Diabetes mellitus type 2 1 Diabetes mellitus type 2 Diabetes mellitus type 2 Classification and external resources Universal blue

circle symbol for diabetes. ICD-10 ICD-9 OMIM DiseasesDB MedlineP lus eMedicine MeSH E11. [2] [3] [1] 250.00 125853 3661 , 250.02 [4] [5] [6] [7] [8] 000313 article/117853 D003924 [9] Diabetes mellitus type 2 formerly non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes is a metabolic disorder that is characterized by high bloo d glucose in the context of insulin resistance and relative insulin deficiency.[ 10] Diabetes is often initially managed by increasing exercise and dietary modif ication. If the condition progresses, medications may be needed. Unlike type 1 d iabetes, there is very little tendency toward ketoacidosis though it is not unhe ard of.[11] One effect that can occur is nonketonic hyperglycemia. Long-term com plications from high blood sugar can include increased risk of heart attacks, st rokes, amputation, and kidney failure. For extreme cases, circulation of limbs i s affected, potentially requiring amputation. Loss of hearing, eyesight, and cog nitive ability has also been linked to this condition.

Diabetes mellitus type 2 2 Signs and symptoms The classic symptoms of diabetes are polyuria (frequent urination), polydipsia ( increased thirst), polyphagia (increased hunger), fatigue and weight loss.[12] Cause Type2 diabetes is due to a combination of lifestyle and genetic factors.[13] [14] Recently, intrauterine growth restriction (IUGR) or prenatal undernutrition (ma cro- and micronutrient) was identified as another probable factor [15] A clue fo r this concept was the Dutch Hunger Winter and the pioneering work of Professor Barker. Lifestyle A number of lifestyle factors are known to be important to the development of ty pe2 diabetes. In one study, those who had high levels of physical activity, a hea lthy diet, did not smoke, and consumed alcohol in moderation had an 82% lower ra te of diabetes. When a normal weight was included, the rate was 89% lower. In th is study, a healthy diet was defined as one high in fiber, with a high polyunsat urated to saturated fat ratio, and a lower mean glycemic index.[16] Obesity has been found to contribute to approximately 55% of cases of type2 diabetes,[17] and decreasing consumption of saturated fats and trans fatty acids while replacing them with unsaturated fats may decrease the risk.[13] The increased rate of chil dhood obesity between the 1960s and 2000s is believed to have led to the increas e in type2 diabetes in children and adolescents.[18] Environmental toxins may con tribute to recent increases in the rate of type2 diabetes. A weak positive correl ation has been found between the concentration in the urine of bisphenol A, a co nstituent of some plastics, and the incidence of type2 diabetes.[19] Medical conditions There are many factors which can potentially give rise to, or exacerbate, type 2 diabetes. These include obesity, hypertension, elevated cholesterol (combined h yperlipidemia), and with the condition often termed metabolic syndrome (it is al so known as Syndrome X, Reavan's syndrome, or CHAOS). Other causes include acrom egaly, Cushing's syndrome, thyrotoxicosis, pheochromocytoma, chronic pancreatiti s, cancer, and drugs. Additional factors found to increase the risk of type 2 di abetes include aging,[20] high-fat diets[21] and a less active lifestyle.[22] Su bclinical Cushing's syndrome (cortisol excess) may be associated with type 1 dia betes.[23] The percentage of subclinical Cushing's syndrome in the diabetic popu lation is about 9%.[24] Diabetic patients with a pituitary microadenoma can impr ove insulin sensitivity by removal of these microadenomas.[25] Hypogonadism is o ften associated with cortisol excess, and testosterone deficiency is also associ ated with type 2 diabetes,[26] [27] even if the exact mechanism by which testost erone improves insulin sensitivity is still not known. 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 t ype 2 diabetes substantially. In addition, there is also a mutation to the Islet Amyloid Polypeptide gene that results in an earlier onset, more severe, form of diabetes.[28] [29] About 55 percent of type 2 diabetes patients are obese at di agnosis[30] chronic obesity leads to increased insulin resistance that can develo p into type 2 diabetes, most likely because adipose tissue (especially that in t he abdomen around internal organs) is a source of several chemical signals to ot her tissues (hormones and cytokines). 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.[31]

