Diabetes Type 2 Support Group

Diabetes mellitus type 2 (formerly called diabetes mellitus type II, non-insulin-dependent diabetes (NIDDM), obesity related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. It is presently incurable. It is rapidly increasing in the developed world, and there is some evidence that this pattern will be followed in much of the rest of the world in coming years. The CDC has characterized the increase as an epidemic.

Unlike Type 1 diabetes, there is little tendency toward ketoacidosis in Type 2 diabetics, though it is not unknown. Complex and multifactorial metabolic changes lead to damage and function impairment of many organs, most importantly the cardiovascular system in both Types. This leads to substantially increased morbidity and mortality in both Type 1 and Type 2 patients, but the two have quite different origins and treatments despite the similarity in complications which often confuse even diabetics.

Diabetes mellitus type 2 is a chronic, progressive disease that cannot now be cured. There are two main goals of treatment of the disease: 1) reduction of mortality and concomitant morbidity (from assorted diabetic complications), and 2) preservation of quality of life.

The first goal can be achieved through close glycemic control (ie, blood glucose levels); the reduction effect in diabetic complications has been well demonstrated in several extensive clinical trials and is thus well established. The second goal is often addressed (in developed countries) by support and care from teams of diabetic health workers (physician or PA, nurse, dietitian, certified diabetic educator, ...). Knowledgeable patient participation is vital and so patient education is a crucial aspect of this effort.

Type 2 is initially treated by adjustment in diet and exercise, and by weight loss, especially in obese patients. The amount of weight loss which improves the clinical picture is sometimes modest (5 - 10 lb); this is almost certainly due to currently poorly understood aspects of fat tissue chemical signalling (especially in visceral fat tissue in and around abdominal organs). In many cases, such initial efforts can substantially restore insulin sensitivity.

The next step, if necessary, is treatment with oral antidiabetic drugs (oral agents "OA"s), including the sulphonylureas, biguanides (metformin), thiazolidinediones, α-glucosidase inhibitors (acarbose, miglitol), meglitinides (nateglinide, repaglinide and their analogues), and exenatide.

If these fail to help (or stop helping), insulin therapy may be necessary, usually as an adjunct to oral medication therapy, to maintain normal glucose levels. The term non-insulin-dependent diabetes is thus inaccurate and misleading. The classification, or type, of diabetes is determined by the underlying cause of the diabetes, not the type of therapy that is used to treat the diabetes. Many patients with type 2 diabetes will progress insulin to control of blood glucose levels, but these patients are still type 2 diabetics.