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Diff: Type 2 Diabetes

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	'''Type 2 diabetes''' is a long-term condition in which blood glucose levels become too high because the body does not use insulin effectively, does not make enough insulin, or both. It is the most common form of diabetes and is usually managed through a mixture of lifestyle changes, monitoring, medicines and regular review.

Type 2 diabetes, also known as non-insulin-dependent diabetes, is a chronic metabolic disorder characterized by high blood sugar levels due to insulin resistance or insufficient insulin production. It is the most common form of diabetes, accounting for the majority of diabetes cases worldwide. Type 2 diabetes typically develops in adulthood but can also occur in children and adolescents.
	Type 2 diabetes can develop slowly. Some people have clear symptoms, while others are diagnosed through routine blood tests or screening because they have risk factors. Early diagnosis matters because treatment can reduce the risk of complications affecting the heart, blood vessels, kidneys, eyes, nerves and feet.

== Symptoms ==	== Symptoms ==
The symptoms of type 2 diabetes may develop gradually and include:
	Common symptoms include feeling very tired, passing urine more often than usual, feeling thirsty, and losing weight without trying. Other symptoms can include blurred vision, cuts or wounds taking longer to heal, itching around the genitals, and repeated thrush.

* Frequent Urination (Polyuria): Increased frequency of urination, particularly at night.
* Excessive Thirst (Polydipsia): Persistent thirst and the need to drink large amounts of fluids.
* Increased Hunger (Polyphagia): Persistent hunger and cravings, even after eating.
* Unintended Weight Loss: Unexplained weight loss despite increased appetite.
* Fatigue and Weakness: Persistent tiredness, lack of energy, and generalized weakness.
* Blurred Vision: Blurred vision or changes in eyesight.
* Slow Healing: Slow healing of cuts, bruises, or wounds.
* Frequent Infections: Increased susceptibility to infections, particularly skin, urinary tract, and yeast infections.
* Tingling or Numbness: Tingling or numbness in the hands or feet (diabetic neuropathy).
* Darkened Skin Patches: Acanthosis nigricans, characterized by darkened skin patches, especially in the neck, armpits, and groin.
	Symptoms may develop gradually and are sometimes missed. Not everyone with type 2 diabetes has symptoms, so people at higher risk may be advised to have blood tests even if they feel well.

== Causes and Risk Factors ==	== Causes and Risk Factors ==
Type 2 diabetes develops when the body becomes resistant to insulin or fails to produce enough insulin to maintain normal blood sugar levels. The exact cause is multifactorial, involving genetic and environmental factors. Some common causes and risk factors include:
	Type 2 diabetes is linked to insulin resistance and reduced insulin production. Risk is influenced by a mixture of age, family history, body weight, activity level, ethnicity and other health conditions.

* Obesity and Sedentary Lifestyle: Excess body weight, particularly abdominal obesity, and physical inactivity contribute to insulin resistance and the development of type 2 diabetes.
* Genetic Predisposition: A family history of type 2 diabetes increases the risk of developing the condition, suggesting a genetic component.
* Age: The risk of type 2 diabetes increases with age, especially after the age of 45.
* Ethnicity: Certain ethnic groups, such as African Americans, Hispanics, Native Americans, and Asian Americans, have a higher risk of developing type 2 diabetes.
* Prediabetes: Prediabetes, a condition characterized by higher than normal blood sugar levels but not yet meeting the criteria for diabetes, increases the risk of developing type 2 diabetes.
* Gestational Diabetes: Women who have experienced gestational diabetes during pregnancy are at a higher risk of developing type 2 diabetes later in life.
	In UK guidance, higher-risk groups include people who are overweight and not very physically active, people with a close relative with diabetes, people with high blood pressure, and people from South Asian, Chinese, Black African or Black Caribbean backgrounds at younger ages than the white population.

	Gestational diabetes also raises later risk. Someone who has had diabetes during pregnancy should normally be followed up after birth and then checked regularly for type 2 diabetes.

== Diagnosis ==	== Diagnosis ==
Diagnosing type 2 diabetes involves several tests and criteria, including:
	Diagnosis is made with blood tests that measure blood glucose control. Tests may include HbA1c, fasting plasma glucose or an oral glucose tolerance test depending on the situation.

* Fasting Plasma Glucose (FPG) Test: Measuring blood glucose levels after fasting for at least eight hours. A reading of 126 mg/dL (7.0 mmol/L) or higher on two separate occasions indicates diabetes.
* Oral Glucose Tolerance Test (OGTT): Assessing blood glucose levels before and two hours after consuming a glucose-rich drink. A two-hour blood glucose level of 200 mg/dL (11.1 mmol/L) or higher confirms diabetes.
* Glycated Hemoglobin (HbA1c) Test: Measuring average blood glucose levels over the past two to three months. An HbA1c level of 6.5% or higher indicates diabetes.
* Random Plasma Glucose Test: Assessing blood glucose levels at any time of the day, without regard to fasting. A reading of 200 mg/dL (11.1 mmol/L) or higher, along with classic symptoms, indicates diabetes.
	In the NHS, a blood test is used to check how high the blood glucose level is. The result may also help distinguish type 2 diabetes from type 1 diabetes where the presentation is unclear.

== Treatment ==
The management of type 2 diabetes aims to control blood sugar levels and minimize the risk of complications. Treatment strategies may include:
	Prediabetes means blood glucose is above the normal range but not high enough for a diabetes diagnosis. It is a warning sign that future diabetes risk is higher, and lifestyle support may be offered.

