Diabetes Mellitus, Type 2
Basics
Basics
Basics
Description
Description
Description
Type 2 diabetes mellitus (T2DM) refers to abnormalities in glucose homeostasis characterized by insulin resistance and relative defects in insulin secretion. T2DM is often associated with microvascular and macrovascular complications.
Epidemiology
Epidemiology
Epidemiology
- Increased prevalence over past 3 decades
- Estimated 5,000 new cases per year in the United States
- T2DM accounts for 15–86% of newly diagnosed cases of diabetes in youth (10 to 19 years); wide variation depending on population
- Prevalence (per 1,000 youth <20 years)
- American Indian/Alaskan Native 0.63
- Non-Hispanic black 0.56
- Hispanic 0.40
- Asian/Pacific Islander 0.19
- Non-Hispanic white 0.09
Risk Factors
Risk Factors
Risk Factors
- Female gender
- Adiposity
- Ethnic minorities
- Adolescence (10 to 19 years)
- Offspring of mothers with gestational diabetes
- Family history of type 2 diabetes
- History of the following:
- Large for gestational age at birth
- Intrauterine growth retardation
- Impaired fasting glucose
- Fasting glucose 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L)
- Impaired glucose tolerance
- Based on 2-hour glucose from oral glucose tolerance test (OGTT; see the following) of 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11 mmol/L)
Pathophysiology
Pathophysiology
Pathophysiology
- Insulin resistance
- Major abnormality in youth with T2DM
- Tissues (muscle, hepatic, adipose) have a decreased response to insulin, mediated by abnormal phosphorylation of insulin receptor.
- Ideally, a compensatory hyperinsulinemia develops to maintain euglycemia.
- In the presence of β-cell dysfunction, inadequate amounts of insulin are secreted to meet demands from insulin resistance.
- This relative deficiency of insulin secretion leads to hyperglycemia and diabetes.
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