Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by insulin deficiency or insulin resistance, which leads to increased blood glucose levels. The main mechanism underlying T2DM is a violation of carbohydrate metabolism, which in turn causes a complete or partial deficiency of insulin and / or its effectiveness at the cellular level. This condition leads to various metabolic disorders and, as a consequence, to the development of a number of complications affecting the cardiovascular, nervous and genitourinary systems. The disease most often develops in people over 45 years of age, but in recent years there has been an increase in the incidence among young people and children, which is of concern to doctors and scientists.
History of the disease and interesting historical facts
The history of diabetes mellitus goes back thousands of years. The first mentions of the disease are found in ancient Egyptian papyri, which described a number of symptoms associated with frequent urination and thirst. In the 3rd century AD, Hippocrates already mentioned “a medical condition in which urine tastes sweet.” Systematic study of diabetes began in the early 19th century, when in 1869 Paul Langerhans discovered the islets of ancestral cells, which were later called the islets of Langerhans. However, a significant breakthrough in understanding the pathogenesis of diabetes occurred in 1921, when it was discovered that insulin is the key hormone regulating blood sugar levels. This discovery became the basis for revolutionary changes in the treatment of diabetes. Throughout the 20th and 21st centuries, researchers continue to study the mechanisms of the disease in depth, which has led to the development of various therapeutic approaches, diets, and educational programs.
Epidemiology
According to the World Health Organization (WHO), the number of people with diabetes worldwide has increased significantly. In 2021, according to statistics, about 537 million people with diabetes were registered, and this number is expected to increase to 643 million by 2030. According to the International Diabetes Federation, 90% of them are patients with type 2 diabetes. This disease is especially common in countries with high levels of urbanization and lifestyle changes, which is associated with an increase in chronic diseases, including obesity. Studies show that the highest number of cases of T2DM are registered in the regions of Europe, North America and the Pacific Ocean.
Genetic predisposition to this disease
Genetic factors play an important role in the development of type 2 diabetes. Studies show that having close relatives with this disease significantly increases the risk of its development. Many genes are involved in the pathogenesis of type 2 diabetes, including: TCF7L2, FTO, PPARG, KCNJ11. Mutations in these genes can affect both insulin secretion and insulin resistance. For example, the rs7903146 polymorphism in the TCF7L2 gene is associated with an increased risk in both European and Asian populations. In addition, some rare mutations, such as in the HNF4A gene, can also lead to an increased predisposition to type 2 diabetes.
Risk factors for the development of this disease
The development of type 2 diabetes is caused by many risk factors, which can be classified as genetic, physical and chemical. The main risk factors include:
- Obesity and overweight.
- Sedentary lifestyle and lack of physical activity.
- Uncontrolled eating, high consumption of carbohydrates and sugar.
- Age (especially over 45 years).
- Family history of the disease.
- Ethnicity (higher risk among people of African and Native American descent).
- Metabolic syndrome.
- High blood pressure and dyslipidemia.
Diagnosis of this disease
Diagnosis of type 2 diabetes is based on clinical symptoms and laboratory tests. The main symptoms are:
- Frequent urination.
- Growing thirst.
- Unexplained weight loss.
- Fatigue and general weakness.
- Delayed healing of wounds and infections.
Several laboratory methods are used for diagnostics:
- Fasting plasma glucose test (≥ 7.0 mmol/L).
- OGTT test (post-exercise glucose test - ≥ 11.1 mmol/L after 2 hours).
- Determination of the level of glycosylated hemoglobin (HbA1c ≥ 6.5%).
It is important to note that a differential diagnosis should be made to exclude other forms of diabetes and conditions that can cause hyperglycemia.
Treatment
Treatment for type 2 diabetes involves lifestyle changes, medications, and, in some cases, surgery. The main approaches are as follows:
- Changing your diet and increasing physical activity.
- Use of antidiabetic agents to control blood glucose levels.
- Monitoring blood sugar levels.
- Maintaining a healthy lifestyle, including not smoking and limiting alcohol consumption.
- In some cases, if conservative treatment is not effective, surgical treatment, such as bariatric surgery, may be recommended.
List of drugs used to treat this disease
There are several classes of antidiabetic drugs used to treat type 2 diabetes:
- Biguanides (Metformin).
- Sulfonylureas (Glimepiride, Glipizide).
- Glinides (Repaglinide).
- Incretin mimetics (Exenatide, Liraglutide).
- DPP-4 inhibitors (Sacragliptin, Linagliptin).
- Thiazolidinones (Pioglitazone).
- SGLT2 inhibitors (Dapagliflozin, Empagliflozin).
Disease monitoring
Monitoring of patients with type 2 diabetes is an important aspect of disease management. Control steps include:
- Regular monitoring of blood sugar levels (glucometer).
- Monitoring blood pressure and blood lipid levels.
- Regular examinations to detect complications (ophthalmological and neurological examinations).
The prognosis for patients with adequate disease control is usually good. However, if left untreated, serious complications such as diabetic neuropathy, retinopathy, and cardiovascular disease may develop.
Age-related features of the disease
Type 2 diabetes mellitus can manifest itself differently depending on the age group. In young people, the disease can progress faster and be characterized by more severe forms of insulin resistance. In older patients, diabetes can be combined with other chronic diseases and complicated by polypharmacy, which complicates its control and treatment. In addition, in children and adolescents, the disease is often associated with obesity and poor nutrition, which requires more careful monitoring.
Questions and Answers
- How can you prevent type 2 diabetes? Prevention includes staying active, eating healthy, maintaining a healthy weight, and getting regular medical checkups.
- What are the main symptoms of type 2 diabetes? Key symptoms include constant thirst, dry mouth, frequent urination and memory lapses.
- Is there a genetic predisposition to this disease? Yes, having first-degree relatives with type 2 diabetes increases a person's risk of developing it.
- What is the role of insulin in this disease? In T2DM, insulin may either be ineffective or its secretion may be reduced, leading to increased blood glucose levels.
- How often should you check your blood sugar levels? The frequency of monitoring depends on disease control and the recommendations of the treating physician, but generally it should be done at least once a day.
