Type 2 diabetes mellitus

Type 2 diabetes is a chronic metabolic condition characterised by insulin resistance (that is, the body's inability to effectively use insulin) and insufficient pancreatic insulin production, resulting in high blood glucose levels (hyperglycaemia)

• Type 2 diabetes is commonly associated with obesity, physical inactivity, raised blood pressure, disturbed blood lipid levels and a tendency to develop thrombosis, and therefore is recognised to have an increased cardiovascular risk
• is associated with long-term microvascular and macrovascular complications, together with reduced quality of life and life expectancy

In 2013, over 3.2 million adults were diagnosed with diabetes, with prevalence rates of 6% and 6.7% in England and Wales respectively

• estimated that about 90% of adults currently diagnosed with diabetes have type 2 diabetes
• Type 2 diabetes is more common in people of African, African-Caribbean and South Asian family origin
• can occur in all age groups and is increasingly being diagnosed in children

Characteristics (in general):

• onset often after 40 years of age
• no HLA associations
• 58% concordance in identical twins (2)
• no islet cell antibodies
• there is insulin resistance
• glucagon secretion is increased
• often the patient is obese
• the patient is not prone to ketoacidosis
• there is no association with autoimmune disease
• more common in people of African, African-Caribbean and South Asian family origin

Treatment:

• nutritional therapy
• oral hypoglycaemic agents
• occasionally insulin therapy

lifetime risk of type 2 diabetes

• study evidence found type 2 diabetes lifetime risk ranged from 16.3% (95% CI 15.6-17.0) for Scottish women to 59.6% (58.5-60.8) for Singaporean men (3)

Reference:

1. NICE (December 2015). Type 2 diabetes in adults: management
2. Newman B et al.Concordance for type 2 (non-insulin-dependent) diabetes mellitus in male twins. Diabetologia 1987;30:763-8
3. Tomic D et al. Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study. Lancet - Diabetes and Endocrinology September 29th 2022.