See diabetes mellitus for further general information on diabetes.

Diabetes mellitus type 2 (formerly called diabetes mellitus type II, non-insulin-dependent diabetes (NIDDM), obesity related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. It is presently incurable. It is rapidly increasing in the developed world, and there is some evidence that this pattern will be followed in much of the rest of the world in coming years. The CDC has characterized the increase as an epidemic. The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Diseases Database is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... For the disease characterized by excretion of large amounts of severely diluted urine, see diabetes insipidus. ... It has been suggested that Oral insulin be merged into this article or section. ... Metabolism (from Greek μεταβολισμός metabolismos) is the biochemical modification of chemical compounds in living organisms and cells. ... In medicine, insulin resistance is a decompensation of glucose homeostasis where tissues appear to be less responsive to insulin. ... Hyperglycemia or High Blood Sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ...

Unlike Type 1 diabetes, there is little tendency toward ketoacidosis in Type 2 diabetics, though it is not unknown. Complex and multifactorial metabolic changes lead to damage and function impairment of many organs, most importantly the cardiovascular system in both Types. This leads to substantially increased morbidity and mortality in both Type 1 and Type 2 patients, but the two have quite different origins and treatments despite the similarity in complications which often confuse even diabetics. Ketoacidosis is a type of metabolic acidosis which is caused by high concentrations of keto acids, formed by the deamination of amino acids. ... In biology, an organ (Latin: organum, instrument, tool) is a group of tissues that perform a specific function or group of functions. ... The circulatory system or cardiovascular system is the organ system which circulates blood around the body of most animals. ... In medicine, epidemiology and actuarial science, the term morbidity can refer to the state of being diseased (from Latin morbidus: sick, unhealthy), the degree or severity of a disease, the prevalence of a disease: the total number of cases in a particular population at a particular point in time, the...

Fructosamine, also known as Glycated Serum Protein (GSP) or Glycated Albumin, is used primarily to identify the plasma glucose concentration over time and so assess diabetic control . ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ...

Pathophysiology

Genetic factors, usually polygenic, are present in most patients. However, environmental factors such as obesity, lack of exercise and a sedentary lifestyle are thought by most observers to lead to insulin resistance. Certainly not all type 2 diabetics have a family history of the condition. Genetics (from the Greek genno γεννώ= give birth) is the science of genes, heredity, and the variation of organisms. ... A genetic disorder, or genetic disease is a disease caused, at least in part, by the genes of the person with the disease. ...

Insulin resistance means that body cells do not respond appropriately when insulin is present. Cells in culture, stained for keratin (red) and DNA (green). ...

Other important contributing factors:

• increased hepatic glucose production (eg, from glycogen degradation), especially at inappropriate times
• decreased insulin-mediated glucose transport in (primarily) muscle and adipose tissues (receptor and post-receptor defects)
• impaired beta-cell function - loss of early phase of insulin release in response to hyperglycemic stimuli
• Cancer survivors who received allogenic Hematopoeitic Cell Transplantation (HCT) are 3.65 times more likely to report type 2 diabetes than their siblings. Total body irradiation (TBI) is also associated with a higher risk of developing diabetes.

This is a more complex problem than type 1, but is sometimes easier to treat, especially in the initial years when insulin is often still being produced internally. Type 2 may go unnoticed for years in a patient before diagnosis, since the symptoms are typically milder (no ketoacidosis) and can be sporadic. However, severe complications can result from unnoticed type 2 diabetes, including renal failure, blindness, wounds that fail to heal, and coronary artery disease. The onset of the disease is most common in middle age and later life. Glucose (Glc), a monosaccharide (or simple sugar), is one of the most important carbohydrates in biology. ... A top-down view of skeletal muscle Muscle (from Latin musculus little mouse, referring to muscles like the biceps which pop up as though a mouse were scurrying about under the skin [1]) is contractile tissue of the body and is derived from the mesodermal layer of embryonic germ cells. ... Renal failure is the condition where the kidneys fail to function properly. ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ... Middle age is a non-specific stage in life when one is neither young nor old, but somewhere in between. ... Old age consists of ages nearing the average life span of human beings, and thus the end of the human life cycle. ...

Diabetes mellitus type 2 is presently of unknown etiology (ie, origin). Diabetes mellitus with a known etiology, such as secondary to other diseases, known gene defects, trauma or surgery, or the effects of drugs, is more appropriately called secondary diabetes mellitus. Examples include diabetes mellitus caused by hemochromatosis, pancreatic insufficiency, or certain types of medications (e.g. long-term steroid use). 2006 is a common year starting on Sunday of the Gregorian calendar. ... Etiology (alternately aetiology, aitiology) is the study of causation. ... Haemochromatosis, also spelled hemochromatosis, is a hereditary disease characterized by improper processing by the body of dietary iron which causes iron to accumulate in a number of body tissues, eventually causing organ dysfunction. ... Steroid skeleton. ...

About 90-95% of all North American cases of diabetes are type 2, and about 20% of the population over the age of 65 has diabetes mellitus type 2. The fraction of type 2 diabetics in other parts of the world varies substantially, almost certainly for environmental and lifestyle reasons, though these are not known in detail. There is also a strong inheritable genetic connection in type 2 diabetes: having relatives (especially first degree) with type 2 is a considerable risk factor for developing type 2 diabetes. The majority of patients with type 2 diabetes mellitus have been obese - chronic obesity leads to increased insulin resistance that can develop into diabetes, most likely because adipose tissue is a (recently identified) source of chemical signals (hormones and cytokines). Other research shows that type 2 diabetes causes obesity.^[1] Genetics (from the Greek genno γεννώ= give birth) is the science of genes, heredity, and the variation of organisms. ... Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and mammals, is increased to a point where it is a risk factor for certain health conditions or increased mortality. ... Adipose tissue is an anatomical term for loose connective tissue composed of adipocytes. ... Cytokines are small protein molecules that are the core of communication between immune system cells, and even between immune system cells and cells belonging to other tissue types. ...

