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Type 2
diabetes

What is type 2 diabetes?

Diabetes is a chronic condition marked by abnormally high blood sugar (glucose) which can damage nerves and blood vessels.

There are two types of diabetes: type 1 and type 2. This information focuses on type 2 diabetes.

Type 2 diabetes (T2D) affects around 425 million people worldwide [1], and one in 20 Australians [2].

Main types of diabetes, [3,4]

Type of diabetes Percentage of people registered with National Diabetes Services Scheme as of 31 December 2021 Onset Mechanism
Type 1 (T1D)

9%

Childhood/young adulthood

Autoimmune (body attacks pancreas) therefore insufficient insulin produced

Type 2 (T2D)

86%

People aged over 45 but increasingly being seen in younger people

Body responds poorly to insulin (insulin resistance), or stops making enough

Gestational diabetes

4%

Pregnancy

Hormonal changes and weight gain cause insulin resistance

Normal sugar metabolism:

The rise of blood sugar from a digested meal triggers the pancreas to release insulin, enabling glucose to be used for energy, or stored. When blood sugars drop, insulin levels fall, leading to release of energy from reserves.

Abnormally high blood sugar occurs when:

  • The body produces insufficient insulin due to the body making antibodies that attack the pancreas (type 1 diabetes)
  • There is insulin resistance which is a condition where the body’s liver, muscle and fat cells do not respond adequately to insulin, which is worsened by the development of insulin resistance (type 2 diabetes)
  • In a normal pregnancy, the placenta produces several hormones which leads to a necessary insulin resistance to provide enough carbohydrates to the growing foetus. However, most women with gestational diabetes are unable to produce enough insulin, although a minority are women who already have pre-existing diabetes

Table 1 describes the three main types of diabetes.

Data suggest there is an interplay between genes and environment. Some common risk factors or associations are:

  • Genetics – 40% (four in ten) risk of type 2 diabetes if one parent has the condition; 70% (seven in ten) risk if both; increased risk in twins [5]
  • Increasing age [6]
  • Higher body mass index (BMI)—increases risk up to 10-fold [7]
  • Higher intake of processed meat and sugar-sweetened drinks, or lower wholegrain intake [7]
  • Physical inactivity [7]
  • History of gestational diabetes [7]

Diagnosis of type 2 diabetes can be delayed due to lack of symptoms [8].

Common symptons include [9]:

  • Increased thirst and urination
  • Fatigue
  • Bacterial and fungal infections
  • Sensory changes in hands or feet
  • Weight loss

Circulation complications can cause:

  • Stroke
  • Heart attack
  • Leg pain with walking
  • Chronic wounds
  • Foot/leg ulcers
  • Kidney failure
  • Blurred vision

For many years, type 2 diabetes has been diagnosed by either a fasting glucose test (a blood test after not eating for eight hours), or a “random” glucose test (where the test does not require fasting, but the criteria for an abnormal result is different).

A more time-consuming test is the glucose tolerance test. After eight hours of no food, a fasting blood test is taken, the person has a glucose drink, and after two hours a further fasting test. This can be used to diagnose both diabetes and pre-diabetes (the condition where there are no symptoms but the person has a higher risk than average of developing true diabetes).

In recent years, another test is now also available called glycated haemoglobin (HbA1c). This name arises because glucose becomes attached to haemoglobin, the red oxygen-carrying pigment in blood. As red blood cells live for about four months, HbA1c indicates glucose control for the preceding three months or so. In some situations, this test might be used in addition to fasting tests.

Management of type 2 diabetes is lifelong, with education, lifestyle changes and regular physical checks.

Here are some interesting data about people with type 2 diabetes:

  • Almost 75% require medication [10]
  • The average person takes 4-10 drugs daily [11]
  • 25% are taking insulin [10]
  • Only 20% regularly take their medications [12]

Table 2 summarises treatment strategies

TABLE 2

Treatment for type 2 diabetes [1,8,13]

Lifestyle changes – for prevention and/or treatment

Reduce weight if overweight/obese using calorie restriction

Healthy diet including:

  • Fibre: >40 g/day
  • Carbohydrates: 45-60% total energy
  • Protein: 10-20% total energy
  • Fat :< 35% total energy; saturated/trans fats < 10% total daily energy
  • Regular fruit/vegetable intake

Alcohol ≤2 standard drinks/day

Regular aerobic and/or resistance training for >150 minutes/week

Avoid/stop smoking

Medications
  • Oral glucose-lowering medicine
  • Addition of injectable medications such as insulin
Weight loss surgery
  • In obese people, can reduce risk of type 2 diabetes; variable rates of “remission”

New treatment under development at the Bionics Institute

Bionics Institute researchers are developing an electrical medical device that aims to improve long-term outcomes for people with type 2 diabetes.

