Type 2 diabetes
Also called: T2DM, Adult-onset diabetes, Diabetes mellitus
A long-term condition in which the body does not respond properly to insulin and the pancreas cannot keep up, so blood sugar stays high. Over years this damages blood vessels, nerves, eyes and kidneys.
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About 500 million people worldwide.
What happens in the body
Insulin resistance in muscle, liver and fat — linked to excess visceral and liver fat — combined with progressive failure of insulin-producing beta cells.
Causes
- Insulin resistance plus beta-cell dysfunction
Risk factors
- Overweight, especially abdominal fat
- Physical inactivity
- Family history
- South Asian, African, Caribbean or Hispanic ancestry
- Age over 40
- Previous gestational diabetes
- Polycystic ovary syndrome
- Prediabetes
Symptoms
- Often none for years
- Thirst and frequent urination
- Tiredness
- Blurred vision
- Recurrent infections (thrush, skin)
- Slow-healing wounds
Diagnosis — tests and examinations
- HbA1c ≥ 48 mmol/mol (6.5%)
- Fasting glucose ≥ 7.0 mmol/L
- Oral glucose tolerance test
Treatment
Medicines and medical treatment
- Metformin (first-line in most people)
- SGLT2 inhibitors (empagliflozin, dapagliflozin) — protect heart and kidneys
- GLP-1 receptor agonists (semaglutide) and dual GIP/GLP-1 agonist tirzepatide — lower glucose, weight and cardiovascular risk
- DPP-4 inhibitors, pioglitazone, sulfonylureas
- Insulin when needed
- Statins, blood-pressure control and aspirin where indicated
Operations and procedures
- Bariatric (metabolic) surgery can induce remission in obesity
Self-care, home remedies and lifestyle
- Weight loss of 10–15 kg can put diabetes into remission
- Healthy diet lower in refined carbohydrates and sugary drinks
- 150 minutes of activity a week
- Stop smoking
- Annual eye, foot and kidney checks
Possible complications
- Heart attack and stroke
- Kidney disease
- Retinopathy and blindness
- Neuropathy, foot ulcers and amputation
- Erectile dysfunction
Prevention
- Healthy weight, diet and activity — lifestyle programmes cut risk by about 60% in prediabetes
Outlook
Good control greatly reduces complications; remission is possible with significant weight loss.
When to see a doctor
See a doctor for thirst, frequent urination or unexplained weight loss; seek urgent care for vomiting, confusion or very high glucose readings.
Sources and further reading
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