* Lifestyle Modifications: Adopting a healthy diet, engaging in regular physical activity, and achieving and maintaining a healthy weight are essential components of managing type 2 diabetes.
* Oral Medications: Several classes of oral antidiabetic medications, such as metformin, sulfonylureas, thiazolidinediones, and DPP-4 inhibitors, may be prescribed to lower blood sugar levels and improve insulin sensitivity.
* Injectable Medications: In some cases, injectable medications like GLP-1 receptor agonists or insulin may be necessary to achieve adequate blood sugar control.
* Blood Sugar Monitoring: Regular monitoring of blood sugar levels helps individuals with diabetes track their response to treatment and make necessary adjustments.
* Education and Support: Diabetes education and support programs assist individuals in understanding the condition, managing medications, adopting healthy lifestyle habits, and preventing complications.
	== Treatment and Management ==
	Management is usually individualised. Many people start with lifestyle changes, such as improving diet, increasing physical activity, losing weight where appropriate, stopping smoking, moderating alcohol intake, and attending diabetes education.

	NHS advice says lifestyle changes can lower blood glucose and, for some people, may lead to remission. Diabetes courses are recommended so people understand monitoring, food choices, medicines, foot care, sick-day rules and when to ask for help.

	Medicines may be needed if lifestyle change is not enough or if blood glucose is high at diagnosis. Common medicines include metformin, SGLT2 inhibitors, GLP-1 receptor agonists and insulin. Choice depends on blood glucose levels, weight, kidney function, cardiovascular risk, side effects, pregnancy plans, other conditions and patient preference.

	== Monitoring ==
	Long-term follow-up normally includes HbA1c checks, blood pressure review, cholesterol and kidney checks, weight review, foot checks and diabetic eye screening. The timing depends on the person's health, treatment and previous results.

	Monitoring is not only about blood sugar. Cardiovascular risk is a major part of type 2 diabetes care, so blood pressure, smoking, cholesterol and kidney health are also important.

== Complications ==	== Complications ==
If left uncontrolled, type 2 diabetes can lead to various acute and chronic complications, including:
	Poorly controlled diabetes can damage blood vessels and nerves over time. Possible complications include heart disease, stroke, kidney disease, diabetic retinopathy, neuropathy, foot ulcers, infections and, in severe cases, amputation.

* Cardiovascular Diseases: The risk of heart disease, stroke, and peripheral artery disease is significantly increased in individuals with type 2 diabetes.
* Kidney Disease (Nephropathy): Persistent high blood sugar levels can damage the kidneys over time, leading to impaired kidney function or kidney failure.
* Eye Complications (Retinopathy): Damage to the blood vessels in the retina can cause diabetic retinopathy, potentially leading to vision loss or blindness.
* Nerve Damage (Neuropathy): Chronic high blood sugar levels can damage the nerves, causing pain, tingling, or loss of sensation, often in the feet and hands.
* Foot Complications: Nerve damage and poor blood circulation can increase the risk of foot ulcers, infections, and, in severe cases, amputation.
* Skin Conditions: Individuals with type 2 diabetes are more prone to developing skin infections, fungal infections, and certain skin conditions like diabetic dermopathy and necrobiosis lipoidica.
	Good diabetes care aims to reduce these risks through blood glucose control, blood pressure control, cholesterol management, smoking cessation, foot care, eye screening and early treatment of problems.

== Prevention ==
Preventing or delaying the onset of type 2 diabetes is possible through lifestyle modifications and risk factor management. Prevention strategies include:
	== Prevention and Remission ==
	Type 2 diabetes can sometimes be delayed or prevented in people at high risk. Useful measures include weight loss where needed, regular physical activity, a balanced diet, reduced intake of highly processed sugary foods, and treatment of blood pressure and cholesterol.

* Healthy Eating: Following a balanced diet rich in whole grains, lean proteins, fruits, vegetables, and healthy fats while limiting processed foods, sugary beverages, and saturated fats.
* Regular Physical Activity: Engaging in regular exercise, such as brisk walking, cycling, or swimming, for at least 150 minutes per week.
* Weight Management: Maintaining a healthy weight or losing weight if overweight or obese through a combination of diet and exercise.
* Blood Pressure Control: Monitoring and managing blood pressure levels to reduce the risk of cardiovascular complications.
* Smoking Cessation: Quitting smoking, as smoking increases the risk of various diabetes-related complications.
* Regular Check-ups: Undergoing regular medical check-ups to monitor blood sugar levels, blood pressure, and cholesterol levels.
	Some people with type 2 diabetes can reach remission, meaning blood glucose returns below the diabetes range without glucose-lowering medicine. Remission is not the same as a permanent cure, so ongoing checks are still needed.

== See Also ==	== See Also ==
	* [[Type_1_Diabetes]]
	* [[Gestational_Diabetes]]
	* [[Diabetes_Mellitus]]
	* [[Hypoglycaemia]]
	* [[Hyperglycaemia]]

* [[Type 1 Diabetes]] - Explore a chronic autoimmune condition characterized by a lack of insulin production.
* [[Gestational Diabetes]] - Learn about diabetes that develops during pregnancy.
	== References ==
	* [https://www.nhs.uk/conditions/type-2-diabetes/symptoms/ NHS: Symptoms of type 2 diabetes and how it is diagnosed]
	* [https://www.nhs.uk/conditions/type-2-diabetes/treatment/ NHS: Treatment for type 2 diabetes]
	* [https://www.nice.org.uk/guidance/ng28 NICE guideline NG28: Type 2 diabetes in adults, management]
	* [https://www.england.nhs.uk/diabetes/diabetes-prevention/ NHS England: Healthier You NHS Diabetes Prevention Programme]

	[[Category:Medicine]]
	[[Category:Endocrinology]]