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Type 2 diabetes mellitus (T2DM or T2D)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Type 2 diabetes is a chronic metabolic condition characterised by insulin resistance (that is, the body's inability to effectively use insulin) and insufficient pancreatic insulin production, resulting in high blood glucose levels (hyperglycaemia)

  • Type 2 diabetes is commonly associated with obesity, physical inactivity, raised blood pressure, disturbed blood lipid levels and a tendency to develop thrombosis, and therefore is recognised to have an increased cardiovascular risk
  • is associated with long-term microvascular and macrovascular complications, together with reduced quality of life and life expectancy

In 2013, over 3.2 million adults were diagnosed with diabetes, with prevalence rates of 6% and 6.7% in England and Wales respectively

  • estimated that about 90% of adults currently diagnosed with diabetes have type 2 diabetes
  • Type 2 diabetes is more common in people of African, African-Caribbean and South Asian family origin
  • can occur in all age groups and is increasingly being diagnosed in children

Characteristics (in general):

  • onset often after 40 years of age
  • no HLA associations
  • 58% concordance in identical twins (2)
  • no islet cell antibodies
  • there is insulin resistance
  • glucagon secretion is increased
  • often the patient is obese
  • the patient is not prone to ketoacidosis
  • there is no association with autoimmune disease
  • more common in people of African, African-Caribbean and South Asian family origin

Treatment:

  • nutritional therapy
  • oral hypoglycaemic agents
  • occasionally insulin therapy

lifetime risk of type 2 diabetes

  • study evidence found type 2 diabetes lifetime risk ranged from 16.3% (95% CI 15.6-17.0) for Scottish women to 59.6% (58.5-60.8) for Singaporean men (3)

Reference:

  1. NICE (December 2015). Type 2 diabetes in adults: management
  2. Newman B et al.Concordance for type 2 (non-insulin-dependent) diabetes mellitus in male twins. Diabetologia 1987;30:763-8
  3. Tomic D et al. Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study. Lancet - Diabetes and Endocrinology September 29th 2022.

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