
Lipid profile, liver function tests, urine albumin-to-creatinine ratio (ACR).
7. Management Overview
Goals : Achieve and maintain optimal glycaemic control (HbA1c <7%), reduce cardiovascular risk, and prevent complications.
Approach : Lifestyle modifications, pharmacological therapy, and routine monitoring of blood glucose and complications.
8. Treatment Options with Cost (USD)
Lifestyle Modifications :
Healthy diet and exercise: Minimal cost.
Weight management programs: ~$50–$150/month.
Oral Medications :
Metformin: ~$10–$30 per month.
Sulfonylureas (e.g., glimepiride): ~$10–$50 per month.
DPP-4 inhibitors (e.g., sitagliptin): ~$200–$300 per month.
Injectable Therapies :
GLP-1 receptor agonists (e.g., semaglutide): ~$800–$1,200 per month.
Insulin (for advanced cases): ~$150–$300 per vial.
9. Advanced Treatment Options with Cost (USD)
SGLT2 Inhibitors (e.g., empagliflozin) : ~$300–$400 per month.
Insulin Pumps (if required) : Device cost ~$4,000–$7,000, with ~$100–$300/month for supplies.
Bariatric Surgery (for obesity and diabetes remission) : ~$15,000–$25,000.
10. Pharmacological Treatment
First-line : Metformin, combined with lifestyle changes.
Second-line : Sulfonylureas, SGLT2 inhibitors, or DPP-4 inhibitors, depending on patient-specific factors like cardiovascular risk or weight.
Third-line : Insulin therapy or GLP-1 receptor agonists in advanced cases or when glycaemic targets are not met.
11. Medication Tables
Table 1: Doses and Side Effects
Drug Indication Dose Common Side Effects Metformin First-line therapy 500–2,000 mg daily GI upset, lactic acidosis (rare) Glimepiride Sulfonylurea 1–4 mg daily Hypoglycaemia, weight gain Sitagliptin DPP-4 inhibitor 100 mg daily Headache, nasopharyngitis Empagliflozin SGLT2 inhibitor 10–25 mg daily UTIs, dehydration Semaglutide GLP-1 receptor agonist 0.25–1 mg weekly (injection) Nausea, weight loss
Table 2: Brand Names and Approximate Costs (USD)
Drug Brand Names Approx. Cost Metformin Glucophage $10–$30 per month Glimepiride Amaryl $10–$50 per month Sitagliptin Januvia $200–$300 per month Empagliflozin Jardiance $300–$400 per month Semaglutide Ozempic $800–$1,200 per month
12. Lifestyle Interventions
Adopt a balanced, low-glycaemic index (GI) diet rich in whole grains, lean proteins, fruits, and vegetables.
Engage in regular aerobic exercise (150 minutes/week) and resistance training.
Limit alcohol intake and avoid smoking.
Set realistic weight loss goals (5–10% reduction in body weight).
13. Monitoring Parameters
Regular blood glucose self-monitoring or continuous glucose monitoring (CGM).
HbA1c every 3–6 months to assess long-term glycaemic control.
Annual screening for complications:
Retinopathy: Eye exams.
Nephropathy: Urine albumin-to-creatinine ratio (ACR).
Neuropathy: Foot exams.
Lipid profile and blood pressure monitoring to manage cardiovascular risk.
14. Patient Counseling Points
Educate about the chronic nature of diabetes and the importance of adherence to medications and lifestyle changes.
Discuss signs and management of hypoglycaemia (e.g., sweating, shakiness, confusion).
Encourage routine follow-ups to monitor for complications.
Emphasise the benefits of regular physical activity and healthy eating for long-term diabetes management.
15. Special Populations
In Elderly : Individualise glycaemic targets to minimise hypoglycaemia risks.
In Pregnancy : Switch to insulin therapy as oral agents are typically avoided.
In Obese Patients : Focus on weight loss therapies like GLP-1 receptor agonists or bariatric surgery.
16. Prevention
Maintain a healthy diet and regular exercise routine to prevent or delay T2DM onset in high-risk individuals.
Monitor blood glucose levels in overweight or prediabetic individuals.
Manage comorbidities like hypertension and hyperlipidaemia to reduce overall risk.
17. FAQs
What is Type 2 Diabetes?Answer : A chronic condition where the body becomes resistant to insulin or does not produce enough insulin.
What causes Type 2 Diabetes?Answer : A combination of genetic predisposition and lifestyle factors like obesity and inactivity.
How is Type 2 Diabetes treated?Answer : With lifestyle changes, oral medications, and, in some cases, insulin therapy.
Can Type 2 Diabetes be reversed?Answer : In some cases, weight loss and lifestyle changes can lead to remission.
What foods should I avoid with Type 2 Diabetes?Answer : Sugary drinks, processed foods, and refined carbohydrates.
How often should I check my blood sugar?Answer : This depends on your treatment plan; many patients monitor it daily or several times a week.
What is HbA1c?Answer : A measure of average blood glucose levels over the past 2–3 months.
Can Type 2 Diabetes cause complications?Answer : Yes, it can lead to complications like heart disease, kidney damage, and vision problems.
What is the role of exercise in managing Type 2 Diabetes?Answer : Regular exercise improves insulin sensitivity and helps control blood sugar levels.
Is insulin required for Type 2 Diabetes?Answer : Not initially, but it may be needed in advanced cases or when oral medications fail.
How can I prevent Type 2 Diabetes?Answer : By maintaining a healthy weight, eating a balanced diet, and staying active.
What is prediabetes?Answer : A condition where blood sugar levels are higher than normal but not high enough for a diabetes diagnosis.
Can stress affect blood sugar?Answer : Yes, stress can cause blood sugar to rise.
Is Type 2 Diabetes genetic?Answer : There is a genetic predisposition, but lifestyle factors play a significant role.
What is the best diet for Type 2 Diabetes?Answer : A diet low in refined carbs and high in fibre, lean proteins, and healthy fats.