Diabetes mellitus type 2 However, environmental factors (almost certainly diet a nd weight) play a large part in the development of type 2 diabetes in addition t o any genetic component. This can be seen from the adoption of the type 2 diabet es epidemiological pattern in those who have moved to a different environment as compared to the same genetic pool who have not. Immigrants to Western developed countries, for instance, as compared to lower incidence countries of origins.[3 2] There is a stronger inheritance pattern for type2 diabetes. Those with first-d egree relatives with type2 diabetes have a much higher risk of developing type2 di abetes, increasing with the number of those relatives. Concordance among monozyg otic twins is close to 100%, and about 25% of those with the disease have a fami ly history of diabetes. Genes significantly associated with developing type2 diab etes, include TCF7L2, PPARG, FTO, KCNJ11, NOTCH2, WFS1, CDKAL1, IGF2BP2, SLC30A8 , JAZF1, and HHEX.[33] [34] KCNJ11 (potassium inwardly rectifying channel, subfa mily J, member 11), encodes the islet ATP-sensitive potassium channel Kir6.2, an d TCF7L2 (transcription factor 7like 2) regulates proglucagon gene expression and thus the production of glucagon-like peptide-1.[35] Moreover, obesity (which is an independent risk factor for type2 diabetes) is strongly inherited.[36] Monoge nic forms, e.g., MODY, constitute 15 % of all cases.[37] Various hereditary condi tions may feature diabetes, for example myotonic dystrophy and Friedreich's atax ia. Wolfram's syndrome is an autosomal recessive neurodegenerative disorder that first becomes evident in childhood. It consists of diabetes insipidus, diabetes mellitus, optic atrophy, and deafness, hence the acronym DIDMOAD.[38] Gene expr ession promoted by a diet of fat and glucose, as well as high levels of inflamma tion related cytokines found in the obese, results in cells that "produce fewer and smaller mitochondria than is normal," and are thus prone to insulin resistan ce.[39] 3 Pathophysiology Insulin resistance means that body cells do not respond appropriately when insul in is present. This is a more complex problem than type 1, but is sometimes easi er to treat, especially in the early years when insulin is often still being pro duced internally. Severe complications can result from improperly managed type 2 diabetes, including renal failure, erectile dysfunction, blindness, slow healin g wounds (including surgical incisions), and arterial disease, including coronar y artery disease. The onset of type 2 diabetes has been most common in middle ag e and later life, although it is being more frequently seen in adolescents and y oung adults due to an increase in child obesity and inactivity. A type of diabet es 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. In the 2008 Banting Lecture of the American Diabetes Association, DeFronzo enumerates eight main pa thophysiological factors in the type 2 diabetic organism [40] 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 seconda ry diabetes mellitus or diabetes due to a specific cause. Examples include diabe tes mellitus such as MODY or those caused by hemochromatosis, pancreatic insuffi ciencies, or certain types of medications (e.g., long-term steroid use). Diagnosis

Diabetes mellitus type 2 4 2006 WHO Diabetes criteria[41] Condition 2 hour glucose mmol/l(mg/dl) Normal Impaired fasting glycaemia Impaire d glucose tolerance Diabetes mellitus <7.8 (<140) <7.8 (<140) 7.8 (140) 11.1 (200) F asting glucose mmol/l(mg/dl) <6.1 (<110) 6.1(110) & <7.0(<126) <7.0 (<126) 7.0 (126 ) The ose 42] two World Health Organization definition of diabetes is for a single raised gluc reading with symptoms, otherwise raised values on two occasions, of either:[ fasting plasma glucose 7.0mmol/l (126mg/dl) or With a glucose tolerance test, hours after the oral dose a plasma glucose 11.1mmol/l (200mg/dl)

