Formerly
known as non-insulin dependent diabetes mellitus (NIDDM) is the commonest form of
diabetes mellitus accounting for about 90% of all diabetes. It is considered as
diagnosis exclusion, that is patients are assumed to have type 2 diabetes
because thy do not demonstrate typical features of type 1 diabetes. Most
patients acquire the disease after 40 years of age (insidious onset) but occur
in young people. Here 50% of those with the condition remain
undiagnosed.
T-2 diabetes in children and adolescent is an emerging significant problem.
Fig. Diabetes symptoms |
Here there
is both insulin resistance (primary cause) and relative insulin deficiency (due
to beta cell dysfunction which is inability of pancreas to produce sufficient
insulin to compensate for insulin resistance) or both. Some patient with T2
diabetes will revert of type 1 LADA. Here ketosis develops late in the disease
but patients are likely to go to hyperosmolar coma and are at increased risk of
developing macrovascular and microvascular complications. The typical patient
with type 2 diabetes present with overweight BMI 25-29.9 kg/m2 with
central obesity (most conveniently assessed by waist circumference or waist-hip
ratio). The marked increase in the prevalence of obesity is an important
contributor to the increased prevalence of type 2 diabetes. Increase in
abdominal fat mass, weight gain since young adulthood and sedentary lifestyle
are additional obesity related risk factors. Other environmental risk factors
include being born to a mother with gestational diabetes mellitus, having
exceptionally high birth weight and low birth weight.
The burden of type 2 diabetes is increasing exponentially due to epidemic
of obesity and other conditions. The incidence of type 2 diabetes in children
is approaching type 1 diabetes and will outstrip type 1 diabetes in coming
years.
The need of insulin during puberty in type 2 may be due to double
diabetes effect where the risk of having type 1 diabetes increased by prior
existence of type 2 diabetes or insulin resistance.
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