DIABETES MELLITUS TYPE 2 1

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Diabetes Mellitus Type 2

Diabetes Mellitus Type 2

Introduction

Diabetes Mellitus Type 2 is a long-term metabolic pathology associated with insulin resistance in addition to relatively low blood insulin levels that eventually leads to increased blood sugar. There is excessive production of glucose in the liver coupled with peripheral insulin resistance and impaired secretion of the hormone. Another close association of this condition is central and peripheral obesity, which can be determined by measuring the hip-waist ratio. Adipocyte secretions, including free fatty acids, adiponectin, leptin and TNF-alpha that regulate insulin secretion, peripheral utilisation, and body weight, cause the insulin resistance. Increased satiety, increased urinary frequency, fatigue and general body malaise, chronic sores and unexplained weight loss characterise the disease. Complications include strokes, cardiomyopathies, diabetic retinopathy, diabetic neuropathy and diabetic nephropathy (Nandimath et al., 2016, p.1334).

Epidemiology

As of 2010, about 285 million people were reported to be having diabetes mellitus type 2, which makes about 90% of diabetic cases, and 6% of the global population of adults. The incidence is equally high in developing and developed countries, with reported low incidences in the underdeveloped countries. Latinos, South Asians, Native Americans and Pacific Islanders have a greater risk of developing this condition as well as women (Pugliese & Skyler, 2013, p. 1437). Even though earlier studies and material considered it a disease of adults, more children are being diagnosed with diabetes type 2 due to the adoption of a Western lifestyle, leading to obesity. In the United States, the frequency of diagnosis of type 1 and 2 diabetes mellitus is the same among teenagers (American Diabetic Association, 2013).

In 1985, there were 30 million cases of diabetes mellitus type 2 globally. This figure increased to 135 million people ten years later and a further 217 million people in 2005 (Nandimath et al., 2016, p. 1334). This trend is associated with increased Western lifestyle preference, reduced exercise and physical activity due to advanced technology, increasing the rates of obesity worldwide.

India leads the countries with the highest number of diabetes mellitus type 2 cases as of 2000, with 31.7 million people followed by China which recorded 20.8 million cases. The United States, Indonesia, and Japan follow in third, fourth and fifth respectively with 17.7 million, 8.4 million and 6.8 million cases respectively. The condition is a recognised global epidemic by the World Health Organisation (Pugliese & Skyler, 2013, p. 1437).

Lifestyle and Diabetes Mellitus Type 2

Lifestyle elements are central factors for the development of diabetes mellitus type two. Obesity, overweight (which is defined as having body mass index, BMI, of more than 25), reduced physical activity, increased stress levels, poor/imbalanced diet and urbanisation are among the leading lifestyle determinants of this condition. 30% of cases reported among the Chinese and Japanese are associated with excess body fat. This is compared to between 60 and 80% of the cases seen among the Caucasians and people of African descent and 100% of Pacific Islanders and Pima Indians. High figures in waist-hip ratio measurement are characteristic of obese individuals. Smoking is another important factor that seems to increase the risk of developing diabetes mellitus type 2 (Pugliese & Skyler, 2013, p. 1437).

Dietary factors are also important in determining the risk of developing the metabolic condition. People with a habit of taking drinks with high sugar content are at an increased risk of developing DM type 2. Monounsaturated and polyunsaturated fats are associated with a decreased risk while trans-fatty acids and saturated fats are associated with a higher risk. Another factor associated with an increased risk is excess white rice in an individual’s diet. Lack of exercise appears to cause about 7% of the cases while persistent exposure to organic pollutants is said to play a contributory role (Nandimath et al., 2016, p. 1334).

Greater amounts of exercise coupled with a proper diet are important in managing DM type 2. Increased aerobic exercises among individuals at risk reduce the levels of HbA1c, which is associated with increased risk. It also improves peripheral sensitivity to insulin. A diabetic diet is also important in the prevention and management. Although it is still controversial, a low carbohydrate diet has shown to be beneficial (Sheehan & Ulchacker, 2012). This diet should aim for weight loss.

Regular education that is culturally appropriate may help in ensuring that diabetic patients maintain a low glycemic index state in addition to observing a diet that encourages the same. If a change in lifestyle behavior does not result in any change after six months of monitoring individuals with mild diabetes, medical advice should be sought.

Lifestyle Behavior Determinants

Excessively busy individuals have less time for exercise and adequate physical activity. Such people end up piling calories after meals, which leads to increased unutilised fats. Obesity is high among individuals who are used to motorised forms of mobility as compared to individuals who are used to walking.

Increased stress levels are associated with an increased risk. It leads to reduced physical activity due to associated depression. Physical stress, such as an injury or an illness leads to increased blood glucose levels.

Individual

Dietary Preferences

People with poor dietary preferences that put more emphasis on carbohydrates and unhealthy fats increase their risk. A moderate-low carbohydrate diet with adequate animal products has proven more beneficial compared to a vegetarian diet. Fast food, coupled with limited physical activity increases the risk of developing obesity and an overweight state.

Cultural and Religious Beliefs

Some cultures glorify certain meals. Among certain ethnic groups in East Africa, posho, a mixture of maize flour and water, is a popular dish, even though it has high carbohydrate levels. Being a staple food in the region, it increases the risk of developing DM type 2 especially among people with a sedentary lifestyle.

Environmental

Factors like a good working environment determine the stress level of an individual, which can affect their diet, physical activity, and risk of developing obesity. Excessive exposure to organic pollutants has also been linked with increased risk.

Prevention and Management

Regular exercises and proper diet can be used as measures to delay the onset or prevent the development of this condition. Increased level of physical activity cuts the risk by about 28%. Limiting the amount of dietary sugary drinks and incorporating leafy green in the diet may also be beneficial. Exercise and proper diet alone or together with metformin or acarbose administration are helpful to individuals with impaired glucose tolerance. However, it should be noted that lifestyle interventions are more helpful than medication alone.

The management of this condition emphasizes on therapeutic lifestyle changes, reducing other factors endangering the cardiovascular system as well as maintaining a low blood glucose level. Self-monitoring combined with proper patient education among newly diagnosed patients is encouraged, although the benefits are questionable in patients on multi-dose insulin.

Managing other cardiovascular risks such as high cholesterol levels in blood, hypertension, and microalbuminuria are vital in increasing the life expectancy of patients. Intensive control of blood pressures (ensuring the pressures are under 130/80) as opposed to standard measures (below 140/85) insignificantly reduces the risk of stroke with no change in mortality (Sheehan & Ulchacker, 2012). Additionally, regular eye checks are necessary due to increased risk of developing diabetic retinopathy. Monitoring and timely treating gum pathologies also help in controlling blood glucose levels.

References

American Diabetic Association (ADA). (2013). Rapid Rise in Hypertension and Nephropathy in Youth with Type 2 Diabetes: The Today Clinical Trial. Diabetes Care 36(6), p. 1735.

Nandimath, V., A., Swamy, C., S., Nandimath, S., A., Jatti, G., Jadhav, S. (2016). Evaluation of Certain Risk Factors of Type 2 Diabetes Mellitus: A Case Study. International Journal of Medical Science and Public Health 5(7), p. 1334.

Pugliese, A., & Skyler, J., S. (2013). George S. Eisenbarth: Insulin and Type Diabetes. Diabetic Care 36(6), p. 1437.

Sheehan, J., & Ulchacker, M., M. (2012). Obesity and Type 2 Diabetes Mellitus. Oxford American Endocrinology Library, New York. Oxford University Press.