Early detection If a 2-hour postload glucose level of at least 11.1mmol/L ( 200mg/dL) is used as th e reference standard, the fasting plasma glucose > 7.0mmol/L (126mg/dL) diagnoses current diabetes with[43] : sensitivity about 50% specificity greater than 95% A random capillary blood glucose > 6.7mmol/L (120mg/dL) diagnoses current diabetes with[44] : sensitivity = 75% specificity = 88% Glycosylated hemoglobin values th at are elevated (over 5%), but not in the diabetic range (not over 7.0%) are pre dictive of subsequent clinical diabetes in United States female health professio nals.[45] 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 w ith a glycosylated hemoglobin value of 6.0% or more. This equates to a glycosyla ted hemoglobin value of 6.0% or more having: sensitivity = 16.7% specificity = 9 8.9% Screening No major organization recommends universal screening for diabetes as there is no evidence that such a program would improve outcomes.[46] Screening is recommend ed by the United States Preventive Services Task Force in adults without symptom s whose blood pressure is greater than 135/80mmHg.[47] For those whose blood pres sure is less, the evidence is insufficient to recommend for or against screening .[47] The World Health Organization recommends only testing those groups at high risk.[46]

Diabetes mellitus type 2 5 Prevention Onset of type 2 diabetes can be delayed or prevented through proper nutrition an d regular exercise.[48] [49] Intensive lifestyle measures may reduce the risk by over half.[14] Evidence for the benefit of dietary changes alone however is lim ited.[50] In those with impaired glucose tolerance diet and exercise and/or metf ormin or acarbose may decrease the risk of developing diabetes.[51] [14] Lifesty le interventions are more effective than metformin.[14] Management Management of type 2 diabetes focuses on lifestyle interventions, lowering other cardiovascular risk factors, and maintaining blood glucose levels in the normal range.[14] Self-monitoring of blood glucose for people with newly diagnosed typ e 2 diabetes was recommended by the National Health Services in 2008[52] however the benefit of self monitoring in those not using multi-dose insulin is questio nable.[14] Lifestyle Aerobic exercise is beneficial in diabetes with a greater amount of exercise yie lding better results.[53] It leads to a decrease in HbA1C, improved insulin resi stance, and a better V02 max.[53] Resistance training is also useful and the com bination of both types of exercise may be most effective.[53] A diabetic diet th at promotes weight loss is important.[54] While the best diet type to achieve th is is controversial[54] a low glycemic index diet has been found to improve bloo d sugar control.[55] Culturally appropriate education may help people with type 2 diabetes control their blood sugar levels, for up to six months at least.[56] Medications There are several classes of medications available. Metformin is generally recom mended as a first line treatment as there is good evidence that it decreases mor tality.[14] Injections of insulin may either be added to oral medication or used alone.[14] Other classes of medications used to treat type 2 diabetes are sulfo nylureas, nonsulfonylurea secretagogues, alpha glucosidase inhibitors, and thiaz olidinediones.[14] Insulin Metformin 500mg tablets When insulin is used, a long-acting formulation is usually added initially, whil e continuing oral medications.[14] Doses of insulin are increased to effect.[14] The initial insulin regimen is often chosen based on the patient's blood glucos e profile.[57] Initially, adding nightly insulin to patients failing oral medica tions may be best.[58] Nightly insulin combines better with metformin than with sulfonylureas.[59] When nightly insulin is insufficient, choices include: Premix ed insulin with a fixed ratio of short and intermediate acting insulin; this ten ds to be more effective than long acting insulin, but is associated with increas ed hypoglycemia.[60] [61] [62] Initial total daily dosage of biphasic insulin ca n be 10 units if the fasting plasma glucose values are less than 180mg/dl or 12 u nits when the fasting plasma glucose is above 180mg/dl".[61] A guide to titrating fixed ratio insulin is available.[57] Long acting insulins include insulin glar gine and insulin detemir. A meta-analysis of randomized controlled trials by the Cochrane Collaboration found "only a minor clinical benefit of treatment with l ong-acting insulin analogues for patients with diabetes mellitus type 2".[63] Mo re recently, a randomized controlled trial found that

