Prognosis Of Type 2 Diabetes

Type 2 Diabetes Mellitus

What Is It? Type 2 diabetes is a chronic disease. It is characterized by high levels of sugar in the blood. Type 2 diabetes is also called type 2 diabetes mellitus and adult-onset diabetes. That's because it used to start almost always in middle- and late-adulthood. However, more and more children and teens are developing this condition. Type 2 diabetes is much more common than type 1 diabetes, and is really a different disease. But it shares with type 1 diabetes high blood sugar levels, and the complications of high blood sugar. During digestion, food is broken down into basic components. Carbohydrates are broken down into simple sugars, primarily glucose. Glucose is a critically important source of energy for the body's cells. To provide energy to the cells, glucose needs to leave the blood and get inside the cells. Insulin traveling in the blood signals the cells to take up glucose. Insulin is a hormone produced by the pancreas. The pancreas is an organ in the abdomen. When levels of glucose in the blood rise (for example, after a meal), the pancreas produces more insulin. Type 2 diabetes occurs when your body's cells resist the normal effect of insulin, which is to drive glucose in the blood into the inside of the cells. This condition is called insulin resistance. As a result, glucose starts to build up in the blood. In people with insulin resistance, the pancreas "sees" the blood glucose level rising. The pancreas responds by making extra insulin to maintain a normal blood sugar. Over time, the body's insulin resistance gets worse. In response the pancreas makes more and more insulin. Finally, the pancreas gets "exhausted". It cannot keep up with the demand for more and more insulin. It poops out. As a result, blood glucose levels start to rise. Type 2 diabetes ru Continue reading >>

Long-term Prognosis In Patients With Type 1 And 2 Diabetes Mellitus After Coronary Artery Bypass Grafting

Abstract Background Patients with diabetes mellitus (DM) have an increased risk of adverse outcomes after coronary artery bypass grafting (CABG). Previous studies have reported prognosis in relation to treatment with or without insulin, and not to the type of diabetes. Objectives This study investigated long-term survival in patients with type 1 DM (T1DM) and type 2 DM (T2DM) following CABG. Methods We included all patients from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register who underwent primary isolated CABG in Sweden during 2003 through 2013. We identified patients with T1DM or T2DM in the Swedish National Diabetes Register. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause mortality in patients with T1DM or T2DM. Results In total, 39,235 patients were included, of whom 725 (1.8%) had T1DM and 8,208 (21%) had T2DM. Patients with TDM1 were younger (59 vs. 67 years), had reduced kidney function (31% vs. 24%), and had peripheral vascular disease (21% vs. 11%) more often than patients with TDM2 or no diabetes. During a mean follow-up of 5.9 ± 3.2 years (230,085 person-years), 6,765 (17%) patients died. Among patients with T1DM, 152 (21%) died, and among patients with T2DM, 1,549 (19%) died. Adjusted hazard ratio (95% confidence interval) for death in patients with T1DM and T2DM, compared with patients without diabetes, were 2.04 (1.72 to 2.42), and 1.11 (1.05 to 1.18), respectively. Conclusions Patients with T1DM had more than double the long-term risk of death after CABG compared with patients without diabetes. The long-term risk of death in patients with T2DM was only slightly increased. Key Words The prevalence of diabet Continue reading >>

Prognosis Of Type 2 Diabetic Patients (artemis)

The study will include 1200 patients with type 2 diabetes and angiographically documented coronary artery disease and 600 matched non-diabetic patients without type 2 diabetes. Extensive traditional and novel risk marker tests are performed for the patients and they will be followed-up for 5 years. Sudden cardiac death is the main outcome measure and various other endpoints are secondary endpoints. As a substudy, 120 diabetic patients and 120 non-diabetic patients will undergo exercise training with home monitoring to assess the effects of exercise training on risk profiles. Specific aims of the study: To compare several autonomic, electric and metabolic risk markers in a case-control study between the patients with coronary artery disease with and without type II diabetes at the time of diagnosis of CAD. To assess the prognostic significance of autonomic markers, electrical markers, coronary angiographic markers and metabolic markers in predicting the cardiac events among the CAD patients with and without diabetes To develop and test the feasibility of home-monitoring of biosignals among the type II diabetic patients with CAD. To further explore the molecular, cellular and genetic factors that predispose diabetics to cardiovascular diseases. To develop new methods for the early clinical diagnosis of vulnerable subjects susceptible to the complications of the coronary artery disease in Type 2 diabetes. 5. To assess the effects of controlled exercise training programs to several autonomic, electrical and metabolic risk markers among the type II diabetic patients with CAD Study Type : Observational Actual Enrollment : 1880 participants Observational Model: Cohort Time Perspective: Prospective Official Title: Prediction of Cardiovascular Events in Type 2 Diabetic Patients Continue reading >>

