Diabetes mellitus tipo 2
,Type 2 diabetes mellitus is a metabolic disorder characterized by hyperglycemia (high blood sugar) in the context of insulin resistance and relative lack of insulin;2 in contrast to diabetes mellitus 1, where there is a lack of absolute insulin due to the destruction of pancreatic islets.3 Classic symptoms are thirsty, excessive m's and constant hunger. Type 2 diabetes accounts for about 90% of diabetes cases, with the other 10% mainly due to type 1 diabetes mellitus and gestational diabetes. Obesity is thought to be the primary cause of type 2 diabetes among people with genetic predisposition to the disease.
Type 2 diabetes is initially controlled with increased exercise and dietary changes. If blood glucose does not drop properly with these measures, medicines such as metformin or insulin may be needed. In patients treated with insulin, there was a requirement to check blood glucose.
Rates of type 2 diabetes have increased markedly since 1960, in parallel with obesity. By 2010 there were approximately 285 million people diagnosed with the disease compared to around 30 million in 1985.4 5 Type 2 diabetes is a chronic disease with a decrease in life expectancy of ten years.4 Complications to long-term hyperglycemia may include heart disease, stroke, diabetic retinopathy (affects vision), kidney failure that may require isis, and poor circulation in which you lead an amputations. Ketoacidosis, an acute and fun complication of type 1 diabetes, is rare,6 however it can coma hyperosmolar hyperglycemic hyperglycemic.
Diabetes is one of the first diseases described.7 An Egyptian manuscript from c. 1500 BC mentions "too large emptying of urine".8 The first cases described are believed to be type 1.8 Indian doctors around the same time identified the disease and classified it as madhumeha or honey urine when they noticed that urine attracted ants.8 The term "diabetes" or "pass through" was first used in 230 BC by Greek Apollonius of Memphis.8 The disease was rare during the time of the Roman Empire, Galen commented that he had only seen two cases during his career.8
Type 1 and type 2 diabetes were first identified as separate conditions by Indian doctors Sushruta and Charaka between 400-500 A.D. with type 1 associated with youth and type 2 overweight.8 The term "mellitus" or "honey" was introduced by the British John Rolle in the late 1700s to distinguish it from insipid diabetes, which is also associated with frequent urination.8 Effective treatment did not develop until the first half of the 20th century, when Canadian nobels Frederick Banting and Charles Best discovered insulin between 1921 and 1922.8 This was followed by the development of long-acting insulin (NPH) in the 1940s.8
The incidence of type 2 diabetes is increasing worldwide and reaches epidemic proportions.9 In 2010, it was estimated to affect 285 million people,4 (approximately 6% of the world's adult population10) and accounted for about 90% of all cases of diabetes.4 These numbers are currently estimated to have increased to 347 million people.9
Diabetes is common in both the developed and developing worlds.4 However, it remains less common in underdeveloped countries.3
Women appear to be at greater risk as well as certain ethnic groups,4 11 such as those from Southeast Asia, pacific islands, Latinos and Native Americans.12 The above may be due to a better sensitivity to a Western lifestyle in certain ethnic groups.13 Traditionally considered an adult disease, type 2 diabetes is increasingly diagnosed in parallel with the rise in obesity rates.4 Type 2 diabetes is now diagnosed as frequently as type 1 diabetes in U.S. teens.3
Diabetes rates in 1985 were estimated at 30 million, which increased to 135 million in 1995 and 217 million in 2005.5 This increase is believed to be mainly due to an ageing global population, decreased exercise and rising obesity rates .5 By 2000, the five countries with the highest number of people with diabetes were India (31.7 million), China (20.8), the United States (17.7), Indonesia (8.4) and Japan (6,8).14 The World Health Organization recognized diabetes as a global epidemic.15
