Diabetes Mellitus, Type 2
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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.
- 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
- Female gender
- 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)
- 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.