Diabetes mellitus type 2: Wikis

  
  

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Diabetes mellitus
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Types of diabetes
Prediabetes:
   • Impaired fasting glycaemia
   • Impaired glucose tolerance
Diabetes mellitus type 1
Diabetes mellitus type 2
Gestational diabetes
Blood tests
Blood sugar
Glycosylated hemoglobin
Glucose tolerance test
Fructosamine
Diabetes management
Diabetic diet
Anti-diabetic drugs
Insulin therapy
Glossary of diabetes
Complications
Cardiovascular disease
Diabetic comas:
   • Diabetic hypoglycemia
   • Diabetic ketoacidosis
   • Nonketotic hyperosmolar
Diabetic myonecrosis
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy
Diabetes and pregnancy
.Diabetes mellitus type 2 or type 2 diabetes (formerly called non -insulin-dependent diabetes mellitus (NIDDM), or adult-onset diabetes) is a disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.^ Insulin algorithm for type 2 diabetes mellitus in children and adults.
  • Insulin Therapy for Maximal Glycemic Control in Type 2 Diabetes Mellitus -- Spellman 107 (7): 260 -- Journal of the American Osteopathic Association 19 January 2010 18:018 UTC www.jaoa.org [Source type: Academic]

^ Diabetes is a disease in which levels of blood glucose, also called blood sugar, are above normal.

^ Insulin deficiency also impairs non-hepatic tissue utilization of glucose.

[1] .Diabetes is often initially managed by increasing exercise and dietary modification.^ While it is often initially managed by increasing exercise and dietary modification, medications are typically needed as...
  • Diabetes Type 2 - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC www.kosmix.com [Source type: FILTERED WITH BAYES]
  • Type 2 Diabetes - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC health.kosmix.com [Source type: FILTERED WITH BAYES]

^ However, intensive programs of lifestyle modification (diet, exercise, and behavior) do reduce the incidence of diabetes.
  • Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement -- U.S. Preventive Services Task Force 148 (11): 846 -- Annals of Internal Medicine 17 September 2009 2:40 UTC www.annals.org [Source type: Academic]
  • NGC - NGC Summary 17 September 2009 2:40 UTC www.guideline.gov [Source type: Academic]

^ Modifiable factors, including reductions in physical activity, dietary changes, and increased frequency of testing, may play a role in the increasing prevalence of diabetes (3) .
  • Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement -- U.S. Preventive Services Task Force 148 (11): 846 -- Annals of Internal Medicine 17 September 2009 2:40 UTC www.annals.org [Source type: Academic]

.As the condition progresses, medications are typically needed.^ While it is often initially managed by increasing exercise and dietary modification, medications are typically needed as...
  • Type 2 Diabetes - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC health.kosmix.com [Source type: FILTERED WITH BAYES]

.There are an estimated 23.6 million people in the U.S. (7.8% of the population) with diabetes with 17.9 million being diagnosed,[2] 90% of whom are type 2.[3] With prevalence rates doubling between 1990 and 2005, CDC has characterized the increase as an epidemic.^ Let me explain… The majority of newly diagnosed people have type 2 diabetes.
  • Type 1 Diabetes Mellitus and Possible Causes of It 19 January 2010 18:018 UTC www.optimum-diabetics.org [Source type: Academic]

^ And the number of children being diagnosed with type 2 diabetes is increasing.
  • Type 2 Diabetes - Yahoo! Health 19 January 2010 18:018 UTC health.yahoo.com [Source type: General]

^ Type 2 Diabetes Being Diagnosed with Type 2 Diabetes How I dealt with diabetes and what I had to do to keep healthy.

[4] .Traditionally considered a disease of adults, type 2 diabetes is increasingly diagnosed in children in parallel to rising obesity rates [5] due to alterations in dietary patterns as well as in life styles during childhood.^ People can develop type 2 diabetes at any age, even during childhood.

^ Gumbiner B. Treating obesity in type 2 diabetes.
  • Diabetes Mellitus, Type 2: eMedicine Endocrinology 19 January 2010 18:018 UTC emedicine.medscape.com [Source type: Academic]

^ But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.
  • Type 2 diabetes 20 September 2009 1:53 UTC cnn.com [Source type: General]

[6]
.Unlike type 1 diabetes, there is very little tendency toward ketoacidosis in type 2 diabetes, though it is not unknown.^ There are four types of diabetes mellitus.
  • Diabetes Mellitus-Science Tracer Bullet-Library of Congress 19 January 2010 18:018 UTC www.loc.gov [Source type: Academic]

^ There are several types of diabetes.
  • Type 2 Diabetes | LIVESTRONG.COM 19 January 2010 18:018 UTC www.livestrong.com [Source type: General]
  • Type 2 Diabetes - Symptoms, Diagnosis, Treatment of Type 2 Diabetes - NY Times Health Information 20 September 2009 1:53 UTC health.nytimes.com [Source type: General]

^ There are two primary Type s of diabetes : Type 1 and Type 2.
  • Type 2 Diabetes | LIVESTRONG.COM 19 January 2010 18:018 UTC www.livestrong.com [Source type: General]

[7] .One effect that can occur is nonketonic hyperglycemia which also is quite dangerous, though it must be treated very differently.^ After discontinuation of insulin therapy, if patients are treated with diet alone, hyperglycemia frequently occurs within 2 years of follow-up (2, 8, 33).
  • Narrative Review: Ketosis-Prone Type 2 Diabetes Mellitus - Health News - redOrbit 17 September 2009 2:40 UTC www.redorbit.com [Source type: Academic]

^ However, even very careful testing may fail to detect a problem, particularly one that occurs during sleep.

^ One reason is that if short-acting insulin is given only after hyperglycemia occurs, the patient's blood glucose profile often resembles a roller coaster.
  • Management of Hospitalized Patients with Type 2 Diabetes Mellitus -American Family Physician - March 1, 1998 19 January 2010 18:018 UTC www.aafp.org [Source type: Academic]

.Complex and multifactorial metabolic changes very often lead to damage and function impairment of many organs, most importantly the cardiovascular system in both types.^ The most common symptoms of this disease are excessive urine production often leading to compensatory thirst and increased fluid intake, blurred vision, unexplained weight loss, lethargy, and changes in energy metabolism.
  • Diabetes Mellitus - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC www.kosmix.com [Source type: FILTERED WITH BAYES]

^ Figure 1 summarizes the physiopathology of diabetes with respect to the HPO axis, and shows the most important features associated with the relationship between diabetic hyperglycaemia and metabolic and hormonal dysfunction, leading to the impairment of gonadal function in women with T1DM. .
  • The hypothalamus-pituitary-ovary axis and type 1 diabetes mellitus: a mini review -- Arrais and Dib 21 (2): 327 -- Human Reproduction 19 January 2010 18:018 UTC humrep.oxfordjournals.org [Source type: Academic]

^ Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes .
  • Disease - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

.This leads to substantially increased morbidity and mortality in people with both type 1 and type 2 diabetes, but the two have quite different origins and treatments despite the similarity in complications.^ The following are precautions for all people with diabetes, both type 1 and type 2: .

^ What is the difference between type 1 and type 2 diabetes?
  • Type 2 Diabetes - Yahoo! Health 19 January 2010 18:018 UTC health.yahoo.com [Source type: General]

^ Factors that increase your risk for complications from type 2 diabetes include: .
  • Type 2 Diabetes: Living With Complications - Yahoo! Health 20 September 2009 1:53 UTC health.yahoo.com [Source type: General]

[citation needed]

Contents

Signs and symptoms

The symptoms of type 2 diabetes include:

Cause

Medical conditions

.There are many factors which can potentially give raise or exacerbate type 2 diabetes.^ There are four types of diabetes mellitus.
  • Diabetes Mellitus-Science Tracer Bullet-Library of Congress 19 January 2010 18:018 UTC www.loc.gov [Source type: Academic]

^ There are several types of diabetes.
  • Type 2 Diabetes | LIVESTRONG.COM 19 January 2010 18:018 UTC www.livestrong.com [Source type: General]
  • Type 2 Diabetes - Symptoms, Diagnosis, Treatment of Type 2 Diabetes - NY Times Health Information 20 September 2009 1:53 UTC health.nytimes.com [Source type: General]

^ There are two primary Type s of diabetes : Type 1 and Type 2.
  • Type 2 Diabetes | LIVESTRONG.COM 19 January 2010 18:018 UTC www.livestrong.com [Source type: General]

.These include obesity, hypertension, elevated cholesterol (combined hyperlipidemia), and with the condition often termed Metabolic syndrome (it is also known as Syndrome X, Reavan's syndrome, or CHAOS).^ Obesity and the metabolic syndrome in children and adolescents.
  • Management of Type 2 Diabetes in Youth: An Update - September 1, 2007 -- American Family Physician 20 September 2009 1:53 UTC www.aafp.org [Source type: Academic]

^ Abdominal obesity metabolic syndrome ...
  • Diabetes-like symptoms - WrongDiagnosis.com 19 January 2010 18:018 UTC www.wrongdiagnosis.com [Source type: Academic]

^ Acute metabolic complications include diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic syndrome, and hypoglycemia.
  • Managing Cardiovascular Risk in Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC secure.pharmacytimes.com [Source type: Academic]

.Other causes include acromegaly, Cushing's syndrome, thyrotoxicosis, pheochromocytoma, chronic pancreatitis, cancer and drugs.^ Cushing's syndrome, Acromegaly, thyrotoxicosis, phaeochromocytoma, Friedreich's ataxia, myotonic dystrophy - are all conditions which can cause secondary diabetes.
  • Diabetes-like symptoms - WrongDiagnosis.com 19 January 2010 18:018 UTC www.wrongdiagnosis.com [Source type: Academic]

^ Relative contraindications to the use of this drug include chronic intestinal disorders of digestion or absorption and medical conditions that might deteriorate with increased intestinal gas formation.
  • The Pharmacological Reduction of Blood Glucose in Patients With Type 2 DiabetesMellitus 19 January 2010 18:018 UTC journal.diabetes.org [Source type: Academic]

^ Some stimulant drugs include diethylpropion (Tenuate), epinephrine, phentermine (Ionamin), pseudoephedrine (Sudafed), and many others.
  • COFFEE: Uses, Side Effects, Interactions and Warnings - WebMD 19 January 2010 18:018 UTC www.webmd.com [Source type: Academic]

.Additional factors found to increase the risk of type 2 diabetes include aging,[8] high-fat diets[9] and a less active lifestyle.^ Lifestyle factors that possibly contribute to the global epidemic of type 2 diabetes .
  • Type 2 diabetes mellitus in children and adolescents--the beginning of a renal catastrophe? -- Kiess et al. 19 (11): 2693 -- Nephrology Dialysis Transplantation 19 January 2010 18:018 UTC ndt.oxfordjournals.org [Source type: Academic]

^ Genotype score in addition to common risk factors for prediction of type 2 diabetes .
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

^ An evidence-based approach to risk factor modification in type 2 diabetes.
  • eMJA: Diabetes guidelines: easier to preach than to practise? 17 September 2009 2:40 UTC www.mja.com.au [Source type: Academic]

[10]

Genetics

.There is also a strong inheritable genetic connection in type 2 diabetes: having relatives (especially first degree) with type 2 increases risks of developing type 2 diabetes very substantially.^ Cell function in NGT individuals with a first-degree type 2 diabetic relative .
  • The Genetic Basis of Type 2 Diabetes Mellitus: Impaired Insulin Secretion versus Impaired Insulin Sensitivity -- Gerich 19 (4): 491 -- Endocrine Reviews 19 January 2010 18:018 UTC edrv.endojournals.org [Source type: Academic]

^ It was concluded that insulin resistance was a risk factor for development of type 2 diabetes.
  • The Genetic Basis of Type 2 Diabetes Mellitus: Impaired Insulin Secretion versus Impaired Insulin Sensitivity -- Gerich 19 (4): 491 -- Endocrine Reviews 19 January 2010 18:018 UTC edrv.endojournals.org [Source type: Academic]

^ There are four types of diabetes mellitus.
  • Diabetes Mellitus-Science Tracer Bullet-Library of Congress 19 January 2010 18:018 UTC www.loc.gov [Source type: Academic]

.In addition, there is also a mutation to the Islet Amyloid Polypeptide gene that results in an earlier onset, more severe, form of diabetes.^ There are several types of diabetes.
  • Type 2 Diabetes | LIVESTRONG.COM 19 January 2010 18:018 UTC www.livestrong.com [Source type: General]
  • Type 2 Diabetes - Symptoms, Diagnosis, Treatment of Type 2 Diabetes - NY Times Health Information 20 September 2009 1:53 UTC health.nytimes.com [Source type: General]

^ Human islet amyloid polypeptide (IAPP).
  • Hayden MR, et al. Type 2 Diabetes Mellitus as a Conformational Disease. JOP. J Pancreas (Online) 2005; 6(4):287-302. [Full text] 19 January 2010 18:018 UTC www.joplink.net [Source type: Academic]

^ Islet amyloid polypeptide (IAPP) .
  • Hayden MR, et al. Type 2 Diabetes Mellitus as a Conformational Disease. JOP. J Pancreas (Online) 2005; 6(4):287-302. [Full text] 19 January 2010 18:018 UTC www.joplink.net [Source type: Academic]

[11][12]
.About 55 percent of type 2 patients are obese at diagnosis[13] —chronic obesity leads to increased insulin resistance that can develop into Type 2, most likely because adipose tissue (especially that in the abdomen around internal organs) is a (recently identified) source of several chemical signals to other tissues (hormones and cytokines).^ And as obesity has increased, so has type 2 diabetes.
  • WHFoods: Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.whfoods.com [Source type: Academic]

^ Type 2 diabetes Insulin Resistance ...
  • Diabetes-like symptoms - WrongDiagnosis.com 19 January 2010 18:018 UTC www.wrongdiagnosis.com [Source type: Academic]

^ Insulin, like other hormones, is secreted in pulses and this appears to be a fundamental signal for hormone signaling.
  • Neonatal streptozotocin-induced rat model of Type 2 diabetes mellitus: A glance DK Arulmozhi, A Veeranjaneyulu, SL Bodhankar - Indian J Pharmacol 19 January 2010 18:018 UTC www.ijp-online.com [Source type: Academic]

.Other research shows that type 2 diabetes causes obesity as an effect of the changes in metabolism and other deranged cell behavior attendant on insulin resistance.^ Gumbiner B. Treating obesity in type 2 diabetes.
  • WHFoods: Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.whfoods.com [Source type: Academic]
  • Diabetes Mellitus, Type 2: eMedicine Endocrinology 19 January 2010 18:018 UTC emedicine.medscape.com [Source type: Academic]

^ The effect of diabetes is not limited to carbohydrate metabolism.
  • Treatment of Type 2 Diabetes Mellitus - May 15, 1999 - American Academy of Family Physicians 17 September 2009 2:40 UTC www.aafp.org [Source type: Academic]

^ Type 2 diabetes is caused by insulin resistance, in which the body does not properly use insulin.