Diabetes mellitus type 2 although long acting insulins were less effective, they were associated with reduced hypoglycemic episodes.[60] 6 Cardiovascular risk factors Managing other cardiovascular risk factors including hypertension, high choleste rol, and microalbuminuria improves a person's life expectancy.[14] Surgery Gastric Bypass procedures are currently considered an elective procedure with no universally accepted algorithm to decide who should have the surgery. In the di abetic patient, certain types result in 99-100% prevention of insulin resistance and 80-90% clinical resolution or remission of type 2 diabetes. In 1991, the NI H (National Institutes of Health) Consensus Development Conference on Gastrointe stinal Surgery for Obesity proposed that the body mass index (BMI) threshold to consider surgery should drop from 40 to 35 in the appropriate patient. More rece ntly, 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-m orbidities.[64] Debate has flourished about the role of gastric bypass surgery i n type 2 diabetics since the publication of The Swedish Obese Subjects Study. Th e 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 0.1 4) and at 10 years (odds ratio was 0.25).[65] 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 le vels. Weight loss occurred rapidly in many people in the study who had had the s urgery. The 20% who did not respond to bypass surgery were, typically, those who were older and had had diabetes for over 20 years.[66] Progression The way type 2 diabetes is managed may change with age. Insulin production decre ases because of age-related impairment of pancreatic beta cells. Additionally, i nsulin resistance increases because of the loss of lean tissue and the accumulat ion of fat, particularly intra-abdominal fat, and the decreased tissue sensitivi ty to insulin. Glucose tolerance progressively declines with age, leading to a h igh prevalence of type2 diabetes and postchallenge hyperglycemia in the older pop ulation.[67] Age-related glucose intolerance is often accompanied by insulin res istance, but circulating insulin levels are similar to those of younger people.[ 68] Treatment goals for older patients with diabetes vary with the individual, a nd take into account health status, as well as life expectancy, level of depende nce, and willingness to adhere to a treatment regimen.[69] Prognosis In adults type 2 diabetes is the primary cause of blindness and kidney failure.[ 14] Epidemiology Globally in 2003 it was estimated that there were 150 million people with type 2 diabetes.[70] The incidence varies substantially in different parts of the worl d, almost certainly because of environmental and lifestyle factors, though these are not known in detail.[71] In the United States there are 23.6 million people (7.8% of the population) with diabetes with 17.9 million being diagnosed,[72] 9 0% of whom are type 2.[73] With prevalence rates doubling between 1990 and 2005, CDC has characterized the increase as an epidemic.[74] Traditionally considered a disease of adults, type 2 diabetes is increasingly diagnosed in children in p arallel to rising obesity rates [75] due to alterations in dietary patterns as w ell as in life styles during childhood.[76]

Diabetes mellitus type 2 7 References [1] "Diabetes Blue Circle Symbol" (http:/ / www. diabetesbluecircle. org). Inter national Diabetes Federation. 17 March 2006. . [2] http:/ / apps. who. int/ clas sifications/ apps/ icd/ icd10online/ ?ge10. htm+ e11 [3] http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=250. 00 [4] http:/ / www. icd9data. com/ getICD9Cod e. ashx?icd9=250. 02 [5] http:/ / www. ncbi. nlm. nih. gov/ omim/ 125853 [6] htt p:/ / www. diseasesdatabase. com/ ddb3661. htm [7] http:/ / www. nlm. nih. gov/ medlineplus/ ency/ article/ 000313. htm [8] http:/ / emedicine. medscape. com/ a rticle/ 117853-overview [9] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi ?field=uid& term=D003924 [10] Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Cotr an, Ramzi S. ; Robbins, Stanley L. (2005). Robbins and Cotran Pathologic Basis o f Disease (7th ed.). Philadelphia, Pa.: Saunders. pp.11941195. ISBN0-7216-0187-1. [ 11] Fasanmade, OA; Odeniyi, IA, Ogbera, AO (2008 Jun). "Diabetic ketoacidosis: d iagnosis and management.". African journal of medicine and medical sciences 37 ( 2): 99105. PMID18939392. [12] Cooke