Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. This condition poses significant health challenges globally, impacting millions of individuals and necessitating comprehensive management strategies to mitigate associated complications.
Pathophysiology of Type 2 Diabetes
The pathogenesis of T2DM is multifactorial, involving complex interactions between genetic predisposition and environmental factors. Key pathophysiological mechanisms include:
📉 Insulin Resistance: A hallmark of T2DM, insulin resistance primarily affects muscle, liver, and adipose tissues. In skeletal muscle, reduced glucose uptake and utilization lead to hyperglycemia. In the liver, insulin resistance results in inappropriate hepatic glucose production. Adipose tissue dysfunction contributes to altered lipid metabolism and increased free fatty acids, exacerbating insulin resistance.
🔬 Beta-cell Dysfunction: Progressive pancreatic beta-cell dysfunction impairs insulin secretion. Genetic factors, glucotoxicity, lipotoxicity, and inflammatory mediators contribute to beta-cell apoptosis and reduced insulin biosynthesis.
📈 Incretin Effect: The incretin effect, mediated by hormones such as GLP-1 and GIP, is diminished in T2DM. This leads to impaired insulin secretion and inadequate suppression of glucagon, further contributing to hyperglycemia.
Video from Diabetes UK
Clinical Presentation and Diagnosis
T2DM often has an insidious onset, with hyperglycemia developing gradually. Common clinical manifestations include:
🚽 Polyuria and Polydipsia: Resulting from osmotic diuresis due to hyperglycemia.
🍽️ Polyphagia: Increased hunger due to cellular glucose deficiency.
😴 Fatigue: Resulting from metabolic inefficiency and hyperglycemia.
👁️ Blurred Vision: Caused by changes in lens hydration due to fluctuating glucose levels.
🦠 Recurrent Infections: Particularly fungal and bacterial infections due to impaired immune function.
Diagnosis is confirmed through blood glucose testing, including fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), and glycated hemoglobin (HbA1c) measurements. Diagnostic criteria are as follows:
- FPG ≥ 7.0 mmol/L
- 2-hour plasma glucose ≥ 11.1 mmol/L during an OGTT (75 g oral glucose)
- HbA1c ≥ 6.5%
Epidemiology
🌎 In British Columbia, approximately 6.9% of the population is diagnosed with diabetes, with the majority being T2DM cases. This translates to approximately 365,700 individuals living with diabetes. Contributing factors include aging populations, increasing obesity rates, and sedentary lifestyles.
Footnote: Diabetes Mellitus (Type 1, 2, and gestational); Statistics from 2022 from statista.com
🌐 Globally, the prevalence of diabetes is staggering. According to the International Diabetes Federation, about 537 million adults were living with diabetes in 2021, projected to rise to 643 million by 2030 and 783 million by 2045. T2DM accounts for approximately 90% of these cases, with significant impacts in low- and middle-income countries.
Self-Management Strategies for Patients
Effective self-management is crucial for patients with T2DM to achieve glycemic control and prevent complications. Healthcare providers play a vital role in patient education and support. Key strategies recommended by Diabetes Canada include:
Video from Diabetes UK
🥗 Dietary Management: Emphasize a balanced diet rich in vegetables, whole grains, lean proteins, and healthy fats. Encourage portion control and regular meal timing to maintain stable blood glucose levels. Limit intake of refined carbohydrates, sugary beverages, and processed foods.
🏃 Physical Activity: Recommend at least 150 minutes of moderate-intensity aerobic activity per week, combined with resistance training exercises. Educate patients on the benefits of regular physical activity in improving insulin sensitivity and cardiovascular health.
⚖️ Weight Management: Advocate for weight loss in overweight or obese patients, highlighting its role in enhancing insulin sensitivity and glycemic control. Provide resources for behavioral weight management programs and support groups.
💊 Medication Adherence: Educate patients on the importance of adhering to prescribed medications, including oral hypoglycemic agents, insulin, and other injectable therapies. Discuss potential side effects and management strategies to improve adherence.
📉 Blood Glucose Monitoring: Instruct patients on proper blood glucose monitoring techniques and the importance of regular monitoring to adjust treatment plans. Utilize continuous glucose monitoring (CGM) systems for patients requiring detailed glucose profiles.
❤️ Management of Comorbidities: Address associated conditions such as hypertension, dyslipidemia, and cardiovascular disease. Implement comprehensive cardiovascular risk reduction strategies, including lifestyle modification and pharmacotherapy.
Understanding the pathophysiology, clinical presentation, and self-management strategies for T2DM is essential for healthcare providers to deliver effective patient care. Through patient education and support, providers can empower individuals with T2DM to achieve optimal glycemic control and improve their quality of life. Continuous advancements in diabetes research and treatment options hold promise for better management and outcomes for those living with T2DM.
🔗For more information on what we do to support T2DM prevention - visit T2DNetwork.ca
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