Type 2 Diabetes Mellitus
Type 2 diabetes mellitus, a chronic metabolic disorder, affects approximately 90% of all diabetes patients. Sedentary lifestyles and rising obesity rates have made it a global issue. Patients with type 2 diabetes mellitus are typically obese, with a higher percentage of body fat, primarily in the abdomen. Through a variety of inflammatory mechanisms, abdominal adipose tissue promotes insulin resistance. Physical inactivity, hypertension, gestational diabetes, and dyslipidemia all increase the risk of developing type 2 diabetes. Patients with type 2 diabetes go undiagnosed for many years because they are asymptomatic (Khardori,2020). Weight loss through proper diet and exercise is the cornerstone treatment for type 2 diabetes patients who are obese (Goyal, 2020).
Background Information-Diabetes Mellitus Type 2
Type 2 diabetes mellitus is distinguished by hyperglycemia caused by an excess of glucagon secretion, insulin action resistance, and insufficient insulin secretion. Type 2 diabetes mellitus was previously known as non-insulin-dependent diabetes and adult-onset diabetes. Non-insulin-dependent diabetes is no longer used because some type 2 diabetes patients are treated with insulin. Type 2 diabetes mellitus, which previously affected people over the age of 40, is now affecting younger adults and children as a result of obesity and inactivity. Because of the confusion, the old terms have been phased out (Khardori,2020). Diabetes mellitus type 2 is a chronic disease that necessitates ongoing medical intervention to prevent and manage complications. Uncontrolled hyperglycemia in type 2 diabetes mellitus causes both chronic and acute complications. It is the leading cause of cardiovascular disease, blindness, kidney failure, and amputation of lower limbs (Goyal, 2020).
Type 2 Diabetes Mellitus Causes and Risk Factors
One of the major risk factors for prediabetes and diabetes is beta-cell dysfunction, which results in normal to abnormal glucose tolerance to postprandial blood glucose levels. As hepatic gluconeogenesis fails, fasting hyperglycemia develops later (Khardori,2020). Type 2 diabetes develops only when there is both insufficient insulin secretion and insulin resistance. As an example, all obese patients would have insulin resistance. However, only those who do not increase insulin secretion sufficiently to compensate for insulin resistance will develop diabetes (Khardori,2020).
There are numerous risk factors for type 2 diabetes mellitus. A weight greater than 120% of the recommended body weight, being 45 or older, and having a family history of type 2 diabetes, such as a sibling or parent with type 2 diabetes, are all significant risk factors. A history of delivering an infant weighing more than nine pounds, as well as a history of gestational diabetes, will also put you at risk. Race is another risk factor for type 2 diabetes mellitus. People of Hispanic, Pacific Islander, Native American, and African American descent are more vulnerable. Type 2 diabetes mellitus is also associated with hypertension, triglyceride levels greater than 150 mg/dl, and polycystic ovarian syndrome (Khardori,2020).
Diabetes Mellitus Incidence and Prevalence-Type 2
The Centers for Disease Control and Prevention (CDC) reported in 2017 that in the United States, 30.3 million (9.4%) of all ages had diabetes, while 84.1 million (33.9%) adults had prediabetes. Prediabetes is defined as having blood glucose levels higher than 140 mg/dl but not high enough to be diagnosed as type 2 diabetes by the American Diabetes Association. According to the CDC, 23.1 million people (48.3%) had prediabetes and were 65 or older (Khardori,2020).
The prevalence of type 2 diabetes mellitus varies by race and ethnicity. Type 2 diabetes is most common among Hispanics, Native Americans, African Americans, non-Hispanic whites, and Asians/Pacific Islanders. Type 2 diabetes is becoming a pandemic among Native Americans and Hispanics. Type 2 diabetes mellitus is becoming more common in adolescent and young adult populations, particularly among ethnic and racial minorities. Prepubescent children are being diagnosed with more type 2 diabetes than type 1 diabetes (Khardori,2020).
Diabetes Mellitus Type 2 Diagnosis and Prognosis
The HbA1C (glycated hemoglobin) test is used to diagnose type 2 diabetes. The HbA1C test calculates the average blood glucose level over the previous two to three months. Type 2 diabetes mellitus is indicated by results of 6.5% or higher on two separate tests. Other tests may be used to diagnose type 2 diabetes if the HbA1C test is not available or if there is a known hemoglobin variant. A random plasma glucose test result of 200mg/dl or higher suggests type 2 diabetes, especially if there are diabetes signs and symptoms. A fasting plasma glucose test, which is an overnight fast or at least 8 hours of fasting, is also available. A level of 126mg/dl or higher on two tests indicates type 2 diabetes. The majority of patients have polyuria, polydipsia, polyphagia, and weight loss (Mayo Foundation for Medical Education, n.d.). The prognosis of type 2 diabetes mellitus is determined by the patient’s diabetes control. Chronic hyperglycemia raises the risk of microvascular complications. Over a 15-year period, mortality increased among poorly controlled patients in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study of over 5000 patients with type 2 diabetes mellitus. The study found that every 1% increase in a patient’s HbA1c resulted in a 66% increase in mortality (Khardori,2020).
Diabetes Mellitus Type 2 Treatment Options
The goal of type 2 diabetes mellitus treatment is to avoid complications and eliminate symptoms. Controlling blood pressure and maintaining good glycemic control reduces the risk of microvascular complications such as eye and kidney disease. To avoid cerebrovascular and coronary complications by controlling lipids and hypertension, using aspirin, and quitting smoking. The American Diabetes Association’s medical care recommendations center on educating patients on how to manage type 2 diabetes through nutrition, physical activity, glycemic treatments, and therapeutic targets. It is ideal for maintaining normal blood glucose levels, preprandial levels of 90-130mg/dl, and an HbA1C level of less than 7%. (Khardori,2020). If diet and exercise fail to provide adequate glycemic control, metformin is the first line of treatment. Other treatments include sulfonylurea and dipeptidyl peptidase-4 inhibitors taken orally. (Goyal,2020).