DW, Plotnick L (November 2008). "Type 1 diabet es mellitus in pediatrics". Pediatr Rev 29 (11): 37484; quiz 385. doi:10.1542/pir .29-11-374. PMID18977856. [13] Risrus U, Willett WC, Hu FB (January 2009). "Dietar y fats and prevention of type 2 diabetes". Progress in Lipid Research 48 (1): 445 1. doi:10.1016/j.plipres.2008.10.002. PMC2654180. PMID19032965. [14] Ripsin CM, Ka ng H, Urban RJ (January 2009). "Management of blood glucose in type 2 diabetes m ellitus". Am Fam Physician 79 (1): 2936. PMID19145963. [15] J. Nutr., Mar 2010; 14 0: 437 - 445. [16] Mozaffarian D, Kamineni A, Carnethon M, Djouss L, Mukamal KJ, Siscovic, D (April 2009). "Lifestyle risk factors and new-onset diabetes mellitu s in older adults: the cardiovascular health study". Archives of Internal Medici ne 169 (8): 798807. doi:10.1001/archinternmed.2009.21. PMC2828342. PMID19398692. [1 7] Centers for Disease Control and Prevention (CDC) (November 2004). "Prevalence of overweight and obesity among adults with diagnosed diabetesUnited States, 198 81994 and 19992002" (http:/ / www. cdc. gov/ mmwr/ preview/ mmwrhtml/ mm5345a2. ht m). MMWR. Morbidity and Mortality Weekly Report 53 (45): 10668. PMID15549021. . [1 8] Arlan Rosenbloom, Janet H Silverstein (2003). Type2 Diabetes in Children and A dolescents: A Clinician's Guide to Diagnosis, Epidemiology, Pathogenesis, Preven tion, and Treatment. American Diabetes Association, U.S.. pp.1. ISBN978-1580401555 . [19] Lang IA, Galloway TS, Scarlett A, et al. (September 2008). "Association o f urinary bisphenol A concentration with medical disorders and laboratory abnorm alities in adults". JAMA 300 (11): 130310. doi:10.1001/jama.300.11.1303. PMID18799 442. [20] Jack L, Boseman L, Vinicor F (April 2004). "Aging Americans and diabet es. A public health and clinical response". Geriatrics 59 (4): 147. PMID15086069. [21] Lovejoy JC (October 2002). "The influence of dietary fat on insulin resista nce". Curr. Diab. Rep. 2 (5): 43540. doi:10.1007/s11892-002-0098-y. PMID12643169. [22] Hu FB (February 2003). "Sedentary lifestyle and risk of obesity and type 2 diabetes". Lipids 38 (2): 1038. doi:10.1007/s11745-003-1038-4. PMID12733740. [23] Iwasaki Y, Takayasu S, Nishiyama M, et al. (March 2008). "Is the metabolic syndr ome an intracellular Cushing state? Effects of multiple humoral factors on the t ranscriptional activity of the hepatic glucocorticoid-activating enzyme (11betahydroxysteroid dehydrogenase type 1) gene". Molecular and Cellular Endocrinology 285 (1-2): 108. doi:10.1016/j.mce.2008.01.012. PMID18313835. [24] Chiodini I, Tor lontano M, Scillitani A, et al. (December 2005). "Association of subclinical hyp ercortisolism with type 2 diabetes mellitus: a case-control study in hospitalize d patients". European Journal of Endocrinology 153 (6): 83744. doi:10.1530/eje.1. 02045. PMID16322389. [25] Taniguchi T, Hamasaki A, Okamoto M (May 2008). "Subclin ical hypercortisolism in hospitalized patients with type 2 diabetes mellitus" (h ttp:/ / joi. jlc. jst. go. jp/ JST. JSTAGE/ endocrj/ K07E-045?from=PubMed). Endo crine Journal 55 (2): 42932. doi:10.1507/endocrj.K07E-045. PMID18362453. . [26] Sa ad F, Gooren L (March 2009). "The role of testosterone in the metabolic syndrome : a review". The Journal of Steroid Biochemistry and Molecular Biology 114 (1-2) : 403. doi:10.1016/j.jsbmb.2008.12.022. PMID19444934. [27] Farrell JB, Deshmukh A,

Baghaie AA (2008). "Low testosterone and the association with type 2 diabetes". The Diabetes Educator 34 (5): 799806. doi:10.1177/0145721708323100. PMID18832284. [28] Sakagashira S, Sanke T, Hanabusa T, et al. (September 1996). "Missense mut ation of amylin gene (S20G) in Japanese NIDDM patients". Diabetes 45 (9): 127981. doi:10.2337/diabetes.45.9.1279. PMID8772735. [29] Cho YM, Kim M, Park KS, Kim SY , Lee HK (May 2003). "S20G mutation of the amylin gene is associated with a lowe r body mass index in Korean type 2 diabetic patients" (http:/ / linkinghub. else vier. com/ retrieve/ pii/ S0168822703000196). Diabetes Res. Clin. Pract. 60 (2): 1259. doi:10.1016/S0168-8227(03)00019-6. PMID12706321. . Retrieved 19 July 2008. [30] 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" (http:/ / www. cdc. gov/ mmwr/ preview/ mmwrhtml/ mm5345a2. htm). Morbidity and Mortality Weekl y Report (Centers for Disease Control and Prevention) 53 (45): 10668. PMID15549021 . . Retrieved 19 July 2008.

