Review Article

Type 2 Diabetes: Epidemiologic Trends, Evolving Pathogenic Concepts, and Recent Changes in Therapeutic Approach

Authors: Ali A. Rizvi, MD, FACP, FACE, CDE

Abstract

The prevalence of type 2 diabetes has assumed epidemic dimensions. Children are now vulnerable to a disease that was once the exclusive domain of adulthood. Increased body weight and sedentary behavior accelerate insulin resistance and β-cell dysfunction, leading to the clinical manifestation of hyperglycemia. Other cardiovascular risk factors tend to cluster in this milieu, setting the stage for vastly increased macrovascular morbidity. Many more people have impaired glucose tolerance (‘prediabetes’). They are not only at risk for frank diabetes but also for the recently recognized entity of ‘metabolic syndrome,’ which is further characterized by hypertension, dyslipidemia, and central adiposity. A multifactorial approach addressing these aspects in addition to intensive glycemic control is the most efficacious therapy, optimally achieved through a team effort comprising the clinician, diabetes nurse, dietitian, and other professionals. Early use of oral-agent combinations is gaining favor. Insulin is best utilized in a basal-bolus fashion to manage both fasting and postprandial glycemia, delivered with multiple-dose injections or continuously via the pump. In hospitalized patients, good diabetic control reduces mortality. Finally, recent trials show that optimal weight maintenance and regular exercise can prevent or delay type 2 diabetes. Such information can serve as the foundation for large-scale preventive endeavors at the community level.


Key Points


* Type 2 diabetes is fast becoming a national and global epidemic secondary to the increasing prevalence of obesity and sedentary lifestyle.


* The entities of diabetes, prediabetes, and the metabolic syndrome are closely interlinked, and have overlapping risk factors, common pathophysiology, and related adverse outcomes.


* Intensive glycemic control and an aggressive, targeted, multifactorial therapy for type 2 diabetes and its complications is the current standard of care, achieved through the concepts of multidisciplinary team management and patient empowerment.


* The cornerstones of an approach to the control of type 2 diabetes and its sequelae remain long-term behavior changes for patients and society with the goal of preventing, delaying the emergence, or reducing the impact of the disease.

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