How does it work?

•  The device comprises a tiny electrode array that can be attached to the vagus nerve using keyhole surgery

•  Running from brain to multiple organs, the vagus nerve affects energy metabolism, blood sugar control and food intake, and can be used to lower blood sugar levels

•  The array is designed to stimulate the vagus nerve in response to a rise in blood sugar levels

•  In response to stimulation, the vagus nerve activates the release of hormones to lower blood sugar levels

•  The electrode array will be powered by a small battery implanted at hip level.

With your help, we can accelerate the evolution of this device, improving the lives of those with type 2 diabetes.

Read more

With your help, we can accelerate the evolution of this device, improving the lives of those with type 2 diabetes.

Medical disclaimer

This article contains general information relating to a medical condition. Such information is provided for informational purposes only and does not replace medical advice given by your healthcare professional.

References

1.Hallberg SJ, Gershuni VM, Athinarayanan SJ. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients [Internet]. 2019 Apr 1 [cited 2022 Feb 10];11(4):766. Available from: /labs/pmc/articles/PMC6520897/

2. AIHW. Diabetes Overview. (CC BY) [Internet]. 2022 [cited 2022 Feb 9]. Available from: https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/diabetes/overview

3. NDSS. All types of diabetes. 2021;(December):1. Available from: https://www.ndss.com.au/wp-content/uploads/ndss-data-snapshot-202112-all-types-of-diabetes.pdf

4. NIDDK. Symptoms & Causes of Gestational Diabetes | NIDDK [Internet]. 2017 [cited 2022 Feb 12]. Available from: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational/symptoms-causes

5. Murea M, Ma L, Freedman BI. Genetic and environmental factors associated with type 2 diabetes and diabetic vascular complications. Rev Diabet Stud [Internet]. 2012 [cited 2022 Feb 11];9(1):6–22. Available from: /labs/pmc/articles/PMC3448170/

6. AIHW. Diabetes Web report. (CC BY) [Internet]. 2020 [cited 2022 Feb 9]. Available from: https://www.aihw.gov.au/reports/diabetes/diabetes

7. Bellou V, Belbasis L, Tzoulaki I, Evangelou E. Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. (CC BY 4.0). PLoS One [Internet]. 2018 Mar 1 [cited 2022 Feb 11];13(3):e0194127. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194127

8. Ryden L, Grant P, Anker S, et al. ESC GUIDELINES ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J [Internet]. 2013;34:3035–87. Available from: www.escardio.org/guidelines

9. Goyal R, Jialal I. Diabetes Mellitus Type 2. (CC BY 4.0) [Internet]. StatPearls [Internet]. 2021 [cited 2022 Feb 9]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513253/

10. Australian Bureau of Statistics. Diabetes mellitus. (CC BY 4.0) [Internet]. c=AU; o=Commonwealth of Australia; ou=Australian Bureau of Statistics; 2017 [cited 2022 Feb 12]. p. 02017. Available from: https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by Subject/4364.0.55.002~2014-15~Main Features~Diabetes mellitus~10005

11. Black JA, Simmons RK, Boothby CE, Davies MJ, Webb D, Khunti K, et al. Medication burden in the first 5 years following diagnosis of type 2 diabetes: findings from the ADDITION-UK trial cohort. BMJ Open Diabetes Res Care [Internet]. 2015 Oct 1 [cited 2022 Feb 12];3:e000075. Available from: https://drc.bmj.com/content/3/1/e000075

12. Krass I, Schieback P, Dhippayom T. Adherence to diabetes medication: a systematic review. Diabet Med [Internet]. 2015 Jun 1 [cited 2022 Feb 12];32(6):725–37. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/dme.12651

13. NDSS. Alcohol fact sheet [Internet]. 2020 [cited 2022 Feb 12]. p. 1–3. Available from: https://www.ndss.com.au/wp-content/uploads/fact-sheets/fact-sheet-alcohol.pdf

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