The causes of type 2 diabetes are the result of the interaction between lifestyle, environmental and genetic factors.9 16 17 Genetic mutations appear to be responsible for less than 10% of phenotype variability, so everything indicates that the factors are the main cause of the development of the disease.9 Although some factors are under personal control, such as diet, others are not, such as aging, female belonging and genetics.4 Lack of sleep has been associated with diabetes type 2.18 It is believed that it acts through its effect on metabolism.18 The nutritional status of a mother during fetal development may also play a role, one of whose proposed mechanisms is altered DNA methylation.19
A number of lifestyle factors are known to be important in the development of type 2 diabetes, such as obesity and overweight (defined as a body mass index [BMI] greater than 25), lack of physical activity, poor diet , stress and urbanization.4 20 Excess body fat is associated with 30% of cases in people of Chinese and Japanese descent, 60-80% in those of European and African descent, and 100% in Pima Indians and Pacific islands.3 Non-Obes they tend to have a high waist/hip index.3
Dietary factors also influence the risk of developing type 2 diabetes. Excessive consumption of sugar-sweetened beverages is associated with an increased risk.21 22 The type of fats in the diet is also important: saturated fats and trans fatty acids increase the risk and polyunsaturated and monounsaturated fats what is decrease.17 Eating a lot of white rice seems to play a role in increasing risk.23 Lack of exercise is thought to cause 7% of cases.24 Persistent organic pollutants may also play a role.25
Most cases of diabetes involve many genes and each is a small contribution to a higher likelihood of becoming diabetic type 2.4 If an identical twin has diabetes, the chance of the other developing diabetes during life is higher 90%, while the rate for non-identical siblings is 25 to 50 %.3 By 2011, more than 36 genes have been found that contribute to the risk of type 2 diabetes, however, such genes represent only 10% of the inherited component of the disease.26 TCF7L2 allele, for example, increases the risk of developing diabetes by 1.5 times and has the highest risk among common genetic variants.3 Most diabetes-linked genes are involved in pancreatic islet functions.3
There are a number of rare cases of diabetes that arise from a single-gene abnormality (known as monogenic forms of diabetes or "other specific types of diabetes"). Rabson-Mendenhall, among others.4 MODY type diabetes makes up 1-5% of all diabetes cases among young people.27
Medications and other health problems that may predispose to diabetes.28 Some of the medications are: glucocorticoids, thiazides, beta blockers, atypical antipsychotics29 and statins.30 Women who have previously had diabetes gestational problems are at increased risk of developing type 2.12 diabetes other associated health problems include: acromegaly, Cushing syndrome, hyperthyroidism, pheochromocytoma and certain cancers, such as glucagonomas.28 testosterone is also associated with type 2.31 32 diabetes
Type 2 diabetes is due to insufficient insulin production of pancreatic islets in the context of insulin resistance.3 The latter, which is the inability of cells to respond adequately to normal insulin levels, occurs mainly in muscles, liver and adipose tissue.33 In the liver, insulin normally suppresses glucose release. However, due to insulin resistance, the liver inappropriately releases glucose into the blood.4 The ratio between insulin resistance and beta cell dysfunction differs between individuals. Some have mainly insulin resistance and only a minor defect in insulin secretion; and others have a slight insulin resistance and essentially a lack of insulin secretion.3
Other potentially important mechanisms associated with type 2 diabetes and insulin resistance include: increased lipid degradation within adipocytes, resistance and lack of incretin, high levels of glucagon in the blood, increased retention of salt and water by the kidneys and inadequate regulation of metabolism by the central nervous system.4 However, not all people with insulin resistance develop diabetes, as dysfunction of the secretion of insulin from pancreatic islets.3
Type 2 diabetes is typically a chronic disease associated with a decreased life expectancy of ten years.4 This is partly due to a number of associated complications, including: the risk of increased cardiovascular disease from two to four including ischemic heart disease and stroke; a 20-fold increase in lower limb amputations and an increase in hospitalization rates.4 In the developed world, and increasingly elsewhere, type 2 diabetes is the biggest cause of non-traumatic blindness and kidney failure.16 It has also been killed. increased risk of cognitive dysfunction and dementia through disease processes such as Alzheimer's disease and vascular dementia.34 Other complications include acantosis nigricans, sexual dysfunction and frequent infections.12