Diabetes mellitus type 2 is often associated with obesity and hypertension and elevated cholesterol (combined hyperlipidemia), and with the condition Metabolic syndrome (also known as Syndrome X, Reavan's syndrome, or CHAOS). It is also associated with acromegaly, Cushing's syndrome and a number of other endocrinological disorders. For other forms of hypertension see hypertension (disambiguation). ... Cholesterol is a sterol (a combination steroid and alcohol) and a lipid found in the cell membranes of all body tissues, and transported in the blood plasma of all animals. ... In medicine, combined hyperlipidemia (or -aemia) is a commonly occurring form of hypercholesterolemia (elevated cholesterol levels) characterised by increased LDL and triglyceride concentrations, often accompanied by decreased HDL. On lipoprotein electrophoresis (a test now rarely performed) is shows as a hyperlipoproteinemia type IIB. The elevated triglyceride levels (>5 mmol/l... Metabolic syndrome is a combination of medical disorders that affect a large number of people in a clustered fashion. ... Acromegaly (from Greek akros high and megas large - extremities enlargement) is a hormonal disorder that results when the pituitary gland produces excess growth hormone (hGH). ... Endocrinology is a branch of medicine dealing with disorders of the endocrine system and its specific secretions called hormones. ...

Treatment

Diabetes mellitus type 2 is a chronic, progressive disease that cannot now be cured. There are two main goals of treatment of the disease:

1. reduction of mortality and concomitant morbidity (from assorted diabetic complications)
2. preservation of quality of life

The first goal can be achieved through close glycemic control (ie, blood glucose levels); the reduction effect in diabetic complications has been well demonstrated in several extensive clinical trials and is thus well established. The second goal is often addressed (in developed countries) by support and care from teams of diabetic health workers (physician or PA, nurse, dietitian, certified diabetic educator, ...). Knowledgeable patient participation is vital and so patient education is a crucial aspect of this effort. In medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a research study. ...

Type 2 is initially treated by adjustment in diet and exercise, and by weight loss, especially in obese patients. The amount of weight loss which improves the clinical picture is sometimes modest (5 - 10 lb); this is almost certainly due to currently poorly understood aspects of fat tissue chemical signalling (especially in visceral fat tissue in and around abdominal organs). In many cases, such initial efforts can substantially restore insulin sensitivity. To meet Wikipedias quality standards, this article or section may require cleanup. ...

The next step, if necessary, is treatment with oral antidiabetic drugs (oral agents "OA"s): An anti-diabetic drug is used to treat diabetes mellitus. ...

• the sulfonylureas
• biguanides (metformin)
• thiazolidinediones
• α-glucosidase inhibitors (acarbose, miglitol)
• meglitinides (nateglinide, repaglinide and their analogues)
• exenatide

If these fail to help (or stop helping), insulin therapy may be necessary, usually as an adjunct to oral medication therapy, to maintain normal glucose levels. The term non-insulin-dependent diabetes is thus inaccurate and misleading. The classification, or type, of diabetes is determined by the underlying cause of the diabetes, not the type of therapy that is used to treat the diabetes. Many patients with type 2 diabetes will progress insulin to control of blood glucose levels, but these patients are still type 2 diabetics. Sulfonylurea derivatives are a class of antidiabetic drugs that are used in the management of diabetes mellitus type 2 (adult-onset). They act by increasing insulin release from the beta cells in the pancreas. ... Biguanides (ATC A10 BA) form a class of oral hypoglycemic drugs used for diabetes mellitus treatment. ... Metformin (INN, trade names Glucophage®, Fortamet®, Riomet®, Glumetza® and others) is an anti-diabetic drug from the biguanide class (its other members are the withdrawn agents phenformin and buformin). ... The medication class of thiazolidinedione was introduced in the late 1990s as an adjunctive therapy for diabetes mellitus (type II) and related diseases. ... Acarbose is a drug used to treat type 2 diabetes mellitus. ... This article belongs in one or more categories. ... Nateglinide (Starlix®) is a drug for the treatment of type II diabetes. ... Repaglinide (Prandin® in the US, GlucoNorm® in Canada, NovoNorm® elsewhere) is a for the treatment of type II diabetes. ... Exenatide (marketed as Byetta) is the first of a new class of medications approved for the treatment of type 2 diabetes. ...

See also

• Diabetes Management
• impaired glucose tolerance
• impaired fasting glucose

To meet Wikipedias quality standards, this article or section may require cleanup. ... Impaired glucose tolerance (IGT) is a pre-diabetic state, associated with insulin resistance and increased risk cardiovascular pathology. ... Impaired fasting glycaemia (IFG) is a pre-diabetic state, associated with insulin resistance and increased risk cardiovascular pathology, although of lesser risk that Impaired glucose tolerance (IGT). ...

Footnotes

1. ^ Camastra S, Bonora E, Del Prato S, Rett K, Weck M, Ferrannini E (1999). "Effect of obesity and insulin resistance on resting and glucose-induced thermogenesis in man. EGIR (European Group for the Study of Insulin Resistance)". Int J Obes Relat Metab Disord 23 (12): 1307-13. PMID 10643689.