[14]
.However, environmental factors (almost certainly diet and weight) play a large part in the development of Type 2 in addition to any genetic component.^ Hypothesis for interaction of genetic and environmental factors in the pathogenesis of type 2 diabetes.
  • The Genetic Basis of Type 2 Diabetes Mellitus: Impaired Insulin Secretion versus Impaired Insulin Sensitivity -- Gerich 19 (4): 491 -- Endocrine Reviews 19 January 2010 18:018 UTC edrv.endojournals.org [Source type: Academic]

^ Family history and genetics play a large role in type 2 diabetes.
  • Type 2 diabetes: MedlinePlus Medical Encyclopedia 19 January 2010 18:018 UTC www.nlm.nih.gov [Source type: General]
  • Type 2 Diabetes - Symptoms, Diagnosis, Treatment of Type 2 Diabetes - NY Times Health Information 19 January 2010 18:018 UTC health.nytimes.com [Source type: General]

^ Environmental factors are another part of the picture.
  • Type 1 Diabetes Mellitus and Possible Causes of It 19 January 2010 18:018 UTC www.optimum-diabetics.org [Source type: Academic]

.This can be seen from the adoption of the Type 2 epidemiological pattern in those who have moved to a different environment as compared to the same genetic pool who have not.^ In a meta-analysis from 3 weight loss studies that used orlistat in the same dose as above, obese (BMI 30 kg/m 2 ) patients with IGT who were treated with orlistat experienced a 3.0% incidence of diabetes, compared with a 7.6% incidence in those treated with placebo.
  • Preventing Type 2 Diabetes Mellitus -- Curtis and Wilson 18 (1): 37 -- The Journal of the American Board of Family Medicine 19 January 2010 18:018 UTC www.jabfm.org [Source type: Academic]

^ Further evidence for the role of genetic factors comes from the study of populations with different genetic backgrounds living in the same environment.
  • Epidemiology of Type 2 Diabetes Mellitus 17 September 2009 2:40 UTC www.msdlatinamerica.com [Source type: Academic]

^ Individuals, particularly women, with T2DM may differ in their perception of body image compared with those without diabetes mellitus.
  • Nutrition Journal | Full text | Perceived body image in men and women with type 2 diabetes mellitus: correlation of body mass index with the figure rating scale 19 January 2010 18:018 UTC www.nutritionj.com [Source type: Academic]

.Immigrants to Western developed countries, for instance, as compared to lower incidence countries of origins.^ In one report, older people with type 2 diabetes who drank daily, but moderately, had a dramatically lower incidence of deaths from heart disease compared with nondrinkers.
  • Type 2 Diabetes - [Alternative Medicine] 19 January 2010 18:018 UTC www.peacehealth.org [Source type: Academic]
  • Type 2 Diabetes 19 January 2010 18:018 UTC navarro.wgstudios.com [Source type: Academic]
  • Trinity, Texas - Type 2 Diabetes; Type 1 Diabetes Overview What you need ... 19 January 2010 18:018 UTC www.tmfhs.org [Source type: Academic]

^ In one report, older people with type 2 diabetes who drank daily, but moderately, had a dramatically lower incidence of deaths from cardiovascular disease compared with nondrinkers.
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]

[15]

Pathophysiology

.Insulin resistance means that body cells do not respond appropriately when insulin is present.^ Insulin resistance means that fat, liver, and muscle cells do not respond normally to insulin.
  • Type 2 Diabetes - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC health.kosmix.com [Source type: FILTERED WITH BAYES]
  • Type 2 Diabetes - Symptoms, Diagnosis, Treatment of Type 2 Diabetes - NY Times Health Information 19 January 2010 18:018 UTC health.nytimes.com [Source type: General]

^ The cells in your body become resistant to normal levels of insulin.
  • Type 2 Diabetes | Health | Patient UK 19 January 2010 18:018 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ Insulin resistance means that insulin ...
  • Type 2 Diabetes | LIVESTRONG.COM 19 January 2010 18:018 UTC www.livestrong.com [Source type: General]

.Unlike type 1 diabetes mellitus, insulin resistance is generally "post-receptor", meaning it is a problem with the cells that respond to insulin rather than a problem with the production of insulin.^ Receptor and postreceptor defects contribute to the insulin resistance in noninsulin-dependent diabetes mellitus.
  • Childhood Obesity and Type 2 Diabetes Mellitus -- Hannon et al. 116 (2): 473 -- Pediatrics 19 January 2010 18:018 UTC pediatrics.aappublications.org [Source type: Academic]

^ Thus, insulin resistance is not a requirement for development of type 2 diabetes.
  • The Genetic Basis of Type 2 Diabetes Mellitus: Impaired Insulin Secretion versus Impaired Insulin Sensitivity -- Gerich 19 (4): 491 -- Endocrine Reviews 19 January 2010 18:018 UTC edrv.endojournals.org [Source type: Academic]

^ Type 2 diabetes is often associated with insulin resistance and weight gain.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

Other important contributing factors:[citation needed]
  • increased hepatic glucose production (e.g., from glycogen -> glucose conversion), especially at inappropriate times (typical cause is deranged insulin levels, as those levels control this function in liver cells)
  • decreased insulin-mediated glucose transport in (primarily) muscle and adipose tissues (receptor and post-receptor defects)
  • impaired beta-cell function—loss of early phase of insulin release in response to hyperglycemic stimuli
.This is a more complex problem than type 1, but is sometimes easier to treat, especially in the early years when insulin is often still being produced internally.^ Every 1 to 2 years or more often, if indicated, have a: 5 .
  • Type 2 Diabetes: Living With Complications - Yahoo! Health 20 September 2009 1:53 UTC health.yahoo.com [Source type: General]

^ Injectable medication such as: Incretin-mimetic (eg, exenatide) stimulate the pancreas to produce insulin and suppress appetite often leading to weight loss.
  • Northern Arizona Healthcare - Type 2 Diabetes 19 January 2010 18:018 UTC www.nahealth.com [Source type: Academic]

^ Injectable medication such as: Incretin-mimetic (eg, exenatide ) stimulate the pancreas to produce insulin and suppress appetite often leading to weight loss.

.Type 2 may go unnoticed for years before diagnosis, since symptoms are typically milder (e.g., no ketoacidosis, coma, etc) and can be sporadic.^ I can't believe it has been 11 years since her symptoms started and 7 years since diagnosis.
  • Schizophrenia.com Support Forums: Eleven years after first signs of ... 19 January 2010 18:018 UTC www.schizophrenia.com:8080 [Source type: General]

^ Type 2: People with type 2 diabetes may not have any symptoms for years or decades before they are diagnosed.
  • Diabetes Mellitus: Diabetes Mellitus (DM): Merck Manual Home Edition 19 January 2010 18:018 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ You may not have symptoms for years.

.July 2008" style="white-space:nowrap;">[citation needed] However, severe complications can result from improperly managed type 2 diabetes, including renal failure, erectile dysfunction, blindness, slow healing wounds (including surgical incisions), and arterial disease, including coronary artery disease.^ Patients with a diabetes type 1 were not included in the study.
  • Cardiovascular Diabetology | Full text | Relevance of hemostatic risk factors on coronary morphology in patients with diabetes mellitus type 2 19 January 2010 18:018 UTC www.cardiab.com [Source type: Academic]

^ Manage or prevent complications of diabetes.

^ Symptoms of coronary artery disease include: .
  • Type 2 Diabetes: Living With Complications - Yahoo! Health 20 September 2009 1:53 UTC health.yahoo.com [Source type: General]

.The onset of type 2 has been most common in middle age and later life, although it is being more frequently seen in adolescents and young adults due to an increase in child obesity and inactivity.^ (ESWL) is the most common type of lithotripsy.
  • Type 2 Diabetes | LIVESTRONG.COM 19 January 2010 18:018 UTC www.livestrong.com [Source type: General]

^ But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.
  • Type 2 diabetes 20 September 2009 1:53 UTC cnn.com [Source type: General]

^ Although this condition is more common in children with type 1 diabetes, it can occur in children with type 2.
  • OhioHealth - Type 2 diabetes in children 19 January 2010 18:018 UTC www.ohiohealth.com [Source type: General]

.A type of diabetes called MODY is increasingly seen in adolescents, but this is classified as a diabetes due to a specific cause and not as type 2 diabetes.^ Type 1 diabetes usually starts in adolescence.

^ Type 2 diabetes is caused when your… .
  • Type 1 Diabetes Mellitus and Possible Causes of It 19 January 2010 18:018 UTC www.optimum-diabetics.org [Source type: Academic]

^ Unlike type 2 diabetes, type 1 diabetes does not have a specific known cause.
  • Type 1 Diabetes Mellitus and Possible Causes of It 19 January 2010 18:018 UTC www.optimum-diabetics.org [Source type: Academic]

.Diabetes mellitus with a known etiology, such as secondary to other diseases, known gene defects, trauma or surgery, or the effects of drugs, is more appropriately called secondary diabetes mellitus or diabetes due to a specific cause.^ Diabetes can cause specific complications in women.

^ Unlike type 2 diabetes, type 1 diabetes does not have a specific known cause.
  • Type 1 Diabetes Mellitus and Possible Causes of It 19 January 2010 18:018 UTC www.optimum-diabetics.org [Source type: Academic]

^ Diabetes mellitus is known as a fiber-responsive disease.

.Examples include diabetes mellitus such as MODY or those caused by hemochromatosis, pancreatic insufficiencies, or certain types of medications (e.g., long-term steroid use).^ Follow-up: Diabetes Mellitus, Type 2 .
  • Diabetes Mellitus, Type 2: eMedicine Endocrinology 19 January 2010 18:018 UTC emedicine.medscape.com [Source type: Academic]

^ Animal models of Type 2 diabetes mellitus .
  • Neonatal streptozotocin-induced rat model of Type 2 diabetes mellitus: A glance DK Arulmozhi, A Veeranjaneyulu, SL Bodhankar - Indian J Pharmacol 19 January 2010 18:018 UTC www.ijp-online.com [Source type: Academic]

^ DM = diabetes mellitus; T2DM = type 2 diabetes mellitus.
  • Nutrition Journal | Full text | Perceived body image in men and women with type 2 diabetes mellitus: correlation of body mass index with the figure rating scale 19 January 2010 18:018 UTC www.nutritionj.com [Source type: Academic]

Diagnosis

1999 WHO Diabetes criteria[16]
Condition 2 hour glucose Fasting glucose
mmol/l(mg/dl) mmol/l(mg/dl)
Normal <7.8 (<140) <6.1 (<110)
Impaired fasting glycaemia <7.8 (<140) ≥ 6.1(≥110) & <7.0(<126)
Impaired glucose tolerance ≥7.8 (≥140) <7.0 (<126)
Diabetes mellitus ≥11.1 (≥200) ≥7.0 (≥126)
The World Health Organization definition of diabetes is for a single raised glucose reading with symptoms, otherwise raised values on two occasions, of either:[17]
  • fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl)
or

Screening and prevention

Prevention

.Onset of type 2 diabetes can often be delayed through proper nutrition and regular exercise.^ Pre-diabetes precedes the onset of type 2 diabetes.

^ Proper exercise may prevent, or delay the onset of type 2 diabetes.
  • Type 2 Diabetes 19 January 2010 18:018 UTC www.squidoo.com [Source type: General]

^ Exercise — Regular exercise is also beneficial in type 2 diabetes, independent of weight loss.
  • Initial management of blood glucose in type 2 diabetes mellitus 19 January 2010 18:018 UTC www.uptodateinc.com [Source type: Academic]

[18]
.Interest has arisen in preventing diabetes due to research on the benefits of treating patients before overt diabetes.^ Preventing foot ulcers in patients with diabetes .
  • Disease - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

^ Interest has arisen in preventing diabetes due to research on the benefits of treating patients before overt diabetes.

^ Can we prevent heart disease in diabetic patients?

.Although the U.S. Preventive Services Task Force concluded that "the evidence is insufficient to recommend for or against routinely screening asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose,"[19][20] this was a grade I recommendation when published in 2003. However, the USPSTF does recommend screening for diabetics in adults with hypertension or hyperlipidemia (grade B recommendation).^ Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
  • Preventing Type 2 Diabetes Mellitus -- Curtis and Wilson 18 (1): 37 -- The Journal of the American Board of Family Medicine 19 January 2010 18:018 UTC www.jabfm.org [Source type: Academic]
  • The prevention of type 2 diabetes mellitus: recent advances -- Younis et al. 97 (7): 451 -- QJM 19 January 2010 18:018 UTC qjmed.oxfordjournals.org [Source type: Academic]
  • Progress in defining the molecular basis of type 2 diabetes mellitus through susceptibility-gene identification -- McCarthy 13 (Supplement 1): R33 -- Human Molecular Genetics 19 January 2010 18:018 UTC hmg.oxfordjournals.org [Source type: Academic]

^ Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement .
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

^ Task Force 4: systemic hypertension.
  • Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children -- Gahagan et al. 112 (4): e328 -- AAP Policy 19 January 2010 18:018 UTC aappolicy.aappublications.org [Source type: Academic]

In 2005, an evidence report by the Agency for Healthcare Research and Quality concluded that "there is evidence that combined diet and exercise, as well as drug therapy (metformin, acarbose), may be effective at preventing progression to DM in IGT subjects".[21]
.Milk has also been associated with the prevention of diabetes.^ Primary prevention of cardiovascular diseases in people with diabetes mellitus: A scientific statement from the American Heart Association and the American Diabetes Association.

^ Should children avoid milk to prevent type 1 diabetes?
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]
  • Health: Type 1 Diabetes; Type 2 Diabetes Overview What you need to know ... 19 January 2010 18:018 UTC www.maimonidesmed.org [Source type: Academic]

^ Prevention Conference VI: Diabetes and Cardiovascular Disease: Executive summary: Conference proceeding for health care professionals from a special writing group of the American Heart Association.

.A questionnaire study was done by Choi et al.^ The study by Vanger et al .
  • Pregnancy Outcome in Type 2 Diabetes Mellitus: A Retrospective Analysis from the Netherlands 19 January 2010 18:018 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ A study by Karjalainen et al.
  • Type 1 Diabetes Mellitus and Possible Causes of It 19 January 2010 18:018 UTC www.optimum-diabetics.org [Source type: Academic]

^ Studies by Foster, et al .
  • Nutrition & Metabolism | Full text | Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal 19 January 2010 18:018 UTC www.nutritionandmetabolism.com [Source type: Academic]

of .41,254 men which including a 12 year follow up showed this association.^ Results from a 22-year follow-up of healthy nondiabetic men.

