Diabetes mellitus type 2
The worldwide prevalence of Diabetes mellitus is increasing rapidly; type 2 DM frequency in particular is rising in parallel with the epidemic of obesity. In the past two decades, the worldwide prevalence of DM has increased more than 10-fold, from as estimated 30 million to >400 million cases. In the United States, the adult prevalence of DM ranges from 7–11% of the population, increasing with age. A significant portion of persons with DM are undiagnosed.
DM is attended by serious morbidity and significant mortality; it is consistently a leading cause of death worldwide.
Risk Factors for Type 2 Diabetes mellitus:
- Family history of diabetes (i.e., parent or sibling with type 2 diabetes)
- Overweight or obese (BMI ≥25 kg/m2, ≥23 kg/m2in Asian Americans, or other ethnically relevant definition for overweight)
- Physical inactivity
- Race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander)
- Previously identified with IFG, IGT, or a hemoglobin A1cof 5.7–6.4%
- History of GDM
- Hypertension (blood pressure ≥140/90 mmHg)
- HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)
- Polycystic ovary syndrome or acanthosis nigricans
- History of cardiovascular disease
CLINICAL FEATURES
In early type 2 Diabetes mellitus, symptoms may be more subtle and consist of fatigue, poor wound healing, and paresthesia. The lack of symptoms is the main reason for the delayed diagnosis of type 2 Diabetes mellitus. In a patient with established Diabetes mellitus, assessment of prior diabetes care, HbA1c levels, self-monitoring blood glucose results, frequency of hypoglycemia, and patient’s knowledge about Diabetes mellitus should be obtained. Special attention should be given on physical examination to retinal examination, blood pressure, foot examination (including vibratory sensation and monofilament testing), peripheral pulses, and insulin injection sites.
The chronic complications of Diabetes mellitus are listed below:
- Ophthalmologic:nonproliferative or proliferative diabetic retinopathy, macular edema, rubeosis of iris, glaucoma, cataracts
- Renal:proteinuria, end-stage renal disease (ESRD), type IV renal tubular acidosis
- Neurologic:distal symmetric polyneuropathy, polyradiculopathy, mononeuropathy, autonomic neuropathy
- Gastrointestinal:fatty liver, gastroparesis, diarrhea, constipation
- Genitourinary:cystopathy, erectile dysfunction, female sexual dysfunction, vaginal candidiasis
- Cardiovascular:coronary artery disease, congestive heart failure, peripheral vascular disease, stroke
- Lower extremity:foot deformity (hammer toe, claw toe, Charcot foot), ulceration, amputation
- Dermatologic:Infections (folliculitis, furunculosis, cellulitis), necrobiosis, poor healing, ulcers, gangrene
- Dental:Periodontal disease
- https://www.who.int/
- Endocrine Secrets 7th edition
- Harrison’s Manual of Medicine 20th edition
Dr. Nikdokht Etemadi Tajbakhsh