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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.

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Treasure Island (FL): StatPearls Publishing; 2020 Jan-.

Rajeev Goyal; Ishwarlal Jialal.

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Rajeev Goyal1; reverses diabetes type 2 pancreas (β˜‘ lecture) | reverses diabetes type 2 educationhow to reverses diabetes type 2 for Ishwarlal Jialal2.

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1 Lady Hardinge Medical College, New Delhi, India
2 VA MEDICAL CENTER, MATHER, CA

Last Update: February 28, 2020.Last Update: February 28, 2020.

Introduction

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin, or both. According to the International Diabetes Federation (IDF), approximately 415 million adults between the ages of 20 to 79 years had diabetes mellitus in 2015.[1] DM is proving to be a global public health burden as this number is expected to rise to another 200 million by 2040.[1] Chronic hyperglycemia in synergy with the other metabolic aberrations in patients with diabetes mellitus can cause damage to various organ systems, leading to the development of disabling and life-threatening health complications, most prominent of which are microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications leading to a 2-fold to a 4-fold increased risk of cardiovascular diseases. In this review, we provide an overview of the pathogenesis, diagnosis, clinical presentation, and principles of management of the 1 last update 08 Aug 2020 diabetes.Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin, or both. According to the International Diabetes Federation (IDF), approximately 415 million adults between the ages of 20 to 79 years had diabetes mellitus in 2015.[1] DM is proving to be a global public health burden as this number is expected to rise to another 200 million by 2040.[1] Chronic hyperglycemia in synergy with the other metabolic aberrations in patients with diabetes mellitus can cause damage to various organ systems, leading to the development of disabling and life-threatening health complications, most prominent of which are microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications leading to a 2-fold to a 4-fold increased risk of cardiovascular diseases. In this review, we provide an overview of the pathogenesis, diagnosis, clinical presentation, and principles of management of diabetes.

Etiology

DM is broadly classified into three types by etiology and clinical presentation, type 1 diabetes, type 2 diabetes, and gestational diabetes (GDM). Some other less common types of diabetes include monogenic diabetes and secondary diabetes.[2][3][4][5]

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Type 1 diabetes mellitus (T1DM) accounts for 5% to 10% of DM and is characterized by autoimmune destruction of insulin-producing beta cells in the islets of the pancreas. As a result, there is an absolute deficiency of insulin. A combination of genetic susceptivity and environmental factors such as viral infection, toxins, or some dietary factors have been implicated as triggers for autoimmunity. T1DM is most commonly seen in children and adolescents though it can develop at any age.

Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) accounts for around 90% of all cases of diabetes. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over time, insulin production decreases, resulting in T2DM. T2DM is most commonly seen in persons older than 45 years. Still, it is increasingly seen in children, adolescents, and younger adults due to rising levels of obesity, physical inactivity, and energy-dense diets.

Gestational Diabetes Mellitus

reverses diabetes type 2 fruit (πŸ‘ abbreviation) | reverses diabetes type 2 naturally with diethow to reverses diabetes type 2 for Hyperglycaemia, which is first detected during pregnancy, is classified as gestational diabetes mellitus (GDM), also known as hyperglycemia in pregnancy. Although it can occur anytime during pregnancy, GDM generally affects pregnant women during the second and third trimesters. According to the American Diabetes Association (ADA), GDM complicates 7% of all pregnancies. Women with GDM and their offspring have an increased risk of developing type 2 diabetes mellitus in the future.

GDM can be complicated by hypertension, preeclampsia, and hydramnios and may also lead to increased operative interventions. The fetus can have increased weight and size (macrosomia) or congenital anomalies. Even after birth, such infants may have respiratory distress syndrome, and subsequent childhood and adolescent obesity. Older age, obesity, excessive gestational weight gain, history of congenital anomalies in previous children, or stillbirth, or a family history of diabetes are risk factors for GDM.

Monogenic Diabetes

reverses diabetes type 2 questions and answers (πŸ”΄ breakfast recipes) | reverses diabetes type 2 lifestylehow to reverses diabetes type 2 for A single genetic mutation in an autosomal dominant gene causes this type of diabetes. Examples of monogenic diabetes include conditions like neonatal diabetes mellitus and maturity-onset diabetes of the young (MODY). Around 1% to 5% of all diabetes cases are due to monogenic diabetes. MODY is a familial disorder and usually presents under the age of 25 years.

Secondary Diabetes

Secondary diabetes is caused due to the complication of other diseases affecting pancreas (for example, pancreatitis), hormone disturbances (for example, Cushing’s disease), or due to drugs (for example, corticosteroids).