^ The mean duration of follow-up was 3.2 years.
  • NEJM -- Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance 19 January 2010 18:018 UTC content.nejm.org [Source type: Academic]

^ A 7-year follow-up study.

.In this study, it was found that diets high in low-fat dairy might lower the risk of type 2 diabetes in men.^ High-fat diets are associated with an increased risk for diabetes.
  • WHFoods: Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.whfoods.com [Source type: Academic]

^ Patients with a diabetes type 1 were not included in the study.
  • Cardiovascular Diabetology | Full text | Relevance of hemostatic risk factors on coronary morphology in patients with diabetes mellitus type 2 19 January 2010 18:018 UTC www.cardiab.com [Source type: Academic]

^ This type of diabetes was traditionally found in… .
  • Type 1 Diabetes Mellitus and Possible Causes of It 19 January 2010 18:018 UTC www.optimum-diabetics.org [Source type: Academic]

.Even though these benefits are being considered linked to milk consumption, the effect of diet is only one factor that is affecting the body’s overall health.^ There are a number of proactive steps one can take around proper diet, exercise, lifestyle considerations and specific nutrients that can reduce the effect of diabetes, and even in some cases reduce or eliminate the need for medication.
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]

^ Larosa JC, Fry AG, Muesing R, Rosing DR: Effects of high-protein, low-carbohydrate dieting on plasma lipoproteins and body weight.
  • Nutrition & Metabolism | Full text | Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal 19 January 2010 18:018 UTC www.nutritionandmetabolism.com [Source type: Academic]

^ If one excludes studies that probably included some people with IGT or where there was obvious poor matching of groups for factors known to affect insulin sensitivity ( e.g.
  • The Genetic Basis of Type 2 Diabetes Mellitus: Impaired Insulin Secretion versus Impaired Insulin Sensitivity -- Gerich 19 (4): 491 -- Endocrine Reviews 19 January 2010 18:018 UTC edrv.endojournals.org [Source type: Academic]

[22]

Accuracy of tests for early detection

If a 2-hour postload glucose level of at least 11.1 mmol/L (≥ 200 mg/dL) is used as the reference standard, the fasting plasma glucose > 7.0 mmol/L (126 mg/dL) diagnoses current diabetes with[20]:
A random capillary blood glucose > 6.7 mmol/L (120 mg/dL) diagnoses current diabetes with[23]:
.Glycosylated hemoglobin values that are elevated (over 5%), but not in the diabetic range (not over 7.0%) are predictive of subsequent clinical diabetes in US female health professionals.^ The following health professionals can diagnose diabetes: .
  • Type 2 Diabetes - Yahoo! Health 19 January 2010 18:018 UTC health.yahoo.com [Source type: General]

^ Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy.
  • Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement -- U.S. Preventive Services Task Force 148 (11): 846 -- Annals of Internal Medicine 17 September 2009 2:40 UTC www.annals.org [Source type: Academic]

^ The Health professional's guide to diabetes and exercise.
  • Diabetes Mellitus-Science Tracer Bullet-Library of Congress 19 January 2010 18:018 UTC www.loc.gov [Source type: Academic]

[24] .In this study, 177 of 1061 patients with glycosylated hemoglobin value less than 6% became diabetic within 5 years compared to 282 of 26281 patients with a glycosylated hemoglobin value of 6.0% or more.^ People with diabetes aim for a hemoglobin A 1C level of less than 7%.
  • Diabetes Mellitus: Diabetes Mellitus (DM): Merck Manual Home Edition 19 January 2010 18:018 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ More than 10 years diabetic 2.

^ More than 80% of patients have a family history of type 2 diabetes.
  • Narrative Review: Ketosis-Prone Type 2 Diabetes Mellitus - Health News - redOrbit 17 September 2009 2:40 UTC www.redorbit.com [Source type: Academic]

This equates to a glycosylated hemoglobin value of 6.0% or more having:

Benefit of early detection

.Since publication of the USPSTF statement, a randomized controlled trial of prescribing acarbose to patients with "high-risk population of men and women between the ages of 40 and 70 years with a body mass index (BMI), calculated as weight in kilograms divided by the square of height in meters, between 25 and 40. They were eligible for the study if they had IGT according to the World Health Organization criteria, plus impaired fasting glucose (a fasting plasma glucose concentration of between 100 and 140 mg/dL or 5.5 and 7.8 mmol/L) found a number needed to treat of 44 (over 3.3 years) to prevent a major cardiovascular event.^ NGT was defined as a fasting plasma glucose concentration <6.1 mmol/L ( 15 ).
  • Relationship between Gestational Diabetes Mellitus and Type 2 Diabetes: Evidence of Mitochondrial Dysfunction -- Weijers and Bekedam 53 (3): 377 -- Clinical Chemistry 19 January 2010 18:018 UTC intl.clinchem.org [Source type: Academic]

^ The difference of 0.5% corresponds to about 0.8 mmol/l in fasting plasma glucose concentration (table 6 ).
  • Randomised controlled trial of structured personal care of type 2 diabetes mellitus 19 January 2010 18:018 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial.
  • Diabetes Mellitus, Type 2: eMedicine Endocrinology 19 January 2010 18:018 UTC emedicine.medscape.com [Source type: Academic]

[25]
.Other studies have shown that lifestyle changes,[26] xenical[27] and metformin[28] can delay the onset of diabetes.^ A lifestyle intervention or metformin prevented or delayed the onset of type 2 diabetes in persons at risk .
  • Disease - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

^ On the other hand recent studies suggest, that a high percentage of cardiac patients present with newly diagnosed type 2 diabetes by use of oral glucose tolerance tests (OGTT) [ 24 - 26 ].
  • Cardiovascular Diabetology | Full text | Relevance of hemostatic risk factors on coronary morphology in patients with diabetes mellitus type 2 19 January 2010 18:018 UTC www.cardiab.com [Source type: Academic]

^ Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
  • Childhood Obesity and Type 2 Diabetes Mellitus -- Hannon et al. 116 (2): 473 -- Pediatrics 19 January 2010 18:018 UTC pediatrics.aappublications.org [Source type: Academic]
  • Progress in defining the molecular basis of type 2 diabetes mellitus through susceptibility-gene identification -- McCarthy 13 (Supplement 1): R33 -- Human Molecular Genetics 19 January 2010 18:018 UTC hmg.oxfordjournals.org [Source type: Academic]

Management

.Left untreated, diabetes mellitus type 2 is a chronic, progressive condition, but there are well-established treatments which can delay or prevent entirely the formerly inevitable consequences of the condition.^ Follow-up: Diabetes Mellitus, Type 2 .
  • Diabetes Mellitus, Type 2: eMedicine Endocrinology 19 January 2010 18:018 UTC emedicine.medscape.com [Source type: Academic]

^ Economic consequences of diabetes mellitus in the U.S. in 1997.
  • The prevention of type 2 diabetes mellitus: recent advances -- Younis et al. 97 (7): 451 -- QJM 19 January 2010 18:018 UTC qjmed.oxfordjournals.org [Source type: Academic]

^ Animal models of Type 2 diabetes mellitus .
  • Neonatal streptozotocin-induced rat model of Type 2 diabetes mellitus: A glance DK Arulmozhi, A Veeranjaneyulu, SL Bodhankar - Indian J Pharmacol 19 January 2010 18:018 UTC www.ijp-online.com [Source type: Academic]

.Often, the condition is viewed as progressive since poor management of blood sugar leads to a myriad of steadily worsening complications.^ The reduced circulation results in progressive vascular complications leading to diabetic retinopathy (referred to as diabetic blindness), peripheral neuropathy (resulting in numbness in the extremities and tingling in fingers and toes), poor wound healing, and erectile dysfunction.

^ Aggressive interventions with glycemic control, as well as lipid and blood pressure management, seem to have favorable effects on many complications of diabetes.

^ When ill, it may be necessary to check the blood sugar as often as 4 hourly.

.However, if blood sugar is properly maintained, then the condition is, in a limited sense, cured - that is, patients are at no heightened risk for neuropathy, blindness, or any other high blood sugar complication, though the underlying isssue, a tendency to hyperglycemia has not been addressed directly.^ Diabetes mellitus is a condition in which patients have high blood sugar.

^ Assess physical condition and limitations of the patient.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

^ High blood sugar (hyperglycemia).
  • OhioHealth - Type 2 diabetes in children 19 January 2010 18:018 UTC www.ohiohealth.com [Source type: General]
  • Type 2 diabetes 20 September 2009 1:53 UTC cnn.com [Source type: General]

.A study at UCLA in 2005 showed that the Pritikin Program of diet and exercise brought dramatic improvement to a group of diabetics and pre-diabetics in only three weeks, so that about half no longer met the criteria for the condition.^ Only about half of diabetics are advised to quit smoking.
  • Managing Cardiovascular Risk in Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC secure.pharmacytimes.com [Source type: Academic]

^ Diagnosis of type 2 diabetes was the only criterion for inclusion in this study, whereas exclusion criteria included diagnosis of type 1 diabetes, and presence of any of the following self-reported medical conditions: recent surgery, auto-immune diseases, acute or chronic infection and any other unrelated disease.
  • Cardiovascular Diabetology | Full text | Nitric oxide and superoxide dismutase modulate endothelial progenitor cell function in type 2 diabetes mellitus 19 January 2010 18:018 UTC www.cardiab.com [Source type: Academic]

^ Most people with diabetes develop some diabetic neuropathy over the years, but only about 13% to 15% have noticeable symptoms.
  • Type 2 Diabetes: Living With Complications - Yahoo! Health 20 September 2009 1:53 UTC health.yahoo.com [Source type: General]

[29] [30] [31]
There are two main goals of treatment:
  1. reduction of mortality and concomitant morbidity (from assorted diabetic complications)
  2. preservation of quality of life
.The first goal can be achieved through close glycemic control (i.e., to near 'normal' blood glucose levels); the reduction in severity of diabetic side effects has been very well demonstrated in several large clinical trials and is established beyond controversy.^ The key to treating type 2 diabetes is controlling blood sugar levels.
  • Type 2 Diabetes - Yahoo! Health 19 January 2010 18:018 UTC health.yahoo.com [Source type: General]

^ Difficulty controlling blood glucose Diabetic neuropathy ...
  • Diabetes-like symptoms - WrongDiagnosis.com 19 January 2010 18:018 UTC www.wrongdiagnosis.com [Source type: Academic]

^ (Source: excerpt from Diabetes Overview: NIDDK ) Diabetes is a disease in which blood glucose levels are above normal.
  • Diabetes-like symptoms - WrongDiagnosis.com 19 January 2010 18:018 UTC www.wrongdiagnosis.com [Source type: Academic]

.The second goal is often addressed (in developed countries) by support and care from teams of diabetic health workers (usually physician, PA, nurse, dietitian or a certified diabetic educator).^ Diabetes education and public health.

^ The team usually is composed of a physician, a registered dietitian, a nurse clinician, a social worker, and the patient and the family.
  • Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children -- Gahagan et al. 112 (4): e328 -- AAP Policy 19 January 2010 18:018 UTC aappolicy.aappublications.org [Source type: Academic]

^ Doctors, nurses, dietitians, chiropodists, optometrists and other healthcare workers all play a role in giving advice and checking on progress.
  • Type 2 Diabetes | Health | Patient UK 19 January 2010 18:018 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

.Endocrinologists, family practitioners, and general internists are the physician specialties most likely to treat people with diabetes.^ The New family cookbook for people with diabetes .
  • Diabetes Mellitus-Science Tracer Bullet-Library of Congress 19 January 2010 18:018 UTC www.loc.gov [Source type: Academic]

^ Most people with type 2 diabetes are overweight.
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]
  • Type 2 Diabetes 19 January 2010 18:018 UTC navarro.wgstudios.com [Source type: Academic]
  • Trinity, Texas - Type 2 Diabetes; Type 1 Diabetes Overview What you need ... 19 January 2010 18:018 UTC www.tmfhs.org [Source type: Academic]

^ Family medicine doctor General practitioner Internal medicine doctor Pediatrician Nurse practitioner Physician assistant Endocrinologist Exams and Tests .
  • Type 2 Diabetes - Yahoo! Health 19 January 2010 18:018 UTC health.yahoo.com [Source type: General]

.Knowledgeable patient participation is vital to clinical success, and so patient education is a crucial aspect of this effort.^ Patients with T1DM were selected to participate only when they had no clinical evidence of an autonomic neuropathy or any other complication affecting patients with diabetes.
  • PLoS Medicine: Defective Awakening Response to Nocturnal Hypoglycemia in Patients with Type 1 Diabetes Mellitus 19 January 2010 18:018 UTC www.plosmedicine.org [Source type: Academic]

^ Education should be tailored to patient's current knowledge, individual needs and risk factors.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

^ Primary prevention efforts by primary health care professionals are recommended in 2 arenas: 1) general community health promotion and health education and 2) clinically based activities.
  • Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children -- Gahagan et al. 112 (4): e328 -- AAP Policy 19 January 2010 18:018 UTC aappolicy.aappublications.org [Source type: Academic]

.Type 2 is initially treated by adjustments in diet and exercise, and by weight loss, most especially in obese patients.^ In most studies, type 2 diabetes has improved with weight loss.
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]
  • Type 2 Diabetes - [Alternative Medicine] 19 January 2010 18:018 UTC www.peacehealth.org [Source type: Academic]
  • Type 2 Diabetes 19 January 2010 18:018 UTC navarro.wgstudios.com [Source type: Academic]
  • Trinity, Texas - Type 2 Diabetes; Type 1 Diabetes Overview What you need ... 19 January 2010 18:018 UTC www.tmfhs.org [Source type: Academic]

^ Exercise — Regular exercise is also beneficial in type 2 diabetes, independent of weight loss.
  • Initial management of blood glucose in type 2 diabetes mellitus 19 January 2010 18:018 UTC www.uptodateinc.com [Source type: Academic]

^ Weight loss in severely obese subjects prevents progression of impaired glucose tolerance to type II diabetes.
  • Epidemiology of Type 2 Diabetes Mellitus 17 September 2009 2:40 UTC www.msdlatinamerica.com [Source type: Academic]

.The amount of weight loss which improves the clinical picture is sometimes modest (2–5 kg or 4.4-11 lb); this is almost certainly due to currently poorly understood aspects of fat tissue activity, for instance chemical signaling (especially in visceral fat tissue in and around abdominal organs).^ A modest amount of weight loss is a desirable side effect.
  • Childhood Obesity and Type 2 Diabetes Mellitus -- Hannon et al. 116 (2): 473 -- Pediatrics 19 January 2010 18:018 UTC pediatrics.aappublications.org [Source type: Academic]

^ The role of adipose tissue (fat) stems from the fact that the organ is active at secretion of cytokines, termed adipocytokines .

