Type 2 Diabetes Definition

Type 2 diabetes, which can also be referred to as adult-onset or non-insulin dependent diabetes, can occur at any age although it has historically been seen more commonly in adults. Changes in the health status of younger individuals, particularly the rising rates of obesity in children, has led to a subsequent increase in the rate of type 2 diabetes in younger populations of developed and developing countries.

Unlike type 1 diabetes where no insulin is produced in the pancreas, with type 2 diabetes one of two things can occur. The pancreas may produce lower amounts of insulin than the body requires to signal to the cells of the body that glucose is present in the blood and can be used for energy. The other possibility is that the cells of the body have become resistant to the presence of insulin and do not respond to the presence of the hormone to uptake glucose and store glucose in muscle and fatty tissue.

As with type 1 diabetes, this is a chronic condition for which there is currently no cure (with the possible exception of drastic weight loss surgery). However, those diagnosed with type 2 diabetes often can control their blood sugar levels through diet and exercise. With weight loss and healthy eating programs, it is possible for the insulin resistance to reverse, allowing the body to again use the insulin produced to balance and regulate blood glucose levels.

Some people may require insulin therapy or the use of diabetes medications to help in regulation of blood glucose. This entirely depends on the individual, with early diagnosis and strict adherence to a healthy lifestyle seen as critical factors. Insulin production in the pancreas can also be increased in some patients with type 2 diabetes through the use of various treatment options.

One treatment option includes the administration, in the form of a subcutaneous infusion, of glucagon-like peptide or GLP-1. Results of a short study with a small group of individuals over six weeks administration of GLP-1 showed  an increase in insulin sensitivity and beta cell functioning. In addition the subjects lost weight, had reduced appetite and inhibited gastric emptying, all leading to health improvements. 1 This is just one of many new treatments for diabetes that has been developed in recent years that provides promise of better control in the future.

Risk Factors For Type 2 Diabetes

One of the most recognized and consistent risk factors for the development of type 2 diabetes is obesity. This is why it was originally referred to as adult-onset diabetes as obesity was historically much less common in children. As increasing levels of obesity and numbers of overweight of children are now found within populations, it is not surprising that rates of diagnosis of type 2 diabetes in younger and younger patients is becoming more common.

There are several changes in the body that occur when an individual is overweight or obese. Researchers have found that obesity leads to increases in fatty acids, hormones, pro-inflammatory cytokines and increased levels of glycerol in the blood, all which are linked to the development of insulin resistance in the cells of the body.2 The pro-inflammatory cytokines  are small protein molecules that are produced in the immune system. These are seen as essential in the communication between cells and play an important role in the targeting of specific cells for attack by the immune system.

Other risk factors for type 2 diabetes include high levels of inactivity that naturally elevate the amount of glucose in your blood. This occurs because the cells do not require the glucose in the metabolic process, resulting in chronic high levels. This, coupled with overweight and obesity, also increases the risk for developing type 2 diabetes. Age, when coupled with inactivity and obesity, is another key factor in the increased prevalence of type 2 diabetes in those over 45.

Genetic factors can also play a role in the development of type 2 diabetes. When a family member, specifically a first degree family member, parent, sibling or child, has type 2 diabetes, the risk is increased over people the same age without a first degree family member with the condition. However, it is important to realize that many people have type 2 diabetes but are undiagnosed. Often the diagnosis of one family member leads to other family members being diagnosed if a genetic factor is present.

Ethnicity, although not clearly understood, also plays a role as a risk factor for developing type 2 diabetes. Generally whites of all ages are less likely to develop type 2 diabetes than individuals of any other race in the same age group. In a 20 year longitudinal study of healthy women, at the onset of the study it was found that for each 5 kilograms of increased weight, the risk of developing type 2 diabetes increased 84% for Asians, 44% for Hispanics, 38% for African-Americans and 37% for whites. 3 The same study also showed the minor changes in diet, including adding whole grains and polyunsaturated fats combined with reducing glycemic load and intake of trans fats had more significant positive results in minority populations than for the white women in the study.

Predictors For Developing Type 2 Diabetes

While risk factors are certainly important factors in the possibility of developing diabetes, one of the strongest predictors tends to be the presence of metabolic syndrome, specifically insulin resistance, or prediabetes. In studies with large populations it has been demonstrated that those with metabolic syndrome are more likely to develop type 2 diabetes independent of other risk factors. 4

With advanced knowledge that a patient that has a history of metabolic syndrome is at higher risk for developing type 2 diabetes, doctors and patients can work together proactively to change diet, lifestyle and activity levels. This can minimize the symptoms of type 2 diabetes that are experience and, in many cases, can prevent type 2 diabetes from developing at all.

References

1 Zander, M., Madsbad, S., Lysgaard Madsen, J., & Juul Holst, J. (2002). Effect of 6-week course of glucagon-like peptide 1 on glycaemic control, insulin sensitivity, and β-cell function in type 2 diabetes: a parallel-group study. The Lancet , 824-830.

2 Kahn, S., Hull, R., & Utzschneider, K. (2006). Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature , 840-846.

3 Shai, I., Rui, J., Manson, J. E., et al. (2006). Ethnicity, obesity, and risk of type 2 diabetes in women : A 20-year follow-up study. Diabetes Care , 1585-1590.

4 Lorenzo, C., Okoloise, M., Williams, K., et al. (2003). The Metabolic Syndrome as Predictor of Type 2 Diabetes. Diabetes Care , 3153-3159.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.