Diabetes mellitus type 2 [31] Camastra S, Bonora E, Del Prato S, Rett K, Weck M, Ferrannini E (December 1 999). "Effect of obesity and insulin resistance on resting and glucose-induced t hermogenesis in man. EGIR (European Group for the Study of Insulin Resistance)". Int. J. Obes. Relat. Metab. Disord. 23 (12): 130713. doi:10.1038/sj.ijo.0801072. PMID10643689. [32] Cotran, Kumar, Collins; Robbins Pathologic Basis of Disease, Saunders Sixth Edition, 1999; 913-926. [33] Lyssenko V, Jonsson A, Almgren P, et al. (November 2008). "Clinical risk factors, DNA variants, and the development of type 2 diabetes". The New England Journal of Medicine 359 (21): 222032. doi:10 .1056/NEJMoa0801869. PMID19020324. [34] McCarthy, M. I. (December 2010). Feero, W . G.; Guttmacher, A. E.. eds. "Genomics, Type 2 Diabetes, and Obesity". The New England Journal of Medicine 363 (24): 233950. doi:10.1056/NEJMra0906948. PMID21142 536. [35] Rother KI (April 2007). "Diabetes treatmentbridging the divide". The Ne w England Journal of Medicine 356 (15): 1499501. doi:10.1056/NEJMp078030. PMID1742 9082. [36] Walley AJ, Blakemore AI, Froguel P (October 2006). "Genetics of obesi ty and the prediction of risk for health". Human Molecular Genetics 15 Spec No 2 : R12430. doi:10.1093/hmg/ddl215. PMID16987875. [37] "Monogenic Forms of Diabetes: Neonatal Diabetes Mellitus and Maturity-onset Diabetes of the Young" (http:/ / www. diabetes. niddk. nih. gov/ dm/ pubs/ mody/ ). National Diabetes Information Clearinghouse (NDIC) (National Institute of Diabetes and Digestive and Kidney D iseases, NIH). . Retrieved 2008-08-04. [38] Barrett TG (September 2001). "Mitoch ondrial diabetes, DIDMOAD and other inherited diabetes syndromes". Best Practice & Research. Clinical Endocrinology & Metabolism 15 (3): 32543. doi:10.1053/beem. 2001.0149. PMID11554774. [39] "The origin of diabetes Don't blame your genes They may simply be getting bad instructionsfrom you" (http:/ / www. economist. com/ s ciencetechnology/ displayStory. cfm?story_id=14350157). Economist. 3 September 2 009. . [40] DIABETES april 2009, 58: 773-795 [41] "Definition and Diagnosis of D iabetes Mellitus and Intermediate Hyperglycemia" (http:/ / www. who. int/ diabet es/ publications/ Definition and diagnosis of diabetes_new. pdf) (pdf). World He alth Organization. www.who.int. 2006. . Retrieved 2011-02-20. [42] World Health Organization. "Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO Consultation. Part 1. Diagnosis and classifi cation of diabetes mellitus" (http:/ / www. who. int/ diabetes/ publications/ en / ). . Retrieved 29 May 2007. [43] Harris R, Donahue K, Rathore SS, Frame P, Woo lf SH, Lohr KN (February 2003). "Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force" (http:/ / www. anna ls. org/ cgi/ pmidlookup?view=long& pmid=12558362). Ann. Intern. Med. 138 (3): 2 1529. PMID12558362. . Retrieved 19 July 2008. [44] Rolka DB, Narayan KM, Thompson TJ, et al. (2001). "Performance of recommended screening tests for undiagnosed d iabetes and dysglycemia". Diabetes Care 24 (11): 1899903. doi:10.2337/diacare.24. 11.1899. PMID11679454. [45] Pradhan AD, Rifai N, Buring JE, Ridker PM (2007). "He moglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic wom en". Am. J. Med. 120 (8): 7207. doi:10.1016/j.amjmed.2007.03.022. PMC2585540. PMID1 7679132. [46] Valdez R (2009). "Detecting undiagnosed type 2 diabetes: family hi story as a risk factor and screening tool". J Diabetes Sci Technol 3 (4): 7226. P MC2769984. PMID20144319. [47] "Screening: Type 2 Diabetes Mellitus in Adults" (htt p:/ / www. uspreventiveservicestaskforce. org/ uspstf/ uspsdiab. htm). U.S. Prev entive Services Task Force. 