Diabetes

Key facts The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014 (1). The global prevalence of diabetes* among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014 (1). Diabetes prevalence has been rising more rapidly in middle- and low-income countries. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012**. Almost half of all deaths attributable to high blood glucose occur before the age of 70 years. WHO projects that diabetes will be the seventh leading cause of death in 2030 (1). Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes. Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications. What is diabetes? Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels. In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2015, diabetes was the direct cause of 1.6 million deaths and in 2012 high blood glucose was the cause of another 2.2 million deaths. Type 1 diabetes Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is charact Continue reading >>

About Diabetes

Diabetes is a chronic (long-lasting) disease that affects how your body turns food into energy. Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. Your pancreas makes a hormone called insulin, which acts like a key to let the blood sugar into your body’s cells for use as energy. If you have diabetes, your body either doesn’t make enough insulin or can’t use the insulin it makes as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream, which over time can cause serious health problems, such as heart disease, vision loss, and kidney disease. There isn’t a cure yet for diabetes, but healthy lifestyle habits, taking medicine as needed, getting diabetes self-management education, and keeping appointments with your health care team can greatly reduce its impact on your life. 30.3 million US adults have diabetes, and 1 in 4 of them don’t know they have it. Diabetes is the seventh leading cause of death in the US. Diabetes is the No. 1 cause of kidney failure, lower-limb amputations, and adult-onset blindness. In the last 20 years, the number of adults diagnosed with diabetes has more than tripled as the American population has aged and become more overweight or obese. Types of Diabetes There are three main types of diabetes: type 1, type 2, and gestational diabetes (diabetes while pregnant). Type 1 diabetes is caused by an autoimmune reaction (the body attacks itself by mistake) that stops your body from making insulin. About 5% of the people who have diabetes have type 1. Symptoms of type 1 diabetes often develop quickly. It’s usually diagnosed in children, teens, and young adults. If you have type 1 diabetes, you’ll need t Continue reading >>

Diabetes Life Expectancy

Tweet After diabetes diagnosis, many type 1 and type 2 diabetics worry about their life expectancy. Death is never a pleasant subject but it's human nature to want to know 'how long can I expect to live'. There is no hard and fast answer to the question of ‘how long can I expect to live’ as a number of factors influence one’s life expectancy. How soon diabetes was diagnosed, the progress of diabetic complications and whether one has other existing conditions will all contribute to one’s life expectancy - regardless of whether the person in question has type 1 or type 2 diabetes. How long can people with diabetes expect to live? Diabetes UK estimates in its report, Diabetes in the UK 2010: Key Statistics on Diabetes[5], that the life expectancy of someone with type 2 diabetes is likely to be reduced, as a result of the condition, by up to 10 years. People with type 1 diabetes have traditionally lived shorter lives, with life expectancy having been quoted as being reduced by over 20 years. However, improvement in diabetes care in recent decades indicates that people with type 1 diabetes are now living significantly longer. Results of a 30 year study by the University of Pittsburgh, published in 2012, noted that people with type 1 diabetes born after 1965 had a life expectancy of 69 years.[76] How does diabetic life expectancy compare with people in general? The Office for National Statistics estimates life expectancy amongst new births to be: 77 years for males 81 years for females. Amongst those who are currently 65 years old, the average man can expect to live until 83 years old and the average woman to live until 85 years old. What causes a shorter life expectancy in diabetics? Higher blood sugars over a period of time allow diabetic complications to set in, su Continue reading >>

Early Detection And Treatment Of Type 2 Diabetes May Reduce Heart Disease And Mortality