^ Others have shown that lifestyle changes that promote a modest weight loss of 10% of body weight improve lipid profiles and insulin sensitivity.
  • Childhood Obesity and Type 2 Diabetes Mellitus -- Hannon et al. 116 (2): 473 -- Pediatrics 19 January 2010 18:018 UTC pediatrics.aappublications.org [Source type: Academic]

.In many cases, such initial efforts can substantially restore insulin sensitivity.^ In many cases, such initial efforts can substantially restore insulin sensitivity.

^ The primary events are believed to be an initial deficit in insulin secretion and, in many patients, relative insulin deficiency in association with peripheral insulin resistance ( 16 , 17 ).
  • Type 2 Diabetes Mellitus: Update on Diagnosis, Pathophysiology, and Treatment -- Mahler and Adler 84 (4): 1165 -- Journal of Clinical Endocrinology & Metabolism 19 January 2010 18:018 UTC jcem.endojournals.org [Source type: Academic]

^ In such studies, the lack of treatment produced collapse of the HPO axis and secondary gonadal malfunction, but adequate insulin replacement restored normal conditions.
  • The hypothalamus-pituitary-ovary axis and type 1 diabetes mellitus: a mini review -- Arrais and Dib 21 (2): 327 -- Human Reproduction 19 January 2010 18:018 UTC humrep.oxfordjournals.org [Source type: Academic]

.In some cases strict diet can adequately control the glycemic levels.^ In adolescents with type 1 diabetes, increasing monounsaturated fats relative to other fats in the diet is associated with better control over blood sugar and cholesterol levels.
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]

^ People with diabetes must adjust their diet, exercise, and take drugs to control blood sugar levels.
  • Diabetes Mellitus: Diabetes Mellitus (DM): Merck Manual Home Edition 19 January 2010 18:018 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ For adequate control of blood glucose levels, the drugs should be taken 20 - 30 minutes before a meal.

.Diabetes education is an integral component of medical care.^ Standards of medical care in diabetes—2007.

^ Standards of Medical Care in Diabetes—2008.
  • Type 2 Diabetes Mellitus in Childhood: Obesity and Insulin Resistance -- Schwartz and Chadha 108 (9): 518 -- Journal of the American Osteopathic Association 17 September 2009 2:40 UTC www.jaoa.org [Source type: Academic]

^ Standards of Medical Care in Diabetes—2009.
  • Diabetes Type 2 - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC www.kosmix.com [Source type: FILTERED WITH BAYES]
  • Type 2 Diabetes - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC health.kosmix.com [Source type: FILTERED WITH BAYES]

.Among adults with diagnosed diabetes, 12% take both insulin and oral medications,19% take insulin only, 53% take oral medications only, and 15% do not take either insulin or oral medications.^ Diabetes can only be treated with medication.
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]

^ Also, the use of basal insulin either alone or in combination with an oral antidiabetic agent such as metformin provides considerable flexibility.
  • Insulin Therapy for Maximal Glycemic Control in Type 2 Diabetes Mellitus -- Spellman 107 (7): 260 -- Journal of the American Osteopathic Association 19 January 2010 18:018 UTC www.jaoa.org [Source type: Academic]

^ Some diabetes medications stimulate your pancreas to produce and release more insulin.
  • Type 2 diabetes 20 September 2009 1:53 UTC cnn.com [Source type: General]

[citation needed]

Goals

.Treatment goals for type 2 diabetic patients are related to effective control of blood glucose, blood pressure and lipids to minimize the risk of long-term consequences associated with diabetes.^ Patients with Type 1 diabetes were excluded from the analysis.
  • View Pathway: Type II diabetes mellitus 19 January 2010 18:018 UTC apropos.mcw.edu [Source type: Academic]

^ Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
  • Type 2 Diabetes Mellitus: Update on Diagnosis, Pathophysiology, and Treatment -- Mahler and Adler 84 (4): 1165 -- Journal of Clinical Endocrinology & Metabolism 19 January 2010 18:018 UTC jcem.endojournals.org [Source type: Academic]

^ Diabetes is a disease that is primarily controlled by the patient.
  • ISPUB - Adult Onset Type 1 Diabetes Mellitus Versus Type 2 Diabetes Mellitus: A Case Study 19 January 2010 18:018 UTC www.ispub.com [Source type: Academic]

.They are suggested in clinical practice guidelines released by various national and international diabetes agencies.^ Medical guidelines for clinical practice for the management of diabetes mellitus .
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

^ Despite this consensus, the current and previous studies 17 - 22 demonstrate that many patients with diabetes do not achieve this treatment target in clinical practice ( Box 2 ).
  • eMJA: Diabetes guidelines: easier to preach than to practise? 17 September 2009 2:40 UTC www.mja.com.au [Source type: Academic]

^ European guidelines on cardiovascular disease prevention in clinical practice.
  • eMJA: Diabetes guidelines: easier to preach than to practise? 17 September 2009 2:40 UTC www.mja.com.au [Source type: Academic]

The targets are:
In older patients, clinical practice guidelines by the American Geriatrics Society states "for frail older adults, persons with life expectancy of less than 5 years, and others in whom the risks of intensive glycemic control appear to outweigh the benefits, a less stringent target such as HbA1c of 8% is appropriate".[35]

Lifestyle modification

Exercise
In September 2007, a joint randomized controlled trial by the University of Calgary and the University of Ottawa found that "Either aerobic or resistance training alone improves glycemic control in type 2 diabetes, but the improvements are greatest with combined aerobic and resistance training than either alone."[36][37] The combined program reduced the HbA1c by 0.5 percentage point. .Other studies have established that the amount of exercise needed is not large or extreme, but must be consistent and continuing.^ Large amounts of DDT were sprayed all over the island and its metabolites continue to be detected in the food chain.
  • West Indian Medical Journal - Trends in the incidence of type I diabetes mellitus worldwide 19 January 2010 18:018 UTC caribbean.scielo.org [Source type: Academic]

^ A review of a large Finnish study of smokers concluded that smokers with diabetes (or hypertension ) can benefit from small amounts of vitamin E (50 IU per day).
  • Type 2 Diabetes - [Alternative Medicine] 19 January 2010 18:018 UTC www.peacehealth.org [Source type: Academic]
  • Type 2 Diabetes 19 January 2010 18:018 UTC navarro.wgstudios.com [Source type: Academic]
  • Trinity, Texas - Type 2 Diabetes; Type 1 Diabetes Overview What you need ... 19 January 2010 18:018 UTC www.tmfhs.org [Source type: Academic]

^ The long-term safety of the large amounts of vanadium needed to help people with type 2 diabetes (typically 100 mg per day) remains unknown.
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]
  • Type 2 Diabetes - [Alternative Medicine] 19 January 2010 18:018 UTC www.peacehealth.org [Source type: Academic]
  • Type 2 Diabetes 19 January 2010 18:018 UTC navarro.wgstudios.com [Source type: Academic]
  • Trinity, Texas - Type 2 Diabetes; Type 1 Diabetes Overview What you need ... 19 January 2010 18:018 UTC www.tmfhs.org [Source type: Academic]

.Examples might include a brisk 45 minute walk every other day.^ Exercise regularly, every day if you can or at least 3 times a week and 30 minutes for each session.

^ Subjects in both groups were recommended to walk for at least 30 minutes/day, and encouraged to increase their physical activity level in general.
  • WHFoods: Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.whfoods.com [Source type: Academic]

^ Examples of institutional support would include: donated equipment and space, institutional funded staff time and effort, or other resource investments.
  • RFA-HS-10-001: Recovery Act 2009 Limited Competition: Expansion of Research Capability to Study Comparative Effectiveness in Complex Patients (R24) 19 January 2010 18:018 UTC grants.nih.gov [Source type: Academic]

.Theoretically, exercise does have benefits in that exercise would stimulate the release of certain ligands that cause GLUT4 to be released from internal endosomes to the cell membrane.^ The activation of Ang II would be associated with the activation of the membranous NAD(P)H oxidase enzyme and generation of superoxide with its effect on endothelial cell dysfunction and uncoupling of the eNOS reaction.
  • Nutrition Journal | Full text | Homocysteine and reactive oxygen species in metabolic syndrome, type 2 diabetes mellitus, and atheroscleropathy: The pleiotropic effects of folate supplementation 19 January 2010 18:018 UTC www.nutritionj.com [Source type: Academic]

^ Stimulation of PPAR probably causes an increase in the production of key glucose transporters GLUT1 and GLUT4.
  • The Pharmacological Reduction of Blood Glucose in Patients With Type 2 DiabetesMellitus 19 January 2010 18:018 UTC journal.diabetes.org [Source type: Academic]

^ Mistletoe extract has been shown to stimulate insulin release from pancreas cells, 257 and animal research found that it reduces symptoms of diabetes.
  • Trinity, Texas - Type 2 Diabetes; Type 1 Diabetes Overview What you need ... 19 January 2010 18:018 UTC www.tmfhs.org [Source type: Academic]

.Insulin though, which no longer works effectively in those afflicted with type 2 diabetes, causes GLUT1 to be placed into the membrane.^ What causes type 2 diabetes?
  • Type 2 Diabetes - Yahoo! Health 19 January 2010 18:018 UTC health.yahoo.com [Source type: General]

^ Insulin 1st-Line for Type 2 Diabetes?
  • Type 2 Diabetes | LIVESTRONG.COM 19 January 2010 18:018 UTC www.livestrong.com [Source type: General]

^ However, they are not effective in type 1 diabetes.
  • Diabetes Mellitus: Diabetes Mellitus (DM): Merck Manual Home Edition 19 January 2010 18:018 UTC www.merck.com [Source type: FILTERED WITH BAYES]

.Though they have different structures, they both perform the same function of increasing intake of glucose into the cell from the blood serum[citation needed].^ White blood cell function is impaired.
  • Diabetes Mellitus: Diabetes Mellitus (DM): Merck Manual Home Edition 19 January 2010 18:018 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ Insulin is needed to move blood sugar (glucose) into cells, where it is ...
  • Diabetes Type 2 - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC www.kosmix.com [Source type: FILTERED WITH BAYES]
  • Type 2 Diabetes - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC health.kosmix.com [Source type: FILTERED WITH BAYES]

^ Increases blood glucose level .
  • Management of Hospitalized Patients with Type 2 Diabetes Mellitus -American Family Physician - March 1, 1998 19 January 2010 18:018 UTC www.aafp.org [Source type: Academic]

Exercise also allows for the uptake of glucose independently of insulin, i.e. by adrenaline.
Dietary management
.Modifying the diet to limit and control glucose (or glucose equivalent, e.g., starch) intake, and in consequence, blood glucose levels, is known to assist type 2 patients, especially early in the course of the condition's progression.^ The key to treating type 2 diabetes is controlling blood sugar levels.
  • Type 2 Diabetes - Yahoo! Health 19 January 2010 18:018 UTC health.yahoo.com [Source type: General]

^ Approach to controlling blood glucose levels includes: .

^ For example, birth control pills can raise blood glucose levels.

.Additionally, weight loss is recommended and is often helpful in persons suffering from type 2 diabetes (see above).^ Type 2 diabetes is often associated with insulin resistance and weight gain.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

^ Type 2 diabetes : See Diabetes , type 2 .
  • Diabetes Type 2 - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC www.kosmix.com [Source type: FILTERED WITH BAYES]
  • Type 2 Diabetes - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC health.kosmix.com [Source type: FILTERED WITH BAYES]

^ Weight loss : Many people with type 2 diabetes are overweight.
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]

.Several dietary modifications using dietary supplements are sometimes recommended to those with type 2; there are studies suggesting that there is some beneficial effect for some of these.^ There are several types.
  • Diabetes Mellitus: Diabetes Mellitus (DM): Merck Manual Home Edition 19 January 2010 18:018 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ On the other hand recent studies suggest, that a high percentage of cardiac patients present with newly diagnosed type 2 diabetes by use of oral glucose tolerance tests (OGTT) [ 24 - 26 ].
  • Cardiovascular Diabetology | Full text | Relevance of hemostatic risk factors on coronary morphology in patients with diabetes mellitus type 2 19 January 2010 18:018 UTC www.cardiab.com [Source type: Academic]

^ Some studies reported higher ambulatory BP in patients with MetS, but these patients were older and had higher clinical BP than those without MetS. With regard to the circadian BP profile, contrasting data have been reported, although pooled data suggest a higher risk of nondipping in patients with MetS. Effects of n-3 fatty acids on macro- and microvascular function in subjects with Type 2 diabetes mellitus .
  • View Pathway: Type II diabetes mellitus 19 January 2010 18:018 UTC apropos.mcw.edu [Source type: Academic]

See the discussion below.[citation needed]

Monitoring of blood glucose

.Self-monitoring of blood glucose may not improve outcomes in some cases, that is among "reasonably well controlled non-insulin treated patients with type 2 diabetes".[38] Nevertheless, it is very strongly recommended for patients in whom it can assist in maintaining proper glycemic control, and is well worth the cost (sometimes considerable) if it does.^ Newer agents for blood glucose control in type 2 diabetes: summary of NICE guidance .
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

^ Recruiting Bologna A Study of Taspoglutide versus Pioglitazone in Patients With Type 2 Diabetes Recruiting Catania Intensive self-monitoring blood glucose management added value in non-insulin treated type 2 diabetes mellitus patients.
  • Disease Category Listing By Location Diabetes Mellitus, Type 2 17 September 2009 2:40 UTC roche-trials.com [Source type: Academic]

^ The concept of aspirin resistance is evolving and some patients with diabetes may be aspirin-resistant.