the World Diabetes Health Organization (both type 1 and 2) is a single high blood glucose reading alongwith symptoms, or high values twice without them, or also:36
fasting plasma glucose s 7.0 mmol/l (126 mg/dL)
Or
by means of a glucose tolerance test, a blood glucose two hours after the oral dose of 11.1 mmol/l (200 mg/dL)
A randomized blood glucose of more than 11.1 mmol/l (200 mg/dL) in association with typical symptoms12 or a glycosylated hemoglobin (HbA1c) greater than 48 mmol/mol (x6.5 DCCT %) is another method of diagnosing diabetes.4 In 2009 an International Committee of Experts included representatives of the American Diabetes Association (ADA), the International Diabetes Federation (IDF) and the European Association for the Study of Diabetes (EASD) recommended that a threshold of 48 mmol/mol should be used (x 6.5 DCCT %) to diagnose diabetes.37 This recommendation was adopted by the American Diabetes Association in 2010.38 Positive tests should be repeated unless the person has typical symptoms and blood glucose > 11.1 mmol/l (> 200 mg/dl).37
The threshold for diagnosing diabetes is based on the relationship between the results of glucose tolerance tests, fasting blood glucose or HbA1c and complications such as retinal problems.4 Fasting or random glycaemic test results are preferred over the toy test glucose, as they are more convenient for people.4 HbA1c has the advantages that fasting is not necessary and results are more stable, but has the disadvantage that the test is more expensive than blood glucose measurement.39 It is estimated that 20% of people in the United States don't know they have diabetes.4
Type 2 diabetes mellitus is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.2 In contrast to type 1 diabetes mellitus in which there is absolute insulin deficiency due to cell destruction pancreatic islets and gestational diabetes mellitus which is a new onset of hyperglycemia associated with pregnancy.3 Type 1 and type 2 diabetes can normally be distinguished based on the present circumstances.37 Whether the diagnosis is doubtful Antibody test may be helpful in confirming type 1 diabetes and C peptide levels may be helpful in confirming type 2.40 diabetes as C peptide levels are normal or high in type 2 diabetes, but low in type 1.41 diabetes
No major organization recommends universal screening of diabetes as there is no evidence that such a program improves outcomes.42 43 The United States Preventive Services Task Force (USPSTF) recommends screening in adults without symptoms and blood pressure greater than 135/80 mmHg.44 For those whose blood pressure is lower, the evidence is insufficient to recommend for or against screening.44
The World Health Organization recommends reviewing high-risk groups42 and as of 2014 the USPSTF is considering a similar recommendation.45 High-risk groups in the United States include: those over 45, those with a family member of first grade with diabetes, some ethnic groups (such as Hispanics, African Americans, and Native Americans), a backdrop of gestational diabetes, polycystic ovary syndrome, excess weight, and conditions associated with metabolic syndrome.12 American Diabetes Association recommends screening to those with a BMI of more than 25 (or more than 23 in Asian descendants).46
The onset of type 2 diabetes can be delayed or prevented through proper nutrition and regular exercise.47 48 Intensive lifestyle measures can reduce more than half the risk.16 49 The benefit of exercise occurs regardless of the initial weight or its consequent weight loss.50 Evidence for the benefit of only changes in diet, however, is limited:51 there is some evidence for a diet rich in green leafy vegetables52 and restriction of consumption of sugary drinks.21 In those co.5 n glucose intolerance, diet and exercise, either alone or in combination with metformin or acarbosa may decrease the risk of developing diabetes.16 53 Lifestyle interventions are more effective than metformin.16 While low levels of vitamin D are associated with an increased risk of diabetes, its correction through vitamin D3 supplements does not decrease this risk.54