Screening to identify type 2 diabetes followed by early treatment could result in substantial health benefits, according to new research published today in Diabetes Care that combined large scale clinical observations and innovative computer modelling. This work shows the value of public health modelling to assess impacts and interventions for diseases such as type 2 diabetes that pose an increasing public health challenge The study, led by researchers at the University of Michigan and the MRC Epidemiology Unit, University of Cambridge, used data from the ADDITION-Europe study of diabetes screening and treatment, which it combined with a computer simulation model of diabetes progression. This revealed that screening followed by treatment led to a reduced risk of cardiovascular disease or death within a 5-year follow-up period when compared to patients having no screening. The ADDITION-Europe study enrolled people 40 to 69 years of age without known diabetes from 343 general practices in the United Kingdom, Denmark, and the Netherlands. The study had two objectives: firstly, to determine if routine screening for type 2 diabetes was feasible; secondly, to determine if early, intensive, treatment of high blood sugar and cardiovascular risk factors such as blood pressure, cholesterol status and smoking in those diagnosed with type 2 diabetes reduced the risk of events such as stroke, heart attack, angioplasty, heart bypass surgery, amputation and death. The researchers found that screening was feasible, but that intensive treatment did not yield statistically significant benefits over routine care, most likely because of the overall high quality of routine diabetes care delivered in general practice. An important question is what impact screening followed by treatment has o Continue reading >>

Type 2 Diabetes: Risk Factors, Signs & Treatment

As many as 57 million people in the United States are on the path to becoming diabetic. Over 90% of them will be type 2 diabetics. But, what is this disease, and why has it become so prevalent? This lesson explores the risk factors, symptoms, and treatment of type 2 diabetes. Definition and Risk Factors Have you ever heard someone talk about a friend or relation who has 'sugar?' It's a too sweet term for a serious condition. Diabetes mellitus, usually just called diabetes, is a condition in which the body is unable to use glucose properly. Diabetics mostly fall into one of two groups, based on what factors cause the disease. Unlike type 1 diabetes, which is caused by a lack of insulin in the body, type 2 diabetes, is a condition caused by either the body's inability to make enough insulin, or an inability to use the insulin it makes. Before we get any further, let's review how a healthy body provides its cells with the energy it needs for metabolism. After a healthy person eats a meal, the body breaks it down into simpler parts for the cells to use. Many carbohydrates are broken down into a simple sugar called glucose, which is absorbed by the small intestine, where it enters the bloodstream to be transported to cells. But, glucose can't enter the cells without the help of the protein hormone responsible for helping get glucose into cells, insulin. Insulin is made in the beta cells of the pancreas and is released when blood glucose levels are high. So normally, when blood glucose levels go up, insulin is secreted, and glucose gets stashed away in the cells, where it's either used for energy or stored, usually in the form of starch or fat. This makes blood glucose levels go back down. In type 2 diabetes, though, even though there is insulin present, and many times plenty Continue reading >>

Type 2 Diabetes Mellitus In Adults

Prognosis Diabetes increases the likelihood of major cardiovascular events and death, but the increased risk is variable across patients depending on age at diabetes onset, glucose control, BP control, lipid control, tobacco control, renal function, and other factors. When diabetes is diagnosed at age 40, men lose an average of 5.8 years of life, and women lose an average of 6.8 years of life. [4] The overall excess mortality in those with type 2 diabetes is around 15% higher, but ranges from ≥60% higher in younger adults with poor glucose control and renal function, to better than those without diabetes for those who are age 65 and over with good glucose control and no renal impairment. [26] [27] Prevalence of vision-threatening diabetic retinopathy in the US is about 4.4% among adults with diabetes, and appears to be higher for non-Hispanic black people compared with non-Hispanic white people (9.3% vs. 3.2%, respectively). [93] Prevalence of end-stage renal disease is about 1% in those with type 2 diabetes (cross-sectional data). [94] Effective treatment requires a motivated and informed patient who actively takes responsibility for the care of his or her diabetes, and a health care provider who is willing to frequently adjust medications to maintain adequate disease management over a long period of time. Monitoring Optimal diabetes care requires a long-term relationship with the patient, appropriate use of consultants when needed, and regular monitoring and control of BP, HbA1c, tobacco use, and statin/aspirin use. Most patients require diabetes assessments every 3 to 4 months, and some patients may benefit from more frequent (monthly) visits, especially when motivated to improve their care. Use of diabetes educators is recommended, although traditional information Continue reading >>