2008. . [48] Raina Elley C, Kenealy T (December 2008 ). "Lifestyle interventions reduced the long-term risk of diabetes in adults wit h impaired glucose tolerance". Evid Based Med 13 (6): 173. doi:10.1136/ebm.13.6. 173. PMID19043031. [49] Orozco LJ, Buchleitner AM, Gimenez-Perez G, Roqu I Figuls M, Richter B, Mauricio D (2008). "Exercise or exercise and diet for preventing t ype 2 diabetes mellitus". Cochrane Database Syst Rev (3): CD003054. doi:10.1002/ 14651858.CD003054.pub3. PMID18646086. [50] Nield L, Summerbell CD, Hooper L, Whit taker V, Moore H (2008). "Dietary advice for the prevention of type 2 diabetes m ellitus in adults". Cochrane Database Syst Rev (3): CD005102. doi:10.1002/146518 58.CD005102.pub2. PMID18646120. [51] Santaguida PL, Balion C, Hunt D, et al. (Aug ust 2005). "Diagnosis, prognosis, and treatment of impaired glucose tolerance an d impaired fasting glucose" (http:/ / www. ahrq. gov/ downloads/ pub/ evidence/ pdf/ impglucose/ impglucose. pdf) (PDF). Evid Rep Technol Assess (Summ) (128): 1

0. PMID16194123. . [52] "Clinical Guideline:The management of type 2 diabetes (up date)" (http:/ / www. nice. org. uk/ guidance/ index. jsp?action=byID& o=11983). . [53] Zanuso S, Jimenez A, Pugliese G, Corigliano G, Balducci S (March 2010). "Exercise for the management of type 2 diabetes: a review of the evidence". Acta Diabetol 47 (1): 1522. doi:10.1007/s00592-009-0126-3. PMID19495557. [54] Davis N, Forbes B, Wylie-Rosett J (June 2009). "Nutritional strategies in type 2 diabete s mellitus". Mt. Sinai J. Med. 76 (3): 25768. doi:10.1002/msj.20118. PMID19421969. [55] Thomas D, Elliott EJ (2009). "Low glycaemic index, or low glycaemic load, diets for diabetes mellitus". Cochrane Database Syst Rev (1): CD006296. doi:10.1 002/14651858.CD006296.pub2. PMID19160276. [56] Hawthorne, K.; Robles, Y.; Canning s-John, R.; Edwards, A. G. K.; Robles, Yolanda (2008). "Culturally appropriate h ealth education for type 2 diabetes mellitus in ethnic minority groups". Cochran e Database Syst Rev (3): CD006424. doi:10.1002/14651858.CD006424.pub2. PMID186461 53. CD006424. [57] Mooradian AD, Bernbaum M, Albert SG (July 2006). "Narrative r eview: a rational approach to starting insulin therapy". Ann. Intern. Med. 145 ( 2): 12534. PMID16847295. 8

Diabetes mellitus type 2 [58] Yki-Jrvinen H, Kauppila M, Kujansuu E, et al. (November 1992). "Comparison o f insulin regimens in patients with non-insulin-dependent diabetes mellitus". N. Engl. J. Med. 327 (20): 142633. doi:10.1056/NEJM199211123272005. PMID1406860. [59 ] Yki-Jrvinen H, Ryysy L, Nikkil K, Tulokas T, Vanamo R, Heikkil M (March 1999). "C omparison of bedtime insulin regimens in patients with type 2 diabetes mellitus. A randomized, controlled trial" (http:/ / www. annals. org/ cgi/ pmidlookup?vie w=long& pmid=10068412). Ann. Intern. Med. 130 (5): 38996. PMID10068412. . Retrieve d 19 July 2008. [60] Holman RR, Thorne KI, Farmer AJ, et al. (October 2007). "Ad dition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabete s" (http:/ / content. nejm. org/ cgi/ pmidlookup?view=short& pmid=17890232& prom o=ONFLNS19). N. Engl. J. Med. 357 (17): 171630. doi:10.1056/NEJMoa075392. PMID1789 0232. . Retrieved 19 July 2008. [61] Raskin P, Allen E, Hollander P, et al. (Feb ruary 2005). "Initiating insulin therapy in type 2 Diabetes: a comparison of bip hasic and basal insulin