Type 2 (adult onset) diabetes accounts for 90 percent of all cases and typically strikes after age 45. With this type of the disorder, the body's cells do not properly respond to the insulin that is present in the bloodstream, resulting in high glucose levels despite the fact that adequate insulin is being produced.
Although type 2 diabetes is typically diagnosed after age 45, an increasing number of individuals under the age of 30 are being diagnosed with the disorder each year.
By far the majority of people with diabetes worldwide have T2DM. This is characterized by insulin resistance with relative insulin deficiency (i.e. patients secrete insulin, but not enough to overcome the insulin resistance). Typically, they do not require insulin to survive but often will eventually need insulin to maintain reasonable glycemia control, often after many years.
The precise molecular mechanisms underlying T2DM are not known. Major efforts have been made to discover underlying genetic abnormalities but with only modest success. The most promising to be date has been TCF7L2 which may have a role in insulin secretion but this does not explain diabetes susceptibility in the majority of subjects.
What is clear is that T2DM is closely associated with obesity and physical inactivity, and the westernization of lifestyles. The dramatic increase in T2DM over the past two decades has been closely paralleled by the rise in obesity worldwide. Both obesity, particularly visceral adiposity, and physical inactivity cause insulin resistance which will result in diabetes in those with only a small capacity to increase insulin secretion.
The incidence of T2DM also increases with age, which may be related to decrease in exercise and muscle mass; however, as the incidence increases so T2DM is being found at younger ages and it is now not uncommon in adolescence in many ethnic groups.
T2DM occurs in families so that those with a first - degree relative with diabetes have an almost 50% life - time risk. There is also marked variation between different ethnic groups. Thus, those of Polynesian, Micronesian, South Asian, sub - Saharan African, Arabian and Native American origin are much more prone to develop diabetes than Europids.
T2DM is a diagnosis by exclusion and the prevalence may fall as causes are identified, but this is likely to be a slow process.
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