Pathology And Prognosis Of Type 2 Diabetes Mellitus With Renal Involvement

Type 2 diabetes (T2D) is the most common cause of chronic kidney disease (CKD) and end-stage renal disease worldwide. In China, approximately 21.3% of diabetes was estimated to accompany with CKD and the number of diabetes-related CKDs was 24.3 million, of whom 60.5% preserved renal dysfunction with slightly increased albuminuria.[1,2] In the light of the prevalence and massive health and financial toll, the pathologic diagnosis and prognosis of diabetes-related CKD are of great clinical and societal relevance. Therefore, based on the different pathological types of diabetes with renal impairment, appropriate therapeutic schedules largely impacted on the prognosis of diseases. It was well worthy to summarize the relationship between pathology and prognosis for T2D with renal involvement in the study. The National Kidney Foundation/Kidney Disease Outcomes Quality Initiative guideline (2007) defined CKD related to diabetes as diabetic kidney disease (DKD). As for T2D related to renal involvement, there were three pathological types: DKD, nondiabetic renal disease (NDRD), and DKD superimposed on NDRD. If without the help of renal biopsy, pathologic types were difficult to diagnose and classify, which even be misdiagnosed. Therefore, the prerequisite to the further investigation for pathology and prognosis of DKD was renal biopsy. Although several research centers launched long-term follow-up to T2D with renal function, the number of samples was still insufficient, which was attributed to the inconsistency to execute renal biopsy. Wong et al.[3] followed up 68 diabetic patients with renal damage nearly for 74 months and found that these DKD or DKD superimposed on NDRD had more rapid renal function deterioration and lower renal survival rate than those of NDRD. Defined 5-yea Continue reading >>

Improving The Adverse Cardiovascular Prognosis Of Type 2 Diabetes

Approximately 80% of all patients with diabetes die of cardiovascular disease. The traditional management of type 2 diabetes has been ineffective in altering this dismal prognosis. Insulin resistance is the fundamental defect of type 2 diabetes. Insulin resistance often leads to hyperinsulinemia, which is associated with hypertension, atherogenic dyslipidemia, left ventricular hypertrophy, impaired fibrinolysis, visceral obesity, and sedentary lifestyle. Although all these conditions are associated with atherosclerosis and adverse cardiovascular events, the therapeutic efforts in patients with diabetes have focused predominantly on normalizing glucose levels. Improved insulin sensitivity through lifestyle modifications or pharmacologic therapy (troglitazone and metformin) will lower both insulin and glucose levels as well as diminish dyslipidemia and hypertension. In contrast, sulfonylurea agents lower glucose by increasing insulin levels and may increase the risk of cardiovascular events. Therapy including aspirin, lipid agents (for example, statins), angiotensin-converting enzyme inhibitors, β-adrenergic blockers, postmenopausal estrogen replacement, and vitamin E should be considered for patients with type 2 diabetes. In most patients with diabetes who have multivessel coronary artery disease, coronary artery bypass grafting is superior to coronary angioplasty for improving long-term cardiovascular prognosis. This superiority is mediated in part by the use of a left internal mammary graft to the left anterior descending coronary artery. Urgent coronary angioplasty or thrombolytic therapy should be considered for all patients with diabetes who have acute myocardial infarction. Continue reading >>