Type 2 diabetes control focuses on lifestyle interventions, reducing other cardiovascular risk factors, and maintaining blood glucose in the normal range.16
Self-monitoring of blood glucose in people with newly diagnosed type 2 diabetes can be used in combination with education,55 however, its benefit in those who do not use insulin in multiple doses is questionable.16 56 Controlling other risk factors such as hypertension, high cholesterol and microalbuminuria, improves life expectancy.16 Decreased systolic blood pressure to less than 140 mmHg is associated with a lower risk of death and better outcomes.57 Intensive control of blood pressure (<130/80 mmHg) as opposed to the standard (<140/85–100 mmHg) results in a slight decrease in the risk of stroke, but has no effect on the overall risk of death.58
Intensive decrease in blood glucose (HbA1c . 6%) compared to the standard (HbA1c 7-7.9%) does not appear to change mortality.59 60 The treatment target is typically HbA1c of about 7% or a fasting blood glucose of less than 7.2 mmol/L (130 mg/dL); however, these goals may be modified after professional clinical consultation, taking into account the particular risks of hypoglycaemia and life expectancy.61 62 It is recommended that all people with type 2 diabetes regularly receive a test Ophthalmological.3 Treatment of periodontitis in diabetics may result in a small improvement in blood glucose.63
Proper diet and exercise are the foundations of diabetic care12 and more exercise results.64 Aerobic exercise leads to a decrease in HbA1c and improves insulin sensitivity.64 Strength training it is also useful and the combination of both types of exercise may be more effective.64 It is also important a diet for diabetics that promotes weight loss.65 While the best type of diet to achieve this is controversial,65 a low glycemic index diet ha dem dem improve blood glucose control.66 Culturally appropriate education can help people with type 2 diabetes control their blood glucose, for at least six months.67 If lifestyle changes in mild diabetes have not resulted in better blood glucose l Six weeks, then the use of medicines should be considered.12 There is insufficient evidence to determine whether lifestyle interventions affect mortality in those who already have type 2.68 diabetes mellitus
Several kinds of antidiabetic medications are available. Metformin is generally recommended as a first-line treatment, as there is some evidence that mortality decreases;16 however, this conclusion is discussed.69 Metformin should not be used in those with severe kidney problems or livers.12
A second oral agent of another class or insulin may be added if metformin is not sufficient after three months.61 Other classes of medicines include: sulphonylureas, thiazolidinedionas, dipeptidyl peptidase-4 inhibitors, inhibitors of SGLT2 and glucagon-like peptide type 1.61 There is no significant difference between these agents.61 Rosiglitazone, a thiazolidindione, has not been shown to improve long-term results even though improving blood glucose.70 Additionally associated with blood glucose.70 Additionally associated with rates of heart disease and death.71 Angiotensin-converting enzyme (ACE) inhibitors prevent kidney disease and improve diabetic outcomes;72 73 unlike angiotensin II receptor antagonists (ARAs) II).73
Insulin injections can be added to oral medication or used alone.16 Most people do not initially need insulin.3 When used, a long-acting formulation is normally added at night, maintaining oral medication.12 16 Then doses are increased to improve blood glucose control.16 When night insulin is insufficient, two daily doses can achieve better control.12 Long-acting insulins glargine and detemir are equally safe and effective,74 and not they seem much better than neutral insulin protamine Hagedorn (NPH), but since they are much more expensive, they are not cost-effective.75 In pregnant women insulin is usually the treatment of choice.12
a weight loss surgery in obese is an effective measure to treat diabetes.76 Many are able to maintain normal blood glucose with little or no medication after surgery77 and long-term mortality decreases.78 However, the surgery has some short-term mortality risk of less than 1%.79 The appropriate body mass index thresholds for surgery are not yet clear.78 It is recommended that this option be considered in those who are unable to keep both their weight and blood glucose under control.80
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