.It is the only source of current information on the glycemic state of the body, as changes are rapid and frequent, depending on food, exercise, and medication (dosage and timing with respect to both diet and exercise), and secondarily, on time of day, stress (mental and physical), infection, etc.^ Modifiable factors, including reductions in physical activity, dietary changes, and increased frequency of testing, may play a role in the increasing prevalence of diabetes (3) .
  • Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement -- U.S. Preventive Services Task Force 148 (11): 846 -- Annals of Internal Medicine 17 September 2009 2:40 UTC www.annals.org [Source type: Academic]

^ Medical nutrition therapy Increased physical exercise Pharmacotherapy Beneficial effects of statins on cardiovascular risk reduction may, in part, be independent of their effects on lipids.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

^ Decreasing body weight by 5 to 10 % through diet and exercise can significantly reduce the risk of developing future diabetes.
  • Diabetes Mellitus: Diabetes Mellitus (DM): Merck Manual Home Edition 19 January 2010 18:018 UTC www.merck.com [Source type: FILTERED WITH BAYES]

.The National Institute for Health and Clinical Excellence (NICE), UK released updated diabetes recommendations on 30 May 2008. They indicate that self-monitoring of blood glucose levels for people with newly diagnosed type 2 diabetes should be part of a structured self-management education plan.^ Newer agents for blood glucose control in type 2 diabetes: summary of NICE guidance .
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

^ Management of type 2 diabetes: summary of updated NICE guidance .
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

^ Clinical Practice Recommendations 2008.
  • Type 2 Diabetes: Living With Complications - Yahoo! Health 20 September 2009 1:53 UTC health.yahoo.com [Source type: General]

[39] .However, a recent study found that a treatment strategy of intensively lowering blood sugar levels (below 6%) in patients with additional cardiovascular disease risk factors poses more harm than benefit, and so there appear to be limits to benefit of intensive blood glucose control in some patients.^ Relationship to cardiovascular risk factors: the Insulin Resistance Atherosclerosis Study.
  • Diabetes Mellitus, Type 2: eMedicine Endocrinology 19 January 2010 18:018 UTC emedicine.medscape.com [Source type: Academic]

^ The more active your child is, the lower his or her blood sugar level.
  • OhioHealth - Type 2 diabetes in children 19 January 2010 18:018 UTC www.ohiohealth.com [Source type: General]

^ Review: Interventions that lower cholesterol levels or blood pressure in diabetic patients prevent cardiovascular disease .
  • Disease - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

[40][41]

Medications

Metformin 500mg tablets
.There are several drugs available for type 2 diabetics—most are unsuitable or even dangerous for use by type 1 diabetics.^ There are several types.
  • Diabetes Mellitus: Diabetes Mellitus (DM): Merck Manual Home Edition 19 January 2010 18:018 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ There are four types of diabetes mellitus.
  • Diabetes Mellitus-Science Tracer Bullet-Library of Congress 19 January 2010 18:018 UTC www.loc.gov [Source type: Academic]

^ Most people with type 2 diabetes are overweight.
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]
  • Type 2 Diabetes - [Alternative Medicine] 19 January 2010 18:018 UTC www.peacehealth.org [Source type: Academic]
  • Type 2 Diabetes 19 January 2010 18:018 UTC navarro.wgstudios.com [Source type: Academic]
  • Trinity, Texas - Type 2 Diabetes; Type 1 Diabetes Overview What you need ... 19 January 2010 18:018 UTC www.tmfhs.org [Source type: Academic]

.They fall into several classes and are not equivalent, nor can they be simply substituted one for another.^ Fall into one of the AHRQ identified evidence gaps.
  • RFA-HS-10-001: Recovery Act 2009 Limited Competition: Expansion of Research Capability to Study Comparative Effectiveness in Complex Patients (R24) 19 January 2010 18:018 UTC grants.nih.gov [Source type: Academic]
  • RFA-HS-10-005: ARRA-AHRQ Recovery Act 2009 Limited Competition: PROSPECT Studies: Building New Clinical Infrastructure for Comparative Effectiveness Research (R01) 19 January 2010 18:018 UTC grants.nih.gov [Source type: Academic]

^ In addition, she had previously experienced one episode of severe hypoglycemia (requiring a subcutaneous injection of glucagon by another person).
  • PLoS Medicine: Defective Awakening Response to Nocturnal Hypoglycemia in Patients with Type 1 Diabetes Mellitus 19 January 2010 18:018 UTC www.plosmedicine.org [Source type: Academic]

All are prescription drugs.
.One of the most widely used drugs now used for type 2 diabetes is the biguanide metformin; it works primarily by reducing liver release of blood glucose from glycogen stores and secondarily by provoking some increase in cellular uptake of glucose in body tissues.^ Increases glucose uptake by muscle .
  • Management of Hospitalized Patients with Type 2 Diabetes Mellitus -American Family Physician - March 1, 1998 19 January 2010 18:018 UTC www.aafp.org [Source type: Academic]

^ Most people with type 2 diabetes are overweight.
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]
  • Type 2 Diabetes - [Alternative Medicine] 19 January 2010 18:018 UTC www.peacehealth.org [Source type: Academic]
  • Type 2 Diabetes 19 January 2010 18:018 UTC navarro.wgstudios.com [Source type: Academic]

^ Type 2 diabetes is the most common form of diabetes .
  • Type 2 Diabetes - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC health.kosmix.com [Source type: FILTERED WITH BAYES]

.Both historically, and currently, the most commonly used drugs are in the Sulfonylurea group, of which several members (including glibenclamide and gliclazide) are widely used; these increase glucose stimulated insulin secretion by the pancreas and so lower blood glucose even in the face of insulin resistance.^ Both nonpharmacologic and pharmacologic therapies are used to reduce insulin resistance.
  • Treatment of Type 2 Diabetes Mellitus - May 15, 1999 - American Academy of Family Physicians 17 September 2009 2:40 UTC www.aafp.org [Source type: Academic]

^ Metformin (Glucophage®) is a member of this class and is currently the most widely prescribed insulin-sensitizing drug in current clinical use.

^ Sulfonylureas are oral drugs that stimulate the pancreas to release insulin.

Newer drug classes include:
.
  • Thiazolidinediones (TZDs) (rosiglitazone, pioglitazone, and troglitazone -- the last, as Rezulin, was withdrawn from the US market because of an increased risk of systemic acidosis).^ The thiazolidinediones (rosiglitazone and pioglitazone) reduce glucose production by the liver and increase glucose uptake by muscle, reducing the availability of glucose precursors for hepatic glucose production.
    • Childhood Obesity and Type 2 Diabetes Mellitus -- Hannon et al. 116 (2): 473 -- Pediatrics 19 January 2010 18:018 UTC pediatrics.aappublications.org [Source type: Academic]

    ^ Until recently, the agents in this drug class approved by the U.S. Food and Drug Administration (FDA) included troglitazone (Rezulin), rosiglitazone (Avandia) and pioglitazone (Actos).
    • Oral Agents in the Management of Type 2 Diabetes Mellitus - May 1, 2001 - American Family Physician 17 September 2009 2:40 UTC www.aafp.org [Source type: Academic]

    ^ Thiazolidinediones, such as pioglitazone and rosiglitazone, are agents that increase peripheral insulin sensitivity by increasing transcription of peroxisome proliferator-activated receptor- that helps increase uptake of glucose, probably with effects on free fatty acid levels.
    • Type 2 Diabetes Mellitus in Childhood: Obesity and Insulin Resistance -- Schwartz and Chadha 108 (9): 518 -- Journal of the American Osteopathic Association 17 September 2009 2:40 UTC www.jaoa.org [Source type: Academic]

    .These increase tissue insulin sensitivity by affecting gene expression
  • α-glucosidase inhibitors (acarbose and miglitol) which interfere with absorption of some glucose containing nutrients, reducing (or at least slowing) the amount of glucose absorbed
  • Meglitinides which stimulate insulin release (nateglinide, repaglinide, and their analogs) quickly; they can be taken with food, unlike the sulfonylureas which must be taken prior to food (sometimes some hours before, depending on the drug)
  • Peptide analogs which work in a variety of ways:
    • Incretin mimetics which increase insulin output from the beta cells among other effects.^ Thus, like sulfonylureas, repaglinide reduces blood glucose levels by stimulating insulin release from the pancreas.
      • The Pharmacological Reduction of Blood Glucose in Patients With Type 2 DiabetesMellitus 19 January 2010 18:018 UTC journal.diabetes.org [Source type: Academic]

      ^ Sulfonylureas are oral drugs that stimulate the pancreas to release insulin.

      ^ Hypoglycemic Agents Pharmacotherapy can be used to decrease blood glucose by increasing insulin secretion, increasing insulin action, decreasing hepatic glucose output, decreasing nutrient absorption, or sensitizing tissue to insulin.
      • Type 2 Diabetes Mellitus in Childhood: Obesity and Insulin Resistance -- Schwartz and Chadha 108 (9): 518 -- Journal of the American Osteopathic Association 17 September 2009 2:40 UTC www.jaoa.org [Source type: Academic]

      These includes the Glucagon-like peptide (GLP) analog exenatide, sometimes referred to as lizard spit as it was first identified in Gila monster saliva
    • Dipeptidyl peptidase-4 (DPP-4) inhibitors increase Incretin levels (sitagliptin) by decreasing their deactivation rates
    • Amylin agonist analog, which slows gastric emptying and suppresses glucagon (pramlintide)

Oral

.A systematic review of randomized controlled trials found that metformin and second-generation sulfonylureas are the preferred choices for most with type 2 diabetes, especially those early in the course of the condition.^ Cardiovascular outcomes in trials of oral diabetes medications: a systematic review.

^ Diabetes Control and Complications Trial (1993) .
  • Methods for achieving stable normoglycemia during an educational camp for youth with type 1 diabetes mellitus 19 January 2010 18:018 UTC www.continents.com [Source type: Academic]

^ UKPDS 28: a randomized trial of efficacy of early addition of metformin in sulfonylurea-treated type 2 diabetes.
  • Diabetes Mellitus, Type 2: eMedicine Endocrinology 19 January 2010 18:018 UTC emedicine.medscape.com [Source type: Academic]
  • Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children -- Gahagan et al. 112 (4): e328 -- AAP Policy 19 January 2010 18:018 UTC aappolicy.aappublications.org [Source type: Academic]

[42] .Failure of response after a time is not unknown with most of these agents: the initial choice of anti-diabetic drug has been compared in a randomized controlled trial which found "cumulative incidence of monotherapy failure at 5 years to be 15% with rosiglitazone, 21% with metformin, and 34% with glyburide".[43] Of these, rosiglitazone users showed more weight gain and edema than did non-users.^ Diabetes Control and Complications Trial (1993) .
  • Methods for achieving stable normoglycemia during an educational camp for youth with type 1 diabetes mellitus 19 January 2010 18:018 UTC www.continents.com [Source type: Academic]

^ These drugs do not cause hypoglycemia or weight gain.
  • Current Therapeutic Options in Type 2 Diabetes Mellitus: A Practical Approach -- Sheehan 1 (3): 189 -- Clinical Medicine & Research 19 January 2010 18:018 UTC www.clinmedres.org [Source type: Academic]

^ Therefore, glyburide and insulin are the agents for which this component of weight gain can be substantial.
  • Current Therapeutic Options in Type 2 Diabetes Mellitus: A Practical Approach -- Sheehan 1 (3): 189 -- Clinical Medicine & Research 19 January 2010 18:018 UTC www.clinmedres.org [Source type: Academic]

[43] .Rosiglitazone may increase risk of death from cardiovascular causes though the causal connection is unclear.^ Rosiglitazone may also increase the risk for heart attack.

^ Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes.

^ Medical nutrition therapy Increased physical exercise Pharmacotherapy Beneficial effects of statins on cardiovascular risk reduction may, in part, be independent of their effects on lipids.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

[44] .Pioglitazone and rosiglitazone may also increase the risk of fractures.^ Rosiglitazone may also increase the risk for heart attack.

^ Rosiglitazone may increase the risk of heart problems.
  • Type 2 Diabetes | LIVESTRONG.COM 19 January 2010 18:018 UTC www.livestrong.com [Source type: General]

^ Medical nutrition therapy Increased physical exercise Pharmacotherapy Beneficial effects of statins on cardiovascular risk reduction may, in part, be independent of their effects on lipids.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

[45][46]
.For patients who also have heart failure, metformin may be the best tolerated drug.^ Continuation of both the SU and metformin may be best in these patients.
  • Current Therapeutic Options in Type 2 Diabetes Mellitus: A Practical Approach -- Sheehan 1 (3): 189 -- Clinical Medicine & Research 19 January 2010 18:018 UTC www.clinmedres.org [Source type: Academic]

^ Metformin is contraindicated in patients with heart failure treated with medication.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

^ Patients with heart failure should not use them.

[47]
.The variety of available agents can be confusing, and the clinical differences among type 2 diabetes patients compounds the problem.^ Patients with Type 1 diabetes were excluded from the analysis.
  • View Pathway: Type II diabetes mellitus 19 January 2010 18:018 UTC apropos.mcw.edu [Source type: Academic]

^ Patients with a diabetes type 1 were not included in the study.
  • Cardiovascular Diabetology | Full text | Relevance of hemostatic risk factors on coronary morphology in patients with diabetes mellitus type 2 19 January 2010 18:018 UTC www.cardiab.com [Source type: Academic]

^ Diabetic neuropathy can lead to a variety of problems.
  • Type 2 Diabetes: Living With Complications - Yahoo! Health 20 September 2009 1:53 UTC health.yahoo.com [Source type: General]

.At present, choice of drugs for type 2 diabetics is rarely straightforward and in most instances has elements of repeated trial and adjustment.^ Most people with type 2 diabetes are overweight.
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]
  • Type 2 Diabetes 19 January 2010 18:018 UTC navarro.wgstudios.com [Source type: Academic]
  • Trinity, Texas - Type 2 Diabetes; Type 1 Diabetes Overview What you need ... 19 January 2010 18:018 UTC www.tmfhs.org [Source type: Academic]

^ Type 2 diabetes is the most common form of diabetes .
  • Type 2 Diabetes - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC health.kosmix.com [Source type: FILTERED WITH BAYES]

^ Type 2 diabetes is the most common form of diabetes.
  • Diabetes Type 2 - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC www.kosmix.com [Source type: FILTERED WITH BAYES]
  • Type 2 Diabetes - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC health.kosmix.com [Source type: FILTERED WITH BAYES]

Injectable peptide analogs

.DPP-4 inhibitors lowered HbA1c by 0.74% (points), comparable to other antidiabetic drugs.^ Alpha-glucosidase inhibitors do not cause hypoglycemia when used alone, but combinations with other drugs do.

^ However, unlike exenatide, which is given by injection, DPP-4 inhibitor drugs are taken as pills by mouth.

^ When comparing our study group with other groups in published studies, the gestational age is much lower and the percentage of planned pregnancies is higher in our study group.
  • Pregnancy Outcome in Type 2 Diabetes Mellitus: A Retrospective Analysis from the Netherlands 19 January 2010 18:018 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[48] .GLP-1 analogs resulted in weight loss and had more gastrointestinal side effects, while DPP-4 inhibitors were weight neutral and increased risk for infection and headache, but both classes appear to present an alternative to other antidiabetic drugs.^ Side effects include diarrhea and headache.