Overview of Intervention for Type 2 Diabetes Mellitus
A diagnosis of type 2 diabetes mellitus is a powerful motivator for lifestyle changes, and diet and exercise are the cornerstones of intervention. Changes in diet can help with glycemic control and hypertension. To achieve weight loss in overweight patients, the primary focus should be on behavior modification, such as reducing caloric intake and increasing physical activity. Glycemic control improvement is proportional to caloric restriction and weight loss. A diet low in refined carbohydrates and saturated fats and high in fiber and monounsaturated fats is recommended for type 2 diabetes mellitus. (Goyal, 2020). Because of the increased responsiveness to insulin, exercise will help improve glycemic control. Increased activity and exercise will help reduce the need for glucose-lowering medications. 2020 (Wexler).
Intervention Recommendations for Type 2 Diabetes Mellitus
Dietary changes and exercise can help almost all people with type 2 diabetes achieve near-normal blood glucose levels. Native Americans, African Americans, Hispanics or Asian Americans, and Pacific Islanders are at high risk. Overweight people with a BMI greater than 25 kg/m2 or 23 kg/m2 in Asian Americans can benefit from dietary changes and exercise. Women with the polycystic ovarian syndrome who have a history of cardiovascular disease and hypertension can benefit from dietary changes and exercise (Goyal, 2020). HbA1C reduction is associated with at least 2.5 hours of exercise per week combined with dietary changes. Patients should select an exercise that they enjoy and will continue to do. Walking is an excellent form of exercise that is accessible to almost everyone (Khardori,2020).
Type 2 Diabetes Mellitus Limitations, Harms, and Risks
Diet and exercise are critical components of treatment for people with type 2 diabetes. Diet and exercise improve sensitivity and glycemic control, reducing the need for insulin or oral medications. The best diet is one that patients enjoy. A diet consists of foods that they enjoy not only eating but also foods that are inexpensive and easily obtained, and that is part of their cultural environment (Khardori,2020). Patients who are at risk of developing acute diabetic complications are given special consideration. An example would be during Ramadan when patients refrain from eating as part of their annual observance (Khardori,2020). Women with type 2 diabetes may need to modify their diet and exercise routine during pregnancy. To avoid hypoglycemia, blood glucose levels should be carefully monitored prior to any exercise activity.
Intervention-Related Research – Reliability of the Intervention
The American Association of Clinical Endocrinologists (AACE), a reputable source, published a type 2 diabetes treatment algorithm in 2013. This is the first algorithm to incorporate obesity, prediabetes, and cardiovascular complications into the treatment of type 2 diabetes. Obesity management was included in the algorithm because losing weight lowers blood glucose levels. Weight loss is the most effective treatment for people with prediabetes. All treatments include lifestyle modification, which includes weight loss through diet and exercise (Khardori,2020).
Type 2 Diabetes Mellitus Prevention Levels
A healthy diet combined with exercise, maintaining healthy body weight, and avoiding a sedentary lifestyle are the primary methods of preventing type 2 diabetes. Secondary prevention is used to keep people with prediabetes from developing type 2 diabetes. Tertiary prevention is the prevention of complications associated with type 2 diabetes mellitus. Improved glycemic control and weight loss have aided in the correction of the two most serious metabolic abnormalities associated with type 2 diabetes mellitus, impaired insulin secretion, and insulin resistance (Wexler, 2020).
Conclusion
Because of sedentary lifestyles and rising obesity rates, type 2 diabetes mellitus has become a global issue. Those with type 2 diabetes want to avoid complications and get rid of their symptoms. Exercise and dietary changes are regarded as critical components of type 2 diabetes treatment strategies. The best diet for type 2 diabetes mellitus patients is one that includes foods that they enjoy not only eating but also foods that are affordable and easily obtained, as well as foods that are part of their cultural environment.
References
Goyal, R. (2020, November 20). Diabetes Mellitus Type StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK513253/.
Khardori, R. (2020, December 24). Type 2 Diabetes Mellitus. Practice Essentials, Background, https://emedicine.medscape.com/article/117853-overview.
Mayo Foundation for Medical Education and Research. Diagnosis and treatment. Mayo Clinic. https://mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis- treatment/drc-20351199?p=1.
Wexler, J. (2020, November 5). Initial management of hyperglycemia in adults with type 2 diabetes mellitus. UpToDate. https://www.uptodate.com/contents/initial- management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus.
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Question 
A 20-year-old patient has been diagnosed with Type 2 diabetes and is asking about the disease:
Explain the pathophysiology of Type 1 and Type 2 diabetes.
Explain the differences between insulin resistance and lack of insulin.
Type 2 Diabetes Mellitus
What are the long-term effects of uncontrolled diabetes, and how does it cause damage to tissues? Describe the outcomes of hypoglycemia and hyperglycemia. Consider Home Blood Glucose Monitoring and Continuous Blood Glucose Monitoring including access to supplies and cost. (YOU MUST TOUCH EACH POINT!!!!!)
List 5 bulleted points for each type I and type II Diabetes on how you will advise the patient to manage the disease.
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Whitney, D. G., & Peterson, M. D. (2019). US national and state-level prevalence of mental health disorders and disparities of mental health care use in children. JAMA Pediatrics, 173(4), 389-391. https://doi.org/10.1001/jamapediatrics.2018.5399