Epidemiology

Diabetes is a worldwide epidemic. With changing lifestyles and increasing obesity, the prevalence of DM has increased worldwide. The global prevalence of DM was 425 million in 2017. According to the International Diabetes Federation (IDF), in 2015, about 10% of the American population had diabetes. Of these, 7 million were undiagnosed. With an increase in age, the prevalence of DM also increases. About 25% of the population above 65 years of age has diabetes.[5]

Pathophysiology

In T1DM, there is cellular-mediated, autoimmune destruction of pancreatic beta cells. T1DM has a strong genetic predisposition. The major histocompatibility complex (MHC), also known as human leukocyte antigens (HLA), is reported to account for approximately 40% to 50% of the familial aggregation of T1DM. The significant determinants are polymorphisms of class II HLA genes encoding DQ and DR4-DQ8, with DR3-DQ2, found in 90% of T1DM patients.

Another form of T1DM is latent autoimmune diabetes of adults (LADA). It occurs in adulthood, often with a slower course of onset.

The rate of destruction is generally rapid in children and faster in adults. Autoantibodies against islet cells, insulin, glutamic acid decarboxylase-65 (GAD-65), and zinc transporter 8 (Zn T8) may be detected in the serum of such patients. These antibodies wane over time and do not have sufficient diagnostic accuracy to be used routinely for diagnosis, especially after the first year. With the progressive destruction of beta cells, there is little or no secretion of insulin. These patients are generally not obese. They are more prone to develop other autoimmune disorders such as Addison disease, Graves''Neil LK, Hayes J, Stephens JW, Bracken RM. Physical exercise and non-insulin glucose-lowering therapies in the management of Type 2 diabetes mellitus: a clinical review. Diabet. Med. 2019 Mar;36(3):349-358. [PubMed: 30536728]

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Cepeda Marte JL, Ruiz-Matuk C, Mota M, Pérez S, Recio N, Hernández D, Fernández J, Porto J, Ramos A. Quality of life and metabolic control in type 2 diabetes mellitus diagnosed individuals. Diabetes Metab Syndr. 2019 Sep - Oct;13(5):2827-2832. [PubMed: 31425943]
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Liu Y, Wang D, Li ZS, Hu LH. Design Flaws in the Study of Distinguishing Diabetes Associated With Chronic Pancreatitis and Type 2 Diabetes Mellitus. Clin Transl Gastroenterol. 2019 Nov 01; [PubMed: 31688073]
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Qin Z, Zhou K, Li Y, Cheng W, Wang Z, Wang J, Gao F, Yang L, Xu Y, Wu Y, He H, Zhou Y. The atherogenic index of plasma plays an important role in predicting the prognosis of type 2 diabetic subjects undergoing percutaneous coronary intervention: results from an observational cohort study in China. Cardiovasc Diabetol. 2020 Feb 21;19(1):23. [PMC free article: PMC7035714] [PubMed: 32085772]
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Nowakowska M, Zghebi SS, Ashcroft DM, Buchan I, Chew-Graham C, Holt T, Mallen C, Van Marwijk H, Peek N, Perera-Salazar R, Reeves D, Rutter MK, Weng SF, Qureshi N, Mamas MA, Kontopantelis E. Correction to: The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort. BMC Med. 2020 Jan 25;18(1):22. [PMC free article: PMC6982380] [PubMed: 31980024]
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Akalu Y, Birhan A. Peripheral Arterial Disease and Its Associated Factors among Type 2 Diabetes Mellitus Patients at Debre Tabor General Hospital, Northwest Ethiopia. J for 1 last update 08 Aug 2020 Diabetes Res. J Diabetes Res. 2020;reverses diabetes type 2 term (πŸ‘ test kit) | reverses diabetes type 2 ketohow to reverses diabetes type 2 for 2020:9419413. [PMC free article: PMC7008281] [PubMed: 32090126]
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Patoulias D, Papadopoulos C, Stavropoulos K, Zografou I, Doumas M, Karagiannis A. Prognostic value of arterial stiffness measurements in cardiovascular disease, diabetes, and its complications: The potential role of sodium-glucose co-transporter-2 inhibitors. J Clin Hypertens (Greenwich). 2020 Feb 14; [PubMed: 32058679]
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Liakopoulos V, Franzén S, Svensson AM, Miftaraj M, Ottosson J, Näslund I, Gudbjörnsdottir S, Eliasson B. Pros and cons of gastric bypass surgery in individuals with obesity and type 2 diabetes: nationwide, matched, observational cohort study. BMJ the 1 last update 08 Aug 2020 Open. BMJ Open. 2019 Jan 15; for 1 last update 08 Aug 2020 99(1):e023882. [PMC free article: PMC6340417] [PubMed: 30782717]
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Choi SE, Berkowitz SA, Yudkin JS, Naci H, Basu S. Personalizing Second-Line Type 2 Diabetes Treatment Selection: Combining Network Meta-analysis, Individualized Risk, and Patient Preferences for Unified Decision Support. Med Decis for 1 last update 08 Aug 2020 Making. Med Decis Making. 2019 Apr;39(3):239-252. [PMC free article: PMC6469997] [PubMed: 30767632]
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    Goyal R, Jialal I. Diabetes Mellitus Type 2. [Updated 2020 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. for 1 last update 08 Aug 2020

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