Treatment

Treatment for diabetes aims to keep your blood glucose levels as normal as possible and control your symptoms to prevent health problems developing later in life. If you've been diagnosed with type 2 diabetes, your GP will be able to explain your condition in detail and help you understand your treatment. They'll also closely monitor your condition to identify any health problems that may occur. If there are any problems, you may be referred to a hospital-based diabetes care team. Making lifestyle changes If you're diagnosed with type 2 diabetes, you'll need to look after your health very carefully for the rest of your life. This may seem daunting, but your diabetes care team will be able to give you support and advice about all aspects of your treatment. After being diagnosed with type 2 diabetes, or if you're at risk of developing the condition, the first step is to look at your diet and lifestyle and make any necessary changes. Three major areas that you'll need to look closely at are: You may be able to keep your blood glucose at a safe and healthy level without the need for other types of treatment. Lifestyle changes Diet Increasing the amount of fibre in your diet and reducing your sugar and fat intake, particularly saturated fat, can help prevent type 2 diabetes, as well as manage the condition if you already have it. You should: increase your consumption of high-fibre foods, such as wholegrain bread and cereals, beans and lentils, and fruit and vegetables choose foods that are low in fat – replace butter, ghee and coconut oil with low-fat spreads and vegetable oil choose skimmed and semi-skimmed milk, and low-fat yoghurts eat fish and lean meat rather than fatty or processed meat, such as sausages and burgers grill, bake, poach or steam food instead of frying Continue reading >>

Type 2 Diabetes

Print Overview Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body's important source of fuel. With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn't produce enough insulin to maintain a normal glucose level. More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There's no cure for type 2 diabetes, but you may be able to manage the condition by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enough to manage your blood sugar well, you also may need diabetes medications or insulin therapy. Symptoms Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for: Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual. Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger. Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine. Fatigue. If your cells are deprived of sugar, you may become tired and irritable. Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus. Slow-healing sores o Continue reading >>

Pediatric Type 2 Diabetes Mellitus

Practice Essentials Although type 2 diabetes is widely diagnosed in adults, its frequency has markedly increased in the pediatric age group since the end of the 20th century. Most pediatric patients with type 2 diabetes belong to minority communities. A simplified scheme for the etiology of type 2 diabetes mellitus is shown in the image below. Signs and symptoms Distinguishing between type 1 and type 2 diabetes at diagnosis is important. Typical characteristics of type 2 diabetes include the following: Strong family history of type 2 diabetes: Familial lifestyle risk factors leading to obesity may be present, as may a family history of cardiovascular disease or metabolic syndrome Physical findings may include the following: See Clinical Presentation for more detail. Diagnosis Testing for type 2 diabetes should be considered when a patient is overweight and has any 2 of the following [1] : Signs of insulin resistance or conditions associated with insulin resistance (eg, acanthosis nigricans, hypertension dyslipidemia, PCOS) Recommendations for screening are as follows: Glucose values may be interpreted as follows: Other laboratory results that usually suggest type 2 diabetes are as follows: Testing for albuminuria can be done by means of 1 of the following 3 methods: Fasting lipid profiles should be obtained after stable glycemia is achieved and every 2 years thereafter if normal. Optimal values for children with type 2 diabetes are as follows [3] : See Workup for more detail. Management The goal of therapy is to achieve and maintain euglycemia and near-normal hemoglobin A1c (HbA1c) levels (< 7%). More specifically, glycemic and nonglycemic goals may include the following [4] : Treatments for pediatric type 2 diabetes include the following: To protect these patients from Continue reading >>

Overview

The importance of both diabetes and these comorbidities will continue to increase as the population ages. Therapies that have proven to reduce microvascular and macrovascular complications will need to be assessed in light of the newly identified comorbidities. Lifestyle change has been proven effective in preventing or delaying the onset of type 2 diabetes in high-risk individuals. Based on this, new public health approaches are emerging that may deserve monitoring at the national level. For example, the Diabetes Prevention Program research trial demonstrated that lifestyle intervention had its greatest impact in older adults and was effective in all racial and ethnic groups. Translational studies of this work have also shown that delivery of the lifestyle intervention in group settings at the community level are also effective at reducing type 2 diabetes risk. The National Diabetes Prevention Program has now been established to implement the lifestyle intervention nationwide. Another emerging issue is the effect on public health of new laboratory based criteria, such as introducing the use of A1c for diagnosis of type 2 diabetes or for recognizing high risk for type 2 diabetes. These changes may impact the number of individuals with undiagnosed diabetes and facilitate the introduction of type 2 diabetes prevention at a public health level. Several studies have suggested that process indicators such as foot exams, eye exams, and measurement of A1c may not be sensitive enough to capture all aspects of quality of care that ultimately result in reduced morbidity. New diabetes quality-of-care indicators are currently under development and may help determine whether appropriate, timely, evidence-based care is linked to risk factor reduction. In addition, the scientific evid Continue reading >>