^ This would lead to a reduction in ATP production and, therefore, an increase in the level of AMP and as a result activation of AMPK. In fact, since the cells of the gut will see the highest doses of metformin they will experience the greatest level of inhibited complex I which may explain the gastrointestinal side effects (nausea, diarrhea, anorexia) of the drug that limit its utility in many patients.

^ First, metformin dosages beyond 1,000 mg twice daily will unlikely offer further benefit and may increase the risk of gastrointestinal side effects that could potentially result in the discontinuation of this extremely useful agent.
  • Current Therapeutic Options in Type 2 Diabetes Mellitus: A Practical Approach -- Sheehan 1 (3): 189 -- Clinical Medicine & Research 19 January 2010 18:018 UTC www.clinmedres.org [Source type: Academic]

Insulin

.In rare cases, if antidiabetic drugs fail (i.e., the clinical benefit stops), insulin therapy may be necessary – usually in addition to oral medication therapy – to maintain normal or near normal glucose levels.^ Triple oral therapy or insulin initiation?
  • Current Therapeutic Options in Type 2 Diabetes Mellitus: A Practical Approach -- Sheehan 1 (3): 189 -- Clinical Medicine & Research 19 January 2010 18:018 UTC www.clinmedres.org [Source type: Academic]

^ Thiazolidinediones are usually taken in combination with other oral drugs or insulin.

^ Achieve near-normal blood glucose levels.

[49][50]
.Typical total daily dosage of insulin is 0.6 U/kg.^ Both the incidence of edema and amount of total weight gain with TZDs increases from monotherapy (4%, 1 to 3 kg) to combination with SU (6%, 2 to 2.5 kg) to combination with insulin (15%, 4 to 5.4 kg) (rosiglitazone package insert).
  • Current Therapeutic Options in Type 2 Diabetes Mellitus: A Practical Approach -- Sheehan 1 (3): 189 -- Clinical Medicine & Research 19 January 2010 18:018 UTC www.clinmedres.org [Source type: Academic]

^ If insulin is used to replace oral medications taken at home, it should be initiated at a total daily dosage of 0.5 to 0.75 units per kg, given in divided dosea.
  • Management of Hospitalized Patients with Type 2 Diabetes Mellitus -American Family Physician - March 1, 1998 19 January 2010 18:018 UTC www.aafp.org [Source type: Academic]

^ A suggested starting dosage of regular insulin in insulin-naive patients is approximately 0.1 unit per kg given every four or six hours.
  • Management of Hospitalized Patients with Type 2 Diabetes Mellitus -American Family Physician - March 1, 1998 19 January 2010 18:018 UTC www.aafp.org [Source type: Academic]

[51] .But, of course, best timing and indeed total amounts depend on diet (composition, amount, and timing) as well the degree of insulin resistance.^ It is ideally suited for obese patients with type 2 diabetes who are unresponsive to diet alone and are presumed to be insulin resistant.
  • Type 2 Diabetes Mellitus: Update on Diagnosis, Pathophysiology, and Treatment -- Mahler and Adler 84 (4): 1165 -- Journal of Clinical Endocrinology & Metabolism 19 January 2010 18:018 UTC jcem.endojournals.org [Source type: Academic]

^ Gluud C, Madsbad S, Krarup T and Bennett P (1982) Plasma testosterone and androstenedione in insulin dependent patients at time of diagnosis and during the first year of insulin treatment.
  • The hypothalamus-pituitary-ovary axis and type 1 diabetes mellitus: a mini review -- Arrais and Dib 21 (2): 327 -- Human Reproduction 19 January 2010 18:018 UTC humrep.oxfordjournals.org [Source type: Academic]

^ No pronounced peak: small amounts of insulin are slowly released resulting in a relatively constant concentration/time profile over 24 hours.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

More complicated estimations to guide initial dosage of insulin are:[52]
  • For men, [(fasting plasma glucose [mmol/liter]–5)x2] x (weight [kg]÷(14.3xheight [m])–height [m])
  • For women, [(fasting plasma glucose [mmol/liter]–5)x2] x (weight [kg]÷(13.2xheight [m])–height [m])
.The initial insulin regimen are often chosen based on the patient's blood glucose profile.^ Daily for initiation of insulin or change in regimen .
  • Treatment of Type 2 Diabetes Mellitus - May 15, 1999 - American Academy of Family Physicians 17 September 2009 2:40 UTC www.aafp.org [Source type: Academic]

^ Patients should check blood sugars frequently when insulin is initiated.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

^ Recruiting Bologna A Study of Taspoglutide versus Pioglitazone in Patients With Type 2 Diabetes Recruiting Catania Intensive self-monitoring blood glucose management added value in non-insulin treated type 2 diabetes mellitus patients.
  • Disease Category Listing By Location Diabetes Mellitus, Type 2 17 September 2009 2:40 UTC roche-trials.com [Source type: Academic]

[53] .Initially, adding nightly insulin to patients failing oral medications may be best.^ Insulin may be added to oral agents when secondary failure occurs.
  • Diabetes Mellitus 19 January 2010 18:018 UTC www.sh.lsuhsc.edu [Source type: Academic]

^ Insulin may be administered alone or in combination with an oral medication.
  • http://www.mdguidelines.com/diabetes-mellitus-type-ii 19 January 2010 18:018 UTC www.mdguidelines.com [Source type: Academic]

^ Triple oral therapy or insulin initiation?
  • Current Therapeutic Options in Type 2 Diabetes Mellitus: A Practical Approach -- Sheehan 1 (3): 189 -- Clinical Medicine & Research 19 January 2010 18:018 UTC www.clinmedres.org [Source type: Academic]

[54] .Nightly insulin combines better with metformin than with sulfonylureas.^ Alcohol use may aggravate hypoglycemia caused by sulfonylureas or insulin and increase the risk of lactic acidosis in patients who use metformin.
  • Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children -- Gahagan et al. 112 (4): e328 -- AAP Policy 19 January 2010 18:018 UTC aappolicy.aappublications.org [Source type: Academic]

^ The options for pharmacologic treatment include insulin; oral hypoglycemic agents, especially metformin; and any combination thereof.
  • Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children -- Gahagan et al. 112 (4): e328 -- AAP Policy 19 January 2010 18:018 UTC aappolicy.aappublications.org [Source type: Academic]

^ Less nocturnal hypoglycemia and better post-dinner glucose control with bedtime insulin glargine compared with bedtime NPH insulin during insulin combination therapy in type 2 diabetes.
  • Current Therapeutic Options in Type 2 Diabetes Mellitus: A Practical Approach -- Sheehan 1 (3): 189 -- Clinical Medicine & Research 19 January 2010 18:018 UTC www.clinmedres.org [Source type: Academic]

[51] .The initial dose of nightly insulin (measured in IU/d) should be equal to the fasting blood glucose level (measured in mmol/L).^ The need for insulin supplementation should be determined by the blood glucose levels.
  • Management of Hospitalized Patients with Type 2 Diabetes Mellitus -American Family Physician - March 1, 1998 19 January 2010 18:018 UTC www.aafp.org [Source type: Academic]

^ Blood glucose levels before meals .

^ Insulin levels are especially relevant when fasting glucose and insulin levels do not show insulin resistance.
  • Type 2 Diabetes Mellitus in Childhood: Obesity and Insulin Resistance -- Schwartz and Chadha 108 (9): 518 -- Journal of the American Osteopathic Association 17 September 2009 2:40 UTC www.jaoa.org [Source type: Academic]

If the fasting glucose is reported in mg/dl, multiply by 0.05551 to convert to mmol/L.[55]
When nightly insulin is insufficient, choices include:
.
  • Premixed insulin with a fixed ratio of short and intermediate acting insulin; this tends to be more effective than long acting insulin, but is associated with increased hypoglycemia.^ Insulin therapy can cause further weight gain in obese type 2 diabetics and increase the risk of hypoglycemia (although less commonly than in type 1 diabetes) ( 109 ).
    • Type 2 Diabetes Mellitus: Update on Diagnosis, Pathophysiology, and Treatment -- Mahler and Adler 84 (4): 1165 -- Journal of Clinical Endocrinology & Metabolism 19 January 2010 18:018 UTC jcem.endojournals.org [Source type: Academic]

    ^ The positive benefits of physical activity include improved blood pressure values, improved lipid profile, improved cardiac status, increased insulin sensitivity, more effective weight management, and improved glycemic control, and it helps in the management of depressive symptoms.
    • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

    ^ Twelve patients were on an intensive conventional therapy regime with at least three injections of regular insulin and between one and two injections of long-acting insulin per day.
    • PLoS Medicine: Defective Awakening Response to Nocturnal Hypoglycemia in Patients with Type 1 Diabetes Mellitus 19 January 2010 18:018 UTC www.plosmedicine.org [Source type: Academic]

    [56][57].[58] .Initial total daily dosage of biphasic insulin can be 10 units if the fasting plasma glucose values are less than 180 mg/dl or 12 units when the fasting plasma glucose is above 180 mg/dl".[57] A guide to titrating fixed ratio insulin is available.^ A fasting blood sugar level less than 100 mg/dL is normal.
    • OhioHealth - Type 2 diabetes in children 19 January 2010 18:018 UTC www.ohiohealth.com [Source type: General]
    • Type 2 diabetes 20 September 2009 1:53 UTC cnn.com [Source type: General]

    ^ Fasting glucose level higher than 126 mg/dL on two occasions.

    ^ Fasting plasma glucose (optional) .
    • Treatment of Type 2 Diabetes Mellitus - May 15, 1999 - American Academy of Family Physicians 17 September 2009 2:40 UTC www.aafp.org [Source type: Academic]

    [53]
  • .
  • Long acting insulins such as insulin glargine and insulin detemir.^ A long-acting insulin, such as insulin glargine, is often used for type 2 diabetes in children.
    • OhioHealth - Type 2 diabetes in children 19 January 2010 18:018 UTC www.ohiohealth.com [Source type: General]

    ^ Twelve patients were on an intensive conventional therapy regime with at least three injections of regular insulin and between one and two injections of long-acting insulin per day.
    • PLoS Medicine: Defective Awakening Response to Nocturnal Hypoglycemia in Patients with Type 1 Diabetes Mellitus 19 January 2010 18:018 UTC www.plosmedicine.org [Source type: Academic]

    ^ Long-acting insulin glargine has an onset of action of two hours, reaches a plateau of action at four to six hours, and lasts up to 24 hours.
    • ISPUB - Adult Onset Type 1 Diabetes Mellitus Versus Type 2 Diabetes Mellitus: A Case Study 19 January 2010 18:018 UTC www.ispub.com [Source type: Academic]

    .A meta-analysis of randomized controlled trials by the Cochrane Collaboration found "only a minor clinical benefit of treatment with long-acting insulin analogues for patients with diabetes mellitus type 2".[59] More recently, a randomized controlled trial found that although long acting insulins were less effective, they were associated with reduced hypoglycemic episodes.^ Insulin algorithm for type 2 diabetes mellitus in children and adults.
    • Insulin Therapy for Maximal Glycemic Control in Type 2 Diabetes Mellitus -- Spellman 107 (7): 260 -- Journal of the American Osteopathic Association 19 January 2010 18:018 UTC www.jaoa.org [Source type: Academic]

    ^ Patients with Type 1 diabetes were excluded from the analysis.
    • View Pathway: Type II diabetes mellitus 19 January 2010 18:018 UTC apropos.mcw.edu [Source type: Academic]

    ^ Coffee consumption and serum lipids: a meta-analysis of randomized controlled clinical trials.
    • COFFEE: Uses, Side Effects, Interactions and Warnings - WebMD 19 January 2010 18:018 UTC www.webmd.com [Source type: Academic]

    [56]
  • .
  • Insulin Pump therapy in Type 2 diabetes is gradually becoming popular.In an original published study, in addition to reduction of blood sugars, there is evidence of profound benefits in resistant neuropathic pain and also improvements in sexual performance.^ Thus, insulin resistance is not a requirement for development of type 2 diabetes.
    • The Genetic Basis of Type 2 Diabetes Mellitus: Impaired Insulin Secretion versus Impaired Insulin Sensitivity -- Gerich 19 (4): 491 -- Endocrine Reviews 19 January 2010 18:018 UTC edrv.endojournals.org [Source type: Academic]

    ^ There are two main insulin types: .

    ^ Type 2 diabetes is often associated with insulin resistance and weight gain.
    • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

    [60]

Gastric bypass surgery

.Gastric Bypass procedures are currently considered an elective procedure with no universally accepted algorithm to decide who should have the surgery.^ A 40-year-old woman with diabetes contemplating pregnancy after gastric bypass surgery .
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

^ In no way should it be considered as offering medical advice.
  • Diabetes Mellitus, Type 2: eMedicine Endocrinology 19 January 2010 18:018 UTC emedicine.medscape.com [Source type: Academic]

.In the diabetic patient, certain types result in 99-100% prevention of insulin resistance and 80-90% clinical resolution or remission of type 2 diabetes.^ Patients with Type 1 diabetes were excluded from the analysis.
  • View Pathway: Type II diabetes mellitus 19 January 2010 18:018 UTC apropos.mcw.edu [Source type: Academic]

^ Preventing foot ulcers in patients with diabetes .
  • Disease - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

^ Thus, insulin resistance is not a requirement for development of type 2 diabetes.
  • The Genetic Basis of Type 2 Diabetes Mellitus: Impaired Insulin Secretion versus Impaired Insulin Sensitivity -- Gerich 19 (4): 491 -- Endocrine Reviews 19 January 2010 18:018 UTC edrv.endojournals.org [Source type: Academic]

.In 1991, the NIH (National Institutes of Health) Consensus Development Conference on Gastrointestinal Surgery for Obesity proposed that the body mass index (BMI) threshold to consider surgery should drop from 40 to 35 in the appropriate patient.^ Consensus development conference on insulin resistance.
  • Treatment of Type 2 Diabetes Mellitus - May 15, 1999 - American Academy of Family Physicians 17 September 2009 2:40 UTC www.aafp.org [Source type: Academic]

^ Are overweight (have a body mass index, or BMI , of 25 or higher).
  • Type 2 Diabetes - Yahoo! Health 19 January 2010 18:018 UTC health.yahoo.com [Source type: General]

^ Patients with one or more risk factors for foot complications should be educated about their risk factors and appropriate measures taken to avoid complications.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

.More recently, the American Society for Bariatric Surgery (ASBS) and the ASBS Foundation suggested that the BMI threshold be lowered to 30 in the presence of severe co-morbidities.^ Bariatric surgery has recently been discussed as an option for some individuals with type 2 diabetes who have a BMI of 35 kg/m 2 or more.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

^ In North American adults, drinking 6 or more cups of coffee per day is associated with a 54% lower risk of developing diabetes in men and a 29% lower risk in women.
  • COFFEE: Uses, Side Effects, Interactions and Warnings - WebMD 19 January 2010 18:018 UTC www.webmd.com [Source type: Academic]

^ Bariatric surgery If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery).
  • Type 2 diabetes 20 September 2009 1:53 UTC cnn.com [Source type: General]

[61] .Debate has flourished about the role of gastric bypass surgery in type 2 diabetics since the publication of The Swedish Obese Subjects Study.^ Gastric bypass surgery .
  • Type 2 Diabetes | LIVESTRONG.COM 19 January 2010 18:018 UTC www.livestrong.com [Source type: General]

^ Surgery is not a treatment for type 2 diabetes .
  • Type 2 Diabetes - Yahoo! Health 19 January 2010 18:018 UTC health.yahoo.com [Source type: General]

^ Learning about type 2 diabetes: .
  • Type 2 Diabetes - Yahoo! Health 19 January 2010 18:018 UTC health.yahoo.com [Source type: General]

.The largest prospective series showed a large decrease in the occurrence of type 2 diabetes in the post-gastric bypass patient at both 2 years (odds ratio was 0.14) and at 10 years (odds ratio was 0.25).^ Patients with Type 1 diabetes were excluded from the analysis.
  • View Pathway: Type II diabetes mellitus 19 January 2010 18:018 UTC apropos.mcw.edu [Source type: Academic]

^ But type 2 diabetes must be taken seriously.
  • OhioHealth - Type 2 diabetes in children 19 January 2010 18:018 UTC www.ohiohealth.com [Source type: General]

^ A microalbumin screening test should be done each year on patients with type 2 diabetes.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

[62]
.A study of 20-years of Greenville (US) gastric bypass patients found that 80% of those with type 2 diabetes before surgery no longer required insulin or oral agents to maintain normal glucose levels.^ Patients with Type 1 diabetes were excluded from the analysis.
  • View Pathway: Type II diabetes mellitus 19 January 2010 18:018 UTC apropos.mcw.edu [Source type: Academic]

^ Unlike patients with type 1 diabetes, those with type 2 diabetes have detectable levels of circulating insulin.

