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Type 2 DiabetesWhen you are first diagnosed with Type 2 diabetes, it may be possible to control your blood glucose by taking regular excersie and eating a healthy diet. |
Diabetes Disease Process Information And Progression
Risk factors for type 2 diabetes
Type 2 diabetes disease is a chronic disease and is on the increase globally. In the UK 3.9% of the population has been diagnosed with diabetes. Type 2 diabetes have several trigger factors which promote the progression to poor glucose management. Obesity and physical inactivity are the major proponents of type 2 diabetes. About 80% of people with type 2 diabetes are obese; the risk of developing type 2 diabetes increases progressively in both men and women. Other factors such as increasing age, ethnicity, first degree relative with diabetes, pregnancy and usage of certain drugs also act as triggers for the development of type 2 diabetes.
Type 2 diabetes disease progression
Type 2 diabetes is a result of relative lack of insulin production from the beta cells in the islets of Langerhans in the pancreas. At the time of diagnosis up to 50% of beta cells are non-productive with the rest in gradual decline. The diabetes disease progression continues for the duration of the individual's life. Beta-cell dysfunction constitutes half the diabetes disease process of type 2 diabetes. The other aspect is insulin resistance as a result of central obesity. The interplay between beta cell dysfunction and insulin resistance complete the disease progression of type 2 diabetes which is a chronic lifelong disease.
Type 2 diabetes disease management
The management of type 2 diabetes commences with dietary modifications and other lifestyle changes such as increasing physical activity and smoking cessation. The aim of type 2 diabetes management programmes is to manage weight as studies have shown that a 5 - 10% reduction in weight can lead to significant improvements in outcomes for the patient. Management also hopes to reduce blood glucose levels, increase insulin sensitivity, improve lipid profiles and achieve normal blood pressure. This disease management aims to retard disease progression as well as reduce cardiovascular risk factors.
There are several approaches to achieving the targets listed above. The first line treatment is lifestyle modification such as adherence to the principles of healthy eating and increased exercise for weight management to partially counteract insulin resistance. The pharmacological arm of therapy involves the use of oral hypoglycaemic agents such as metformin, gliclazide, sitagliptin and pioglitazone. The recent introduction of incretin mimetics such as exenatide and liraglutide have expanded treatment options for better disease management. As the disease progresses, treatment options become limited and the patient may need to commence insulin therapy. Disease progression describes the decline in beta cells which accounts for the fact that oral agents can no longer be effective and insulin replacement is the only option. Insulin may be given in combination with oral hypoglycaemia agents either once daily or twice daily. However, there is often the need to intensify treatment as the disease progresses further, with insulin given four times daily. There may be one type of insulin or a combination of types of insulin in one regimen. The type of insulin regimen chosen is individualized to the patient's lifestyle, age, clinical status and choice. Ultimately all treatment is balanced to individual need and clinical targets set for disease management.