^ Bariatric surgery was cost-effective at 2 years for management of type 2 diabetes in obese patients .
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

.Weight loss occurred rapidly in many people in the study who had had the surgery.^ Weight loss : Many people with type 2 diabetes are overweight.
  • Diabetes: Treatment Options for Adult Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.naturaleyecare.com [Source type: FILTERED WITH BAYES]

^ Gastrointestinal adverse effects, such as abdominal discomfort and diarrhea, occur in approximately 20% to 30% of people who take metformin.
  • Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children -- Gahagan et al. 112 (4): e328 -- AAP Policy 19 January 2010 18:018 UTC aappolicy.aappublications.org [Source type: Academic]

^ The commonsense guide to weight loss for people with diabetes .
  • Diabetes Mellitus-Science Tracer Bullet-Library of Congress 19 January 2010 18:018 UTC www.loc.gov [Source type: Academic]

.The 20% who did not respond to bypass surgery were, typically, those who were older and had had diabetes for over 20 years.^ The NHIS self-reported diabetes diagnosed in each calendar year shows that incidence rates increased 18.2% from 1980 to 1996 ( 20 ).
  • Epidemiology of Type 2 Diabetes Mellitus 17 September 2009 2:40 UTC www.msdlatinamerica.com [Source type: Academic]

^ The prevalence of diabetes (diagnosed and undiagnosed) increases with age, reaching 21.6% for those 65 years of age or older.
  • Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement -- U.S. Preventive Services Task Force 148 (11): 846 -- Annals of Internal Medicine 17 September 2009 2:40 UTC www.annals.org [Source type: Academic]

^ Problems in attention and memory can occur even in people under age 55 who have had diabetes for a number of years.

[63]
.In January 2008, The Journal of the American Medical Association (JAMA) published the first randomized controlled trial comparing the efficacy of laparoscopic adjustable gastric banding against conventional medical therapy in the obese patient with type 2 diabetes.^ Patients with Type 1 diabetes were excluded from the analysis.
  • View Pathway: Type II diabetes mellitus 19 January 2010 18:018 UTC apropos.mcw.edu [Source type: Academic]

^ American Diabetes Association (2004).
  • Type 2 Diabetes - Yahoo! Health 19 January 2010 18:018 UTC health.yahoo.com [Source type: General]
  • Type 2 Diabetes: Living With Complications - Yahoo! Health 20 September 2009 1:53 UTC health.yahoo.com [Source type: General]

^ Role of orlistat in the treatment of obese patients with type 2 diabetes.
  • Diabetes Mellitus, Type 2: eMedicine Endocrinology 19 January 2010 18:018 UTC emedicine.medscape.com [Source type: Academic]

.Laparoscopic Adjustable Gastric Banding results in remission of type 2 diabetes among affected patients diagnosed within the previous two years according to a randomized controlled trial.^ Patients with Type 1 diabetes were excluded from the analysis.
  • View Pathway: Type II diabetes mellitus 19 January 2010 18:018 UTC apropos.mcw.edu [Source type: Academic]

^ A trial of nicotinamide in newly diagnosed patients with type 1 (insulin-dependent) diabetes mellitus.
  • Health: Type 1 Diabetes; Type 2 Diabetes Overview What you need to know ... 19 January 2010 18:018 UTC www.maimonidesmed.org [Source type: Academic]

^ Adjustable gastric banding improved glycemic control in obese patients with type 2 diabetes .
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

[64] .The relative risk reduction was 69.0%.^ In the subgroup of 782 patients with diabetes, the relative risk for a cardiovascular event was 0.84 (CI, 0.64 to 1.11) and the absolute risk reduction was 0.04 (CI, –0.02 to 0.09).
  • Lipid Control in the Management of Type 2 Diabetes Mellitus: A Clinical Practice Guideline from the American College of Physicians -- Snow et al. 140 (8): 644 -- Annals of Internal Medicine 17 September 2009 2:40 UTC www.annals.org [Source type: Academic]

^ Aggressive LDL cholesterol lowering led to a relative risk of 0.53 (CI, 0.18 to 1.60) and an absolute risk reduction of 0.12 (CI, –0.03 to 0.27).
  • Lipid Control in the Management of Type 2 Diabetes Mellitus: A Clinical Practice Guideline from the American College of Physicians -- Snow et al. 140 (8): 644 -- Annals of Internal Medicine 17 September 2009 2:40 UTC www.annals.org [Source type: Academic]

^ Of note, the results of ALLHAT-LLT are included in the pooled estimates of relative risk but not those of absolute risk reduction because the latter data were not available.
  • Lipid Control in the Management of Type 2 Diabetes Mellitus: A Clinical Practice Guideline from the American College of Physicians -- Snow et al. 140 (8): 644 -- Annals of Internal Medicine 17 September 2009 2:40 UTC www.annals.org [Source type: Academic]

.For patients at similar risk to those in this study (87.0% had type 2), this leads to an absolute risk reduction of 60%.^ Wagner AM, Perez A, Calvo F. Apolipoprotein(B) identifies dyslipidemic phenotypes associated with cardiovascular risk in normocholesterolemic type 2 diabetic patients.
  • Diabetes Mellitus, Type 2: eMedicine Endocrinology 19 January 2010 18:018 UTC emedicine.medscape.com [Source type: Academic]

^ Sex differences in risk factors for incident type 2 diabetes mellitus: the MONICA Augsburg cohort study .
  • Disease - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

^ The studies, however, were of relatively weak design, and pharmacotherapy for weight loss cannot be recommended for most patients with type 2 diabetes.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

.1.7 patients must be treated for one to benefit (number needed to treat = 1.7).^ However, because of the greater absolute risk among patients with known coronary artery disease, the pooled absolute risk reduction was more than twice as high (0.07 [CI, 0.03 to 0.12]) and the number needed to treat for benefit was only 13.8 for a weighted trial average of 4.9 years.
  • Lipid Control in the Management of Type 2 Diabetes Mellitus: A Clinical Practice Guideline from the American College of Physicians -- Snow et al. 140 (8): 644 -- Annals of Internal Medicine 17 September 2009 2:40 UTC www.annals.org [Source type: Academic]

^ Before we go into details of these complications, there is one very important message that we must get across to you as patients and members of the public.

^ If the patient has a history of severe hypoglycemia (assistance of another person was needed to treat a low sugar) or has developed hypoglycemia unawareness, evaluate the treatment goals for appropriate safety.
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

.Click here to adjust these results for patients at higher or lower risk of type 2 diabetics.^ Patients with Type 1 diabetes were excluded from the analysis.
  • View Pathway: Type II diabetes mellitus 19 January 2010 18:018 UTC apropos.mcw.edu [Source type: Academic]

^ Patients with type 2 diabetes have twice the average risk of suffering a stroke [R] .
  • NGC - NGC Summary 19 January 2010 18:018 UTC www.guideline.gov [Source type: Academic]

^ Risk factors for Type 2 diabetes ; Diabetes risk factors You have a higher risk for diabetes if you have any of the following: ...
  • Diabetes Type 2 - Kosmix : Reference, Videos, Images, News, Shopping and more... 19 January 2010 18:018 UTC www.kosmix.com [Source type: FILTERED WITH BAYES]

.These results have not yet produced a clinical standard for surgical treatment of Type 2 patients, as the mechanism, if any, is currently obscure.^ Because these two types of fiber have slightly different actions in the body, it's important for diabetic patients to get a good mix of both.
  • WHFoods: Type 2 Diabetes Mellitus 19 January 2010 18:018 UTC www.whfoods.com [Source type: Academic]

^ Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
  • Current Therapeutic Options in Type 2 Diabetes Mellitus: A Practical Approach -- Sheehan 1 (3): 189 -- Clinical Medicine & Research 19 January 2010 18:018 UTC www.clinmedres.org [Source type: Academic]

^ These efforts will result in identifying youth who are at increased risk of type 2 diabetes mellitus and have the potential to benefit from primary prevention interventions.
  • Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children -- Gahagan et al. 112 (4): e328 -- AAP Policy 19 January 2010 18:018 UTC aappolicy.aappublications.org [Source type: Academic]

.Surgical cure of Type 2 diabetes must be, as a result, considered currently experimental.^ But type 2 diabetes must be taken seriously.
  • OhioHealth - Type 2 diabetes in children 19 January 2010 18:018 UTC www.ohiohealth.com [Source type: General]

^ Until results of current prevention trials with oral hypoglycemic agents in youth are available, intervention using glucose-lowering drugs for prevention of diabetes is not recommended.
  • Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children -- Gahagan et al. 112 (4): e328 -- AAP Policy 19 January 2010 18:018 UTC aappolicy.aappublications.org [Source type: Academic]

^ There currently is no definitive diagnostic tool to differentiate between type 1 and type 2 diabetes mellitus.
  • Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children -- Gahagan et al. 112 (4): e328 -- AAP Policy 19 January 2010 18:018 UTC aappolicy.aappublications.org [Source type: Academic]

Epidemiology

.About 90–95% of all North American cases of diabetes are type 2,[65] and about 20% of the population over the age of 65 has diabetes mellitus type 2. The fraction of type 2 diabetics in other parts of the world varies substantially, almost certainly for environmental and lifestyle reasons, though these are not known in detail.^ Only about 10% of all people with diabetes have type 1 disease.
  • Diabetes Mellitus: Diabetes Mellitus (DM): Merck Manual Home Edition 19 January 2010 18:018 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ There are four types of diabetes mellitus.
  • Diabetes Mellitus-Science Tracer Bullet-Library of Congress 19 January 2010 18:018 UTC www.loc.gov [Source type: Academic]

^ Type 2 diabetes is the most common form of diabetes, accounting for 90 - 95% of cases.

Diabetes affects over 150 million people worldwide and this number is expected to double by 2025.[65]
.According to CDC, about 23.613 million people in the United States, or 8% of the population, have diabetes.^ Incidence of diabetes in youth in the United States .
  • Public - Diabetes Mellitus, Type 2 - Resources 17 September 2009 2:40 UTC pier.acponline.org [Source type: Academic]

^ CDC growth charts: United States.
  • Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children -- Gahagan et al. 112 (4): e328 -- AAP Policy 19 January 2010 18:018 UTC aappolicy.aappublications.org [Source type: Academic]

^ It is estimated that, by 2025, almost 22 million people in United States will have been diagnosed with diabetes ( 4 ).
  • Epidemiology of Type 2 Diabetes Mellitus 17 September 2009 2:40 UTC www.msdlatinamerica.com [Source type: Academic]

The total prevalence of diabetes increased 13.5% from 2005-2007. It is thought that only 24% of diabetes is now undiagnosed, down from an estimated 30% in 2005 and from the previously estimated 50% in ca 1995.[citation needed]

References

  1. ^ Robbins and Cotran, Pathologic Basis of Disease, 7th Ed. pp 1194-1195.
  2. ^ American Diabetes Association title =Total Prevalence of Diabetes and Pre-diabetes url =http://www.diabetes.org/diabetes-statistics/prevalence.jsp | accessdate =2008-11-29
  3. ^ Inzucchi SE, Sherwin RS, The Prevention of Type 2 Diabetes Mellitus. Endocrinol Metab Clin N Am 34 (2205) 199-219.
  4. ^ Gerberding, Julie Louise (2007-05-24). Diabetes. Atlanta: Centres for Disease Control. http://www.cdc.gov/nccdphp/publications/aag/ddt.htm. Retrieved 2007-09-14. 
  5. ^ Diabetes rates are increasing among youth NIH, November 13, 2007
  6. ^ Steinberger J, Moran A, Hong CP, Jacobs DR Jr, Sinaiko AR: Adiposity in childhood predicts obesity and insulin resistance in young adulthood. J Pediatr 138:469–473, 2001
  7. ^ Brian J. Welch, MD and Ivana Zib, MD: Case Study: Diabetic Ketoacidosis in Type 2 Diabetes: “Look Under the Sheets”, Clinical Diabetes, October 2004, vol. 22 no. 4, 198-200
  8. ^ Jack L, Boseman L, Vinicor F (April 2004). "Aging Americans and diabetes. A public health and clinical response". Geriatrics 59 (4): 14–7. PMID 15086069. 
  9. ^ Lovejoy JC (October 2002). "The influence of dietary fat on insulin resistance". Curr. Diab. Rep. 2 (5): 435–40. doi:10.1007/s11892-002-0098-y. PMID 12643169. 
  10. ^ Hu FB (February 2003). "Sedentary lifestyle and risk of obesity and type 2 diabetes". Lipids 38 (2): 103–8. doi:10.1007/s11745-003-1038-4. PMID 12733740. 
  11. ^ Sakagashira S, Sanke T, Hanabusa T, et al. (September 1996). "Missense mutation of amylin gene (S20G) in Japanese NIDDM patients". Diabetes 45 (9): 1279–81. doi:10.2337/diabetes.45.9.1279. PMID 8772735. 
  12. ^ Cho YM, Kim M, Park KS, Kim SY, Lee HK (May 2003). "S20G mutation of the amylin gene is associated with a lower body mass index in Korean type 2 diabetic patients". Diabetes Res. Clin. Pract. 60 (2): 125–9. doi:10.1016/S0168-8227(03)00019-6. PMID 12706321. http://linkinghub.elsevier.com/retrieve/pii/S0168822703000196. Retrieved 19 July 2008. 
  13. ^ Eberhart, M. S.; Ogden, C, Engelgau, M, Cadwell, B, Hedley, A. A., Saydah, S. H., (November 2004). "Prevalence of Overweight and Obesity Among Adults with Diagnosed Diabetes --- United States, 1988--1994 and 1999--2002". Morbidity and Mortality Weekly Report (Centers for Disease Control and Prevention) 53 (45): 1066–8. PMID 15549021. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5345a2.htm. Retrieved 19 July 2008. 
  14. ^ Camastra S, Bonora E, Del Prato S, Rett K, Weck M, Ferrannini E (December 1999). "Effect of obesity and insulin resistance on resting and glucose-induced thermogenesis in man. EGIR (European Group for the Study of Insulin Resistance)". Int. J. Obes. Relat. Metab. Disord. 23 (12): 1307–13. doi:10.1038/sj.ijo.0801072. PMID 10643689. 
  15. ^ Cotran, Kumar, Collins; Robbins Pathologic Basis of Disease, Saunders Sixth Edition, 1999; 913-926.
  16. ^ "www.who.int" (pdf). World Health Organization. http://www.who.int/diabetes/publications/Definition%20and%20diagnosis%20of%20diabetes_new.pdf. 
  17. ^ World Health Organization. "Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO Consultation. Part 1. Diagnosis and classification of diabetes mellitus". http://www.who.int/diabetes/publications/en/. Retrieved 29 May 2007. 
  18. ^ Raina Elley C, Kenealy T (December 2008). "Lifestyle interventions reduced the long-term risk of diabetes in adults with impaired glucose tolerance". Evid Based Med 13 (6): 173. doi:10.1136/ebm.13.6.173. PMID 19043031. 
  19. ^ U.S. Preventive Services Task Force (February 2003). "Screening for type 2 diabetes mellitus in adults: recommendations and rationale". Ann. Intern. Med. 138 (3): 212–4. PMID 12558361. http://www.annals.org/cgi/pmidlookup?view=long&pmid=12558361. Retrieved 19 July 2008. 
  20. ^ a b Harris R, Donahue K, Rathore SS, Frame P, Woolf SH, Lohr KN (February 2003). "Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force". Ann. Intern. Med. 138 (3): 215–29. PMID 12558362. http://www.annals.org/cgi/pmidlookup?view=long&pmid=12558362. Retrieved 19 July 2008. 
  21. ^ Santaguida PL, Balion C, Hunt D, et al. (August 2005). "Diagnosis, prognosis, and treatment of impaired glucose tolerance and impaired fasting glucose" (PDF). Evid Rep Technol Assess (Summ) (128): 1–11. PMID 16194123. http://www.ahrq.gov/downloads/pub/evidence/pdf/impglucose/impglucose.pdf. Retrieved 19 July 2008. 
  22. ^ Choi HK, Willett WC, Stampfer P, Vasson MP, Maubois JL, Beaufrere B (2005). "Dairy consumption and risk of type 2 diabetes mellitus in men". Archives of Internal Medicine 165: 997–1003. 
  23. ^ Rolka DB, Narayan KM, Thompson TJ, et al. (2001). "Performance of recommended screening tests for undiagnosed diabetes and dysglycemia". Diabetes Care 24 (11): 1899–903. doi:10.2337/diacare.24.11.1899. PMID 11679454. 
  24. ^ Pradhan AD, Rifai N, Buring JE, Ridker PM (2007). "Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women". Am. J. Med. 120 (8): 720–7. doi:10.1016/j.amjmed.2007.03.022. PMID 17679132. 
  25. ^ Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M (July 2003). "Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial". JAMA 290 (4): 486–94. doi:10.1001/jama.290.4.486. PMID 12876091. http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12876091. Retrieved 19 July 2008. 
  26. ^ Lindström J, Ilanne-Parikka P, Peltonen M, et al. (November 2006). "Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study". Lancet 368 (9548): 1673–9. doi:10.1016/S0140-6736(06)69701-8. PMID 17098085. http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(06)69701-8. Retrieved 19 July 2008. 
  27. ^ Torgerson JS, Hauptman J, Boldrin MN, Sjöström L (January 2004). "XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients". Diabetes Care 27 (1): 155–61. doi:10.2337/diacare.27.1.155. PMID 14693982. http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=14693982. Retrieved 19 July 2008. 
  28. ^ Knowler WC, Barrett-Connor E, Fowler SE, et al. (February 2002). "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin". N. Engl. J. Med. 346 (6): 393–403. doi:10.1056/NEJMoa012512. PMID 11832527. PMC 1370926. http://content.nejm.org/cgi/pmidlookup?view=short&pmid=11832527&promo=ONFLNS19. Retrieved 19 July 2008. 
  29. ^ "Physical activity and dietary intervention for chronic diseases: a quick fix after all?", Frank W. Booth & Manu V. Chakravarthy, J Appl Physiol, May 1, 2006; 100(5): 1439 - 1440.
  30. ^ Roberts CK, Won D, Pruthi S, Kurtovic S, Sindhu RK, Vaziri ND, and Barnard RJ. "Effect of a short-term diet and exercise intervention on oxidative stress, inflammation, MMP-9, and monocyte chemotactic activity in men with metabolic syndrome factors", J Appl Physiol 100: 1657-1665, 2006. First published December 15, 2005
  31. ^ "Three-week diet curbs diabetes", New Scientist, 13 January 2006 by Shaoni Bhattacharya.
  32. ^ American Diabetes (January 2006). "Standards of medical care in diabetes--2006". Diabetes Care 29 Suppl 1: S4–42. PMID 16373931. http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=16373931. Retrieved 19 July 2008. 
  33. ^ Qaseem A, Vijan S, Snow V, Cross JT, Weiss KB, Owens DK (September 2007). "Glycemic control and type 2 diabetes mellitus: the optimal hemoglobin A1c targets. A guidance statement from the American College of Physicians". Ann. Intern. Med. 147 (6): 417–22. PMID 17876024. http://www.annals.org/cgi/content/full/147/6/417. Retrieved 19 July 2008. 
  34. ^ a b "Clinical Practice Guidelines". http://www.diabetes.ca/cpg2003/chapters.aspx. Retrieved 19 July 2008. 
  35. ^ Brown AF, Mangione CM, Saliba D, Sarkisian CA (May 2003). "Guidelines for improving the care of the older person with diabetes mellitus". J Am Geriatr Soc 51 (5 Suppl Guidelines): S265–80. doi:10.1046/j.1532-5415.51.5s.1.x. PMID 12694461. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=00028614&date=2003&volume=51&issue=5%20Suppl%20Guidelines&spage=S265. Retrieved 19 July 2008. 
  36. ^ Sigal RJ, Kenny GP, Boulé NG, et al. (2007). "Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial". Ann. Intern. Med. 147 (6): 357–69. PMID 17876019. http://www.annals.org/cgi/content/full/147/6/357.  Non-technical summary
  37. ^ Song S. "Study: The Best Exercise for Diabetes". Time Inc. http://www.time.com/time/health/article/0,8599,1662683,00.html?xid=newsletter-weekly. Retrieved 28 September 2007. 
  38. ^ Farmer A, Wade A, Goyder E, et al. (2007). "Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial". BMJ 335 (7611): 132. doi:10.1136/bmj.39247.447431.BE. PMID 17591623. 
  39. ^ "Clinical Guideline:The management of type 2 diabetes (update)". http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11983. 
  40. ^ Gerstein, H. C., M. E. Miller, et al. (2008). "Effects of intensive glucose lowering in type 2 diabetes.". New England Journal of Medicine, the 358 (358(24)): 2545–59. doi:10.1056/NEJMoa0802743. PMID 18539917. 
  41. ^ http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf
  42. ^ Bolen S et al. Systematic Review: Comparative Effectiveness and Safety of Oral Medications for Type 2 Diabetes Mellitus. Ann Intern Med 2007;147:6
  43. ^ a b Kahn SE, Haffner SM, Heise MA, et al. (2006). "Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy". N. Engl. J. Med. 355 (23): 2427–43. doi:10.1056/NEJMoa066224. PMID 17145742. 
  44. ^ "NEJM -- Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes". http://content.nejm.org/cgi/content/full/NEJMoa072761. Retrieved 21 May 2007. 
  45. ^ "MedWatch - 2007 Safety Information Alerts (Actos (pioglitazone))". http://www.fda.gov/medwatch/safety/2007/safety07.htm#actos. Retrieved 21 May 2007. 
  46. ^ "MedWatch - 2007 Safety Information Alerts (Rosiglitazone)". http://www.fda.gov/medwatch/safety/2007/safety07.htm#rosiglitazone. Retrieved 21 May 2007. 
  47. ^ Eurich DT, McAlister FA, Blackburn DF, et al. (2007). "Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review". BMJ 335 (7618): 497. doi:10.1136/bmj.39314.620174.80. PMID 17761999. 
  48. ^ Amori RE, Lau J, Pittas AG (2007). "Efficacy and safety of incretin therapy in type 2 diabetes: systematic review and meta-analysis". JAMA 298 (2): 194–206. doi:10.1001/jama.298.2.194. PMID 17622601. http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=17622601. 
  49. ^ Diabetes . MyOptumHealth. (Report). Retrieved on Jan 21, 2010.
  50. ^ Diabetes and Medication . Diabetes New Zealand. (Report). Retrieved on Jan 21, 2010.
  51. ^ a b Yki-Järvinen H, Ryysy L, Nikkilä K, Tulokas T, Vanamo R, Heikkilä M (March 1999). "Comparison of bedtime insulin regimens in patients with type 2 diabetes mellitus. A randomized, controlled trial". Ann. Intern. Med. 130 (5): 389–96. PMID 10068412. http://www.annals.org/cgi/pmidlookup?view=long&pmid=10068412. Retrieved 19 July 2008. 
  52. ^ Holman RR, Turner RC (January 1985). "A practical guide to basal and prandial insulin therapy". Diabet. Med. 2 (1): 45–53. doi:10.1111/j.1464-5491.1985.tb00592.x. PMID 2951066. 
  53. ^ a b Mooradian AD, Bernbaum M, Albert SG (July 2006). "Narrative review: a rational approach to starting insulin therapy". Ann. Intern. Med. 145 (2): 125–34. PMID 16847295. 
  54. ^ Yki-Järvinen H, Kauppila M, Kujansuu E, et al. (November 1992). "Comparison of insulin regimens in patients with non-insulin-dependent diabetes mellitus". N. Engl. J. Med. 327 (20): 1426–33. PMID 1406860. 
  55. ^ Kratz A, Lewandrowski KB (October 1998). "Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Normal reference laboratory values". N. Engl. J. Med. 339 (15): 1063–72. doi:10.1056/NEJM199810083391508. PMID 9761809. http://content.nejm.org/cgi/pmidlookup?view=short&pmid=9761809&promo=ONFLNS19. Retrieved 19 July 2008. 
  56. ^ a b Holman RR, Thorne KI, Farmer AJ, et al. (October 2007). "Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes". N. Engl. J. Med. 357 (17): 1716–30. doi:10.1056/NEJMoa075392. PMID 17890232. http://content.nejm.org/cgi/pmidlookup?view=short&pmid=17890232&promo=ONFLNS19. Retrieved 19 July 2008. 
  57. ^ a b Raskin P, Allen E, Hollander P, et al. (February 2005). "Initiating insulin therapy in type 2 Diabetes: a comparison of biphasic and basal insulin analogs". Diabetes Care 28 (2): 260–5. doi:10.2337/diacare.28.2.260. PMID 15677776. http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=15677776. Retrieved 19 July 2008. 
  58. ^ Malone JK, Kerr LF, Campaigne BN, Sachson RA, Holcombe JH (December 2004). "Combined therapy with insulin lispro Mix 75/25 plus metformin or insulin glargine plus metformin: a 16-week, randomized, open-label, crossover study in patients with type 2 diabetes beginning insulin therapy". Clin Ther 26 (12): 2034–44. doi:10.1016/j.clinthera.2004.12.015. PMID 15823767. http://linkinghub.elsevier.com/retrieve/pii/S0149-2918(04)00085-2. Retrieved 19 July 2008. 
  59. ^ Horvath K, Jeitler K, Berghold A, et al. (2007). "Long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus". Cochrane Database Syst Rev (2): CD005613. doi:10.1002/14651858.CD005613.pub3. PMID 17443605. 
  60. ^ Jothydev Kesavadev, Shyam Balakrishnan, Ahammed S,Sunitha Jothydev, et al. (2009). "Reduction of glycosylated hemoglobin following 6 months of continuous subcutaneous insulin infusion in an Indian population with type 2 diabetes". Diabetes Technol Ther 11 (8): 517–521. doi:10.1089/dia.2008.0128. PMID 19698065. 
  61. ^ Cummings DE, Flum DR (2008). "Gastrointestinal surgery as a treatment for diabetes". JAMA 299 (3): 341–3. doi:10.1001/jama.299.3.341. PMID 18212321. http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18212321. 
  62. ^ Folli F, Pontiroli AE, Schwesinger WH (2007). "Metabolic aspects of bariatric surgery". Med. Clin. North Am. 91 (3): 393–414, x. doi:10.1016/j.mcna.2007.01.005. PMID 17509385. http://linkinghub.elsevier.com/retrieve/pii/S0025-7125(07)00006-5. 
  63. ^ Gastric Bypass Surgery - Diabetes Health
  64. ^ Dixon JB, O'Brien PE, Playfair J, et al. (2008). "Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial". JAMA 299 (3): 316–23. doi:10.1001/jama.299.3.316. PMID 18212316. http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18212316. 
  65. ^ a b Zimmet P, Alberti KG, Shaw J (December 2001). "Global and societal implications of the diabetes epidemic". Nature 414 (6865): 782–7. doi:10.1038/414782a. PMID 11742409. http://www.nature.com/nature/journal/v414/n6865/abs/414782a.html. Retrieved 19 July 2008. 

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