analogs" (http:/ / care. diabetesjournals. org/ cgi/ pmi dlookup?view=long& pmid=15677776). Diabetes Care 28 (2): 2605. doi:10.2337/diacar e.28.2.260. PMID15677776. . Retrieved 19 July 2008. [62] Malone JK, Kerr LF, Camp aigne BN, Sachson RA, Holcombe JH (December 2004). "Combined therapy with insuli n 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 beginn ing insulin therapy" (http:/ / linkinghub. elsevier. com/ retrieve/ pii/ S0149-2 918(04)00085-2). Clin Ther 26 (12): 203444. doi:10.1016/j.clinthera.2004.12.015. PMID15823767. . Retrieved 19 July 2008. [63] Horvath K, Jeitler K, Berghold A, et al. (2007). "Long-acting insulin analogues versus NPH insulin (human isophane i nsulin) for type 2 diabetes mellitus". Cochrane Database Syst Rev (2): CD005613. doi:10.1002/14651858.CD005613.pub3. PMID17443605. CD005613. [64] Cummings DE, Fl um DR (2008). "Gastrointestinal surgery as a treatment for diabetes" (http:/ / j ama. ama-assn. org/ cgi/ pmidlookup?view=long& pmid=18212321). JAMA 299 (3): 3413 . doi:10.1001/jama.299.3.341. PMID18212321. . [65] Folli F, Pontiroli AE, Schwesi nger WH (2007). "Metabolic aspects of bariatric surgery" (http:/ / linkinghub. e lsevier. com/ retrieve/ pii/ S0025-7125(07)00006-5). Med. Clin. North Am. 91 (3) : 393414, x. doi:10.1016/j.mcna.2007.01.005. PMID17509385. . [66] Robert J. Tanenb erg (April 1, 2005). "Gastric Bypass Surgery" (http:/ / www. diabeteshealth. com / read/ 2005/ 04/ 01/ 4261. html). Diabetes Health. . [67] Harris MI, Flegal KM, Cowie CC, et al. (April 1998). "Prevalence of diabetes, impaired fasting glucos e, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 19881994". Diabetes Care 21 (4): 51824. doi:10.2337/ diacare.21.4.518. PMID9571335. [68] Chang AM, Halter JB (January 2003). "Aging an d insulin secretion". American Journal of Physiology. Endocrinology and Metaboli sm 284 (1): E712. doi:10.1152/ajpendo.00366.2002 (inactive 2009-10-31). PMID124858 07. [69] "Diabetes and Aging" (http:/ / diabetes. niddk. nih. gov/ about/ dateli ne/ spri02/ 8. htm). Diabetes Dateline. National Institute of Diabetes and Diges tive and Kidney Diseases. 2002. . Retrieved 2007-05-14. [70] Green A, Christian Hirsch N, Pramming SK (2003). "The changing world demography of type 2 diabetes" . Diabetes Metab. Res. Rev. 19 (1): 37. doi:10.1002/dmrr.340. PMID12592640. [71] Z immet P, Alberti KG, Shaw J (December 2001). "Global and societal implications o f the diabetes epidemic" (http:/ / www. nature. com/ nature/ journal/ v414/ n686 5/ abs/ 414782a. html). Nature 414 (6865): 7827. doi:10.1038/414782a. PMID11742409 . . Retrieved 19 July 2008. [72] "Total Prevalence of Diabetes and Pre-diabetes" (http:/ / www. diabetes. org/ diabetes-statistics/ prevalence. jsp). American D iabetes Association. . Retrieved 2008-11-29. [73] Inzucchi SE, Sherwin RS (March 2005). "The prevention of type 2 diabetes mellitus". Endocrinol. Metab. Clin. N orth Am. 34 (1): 199219, viii. doi:10.1016/j.ecl.2004.11.008. PMID15752928. [74] G erberding, Julie Louise (2007-05-24). Diabetes (http:/ / www. cdc. gov/ nccdphp/ publications/ aag/ ddt. htm). Atlanta: Centres for Disease Control. . Retrieved 2007-09-14. [75] Diabetes rates are increasing among youth (http:/ / www. nih. gov/ news/ pr/ nov2007/ niddk-13. htm) National Institutes of Health (NIH), Nove mber 13, 2007 [76] Steinberger J, Moran A, Hong CP, Jacobs DR, Sinaiko AR (2001) . "Adiposity in childhood predicts obesity and insulin resistance in young adult hood.". J Pediatr 138 (4): 46973. doi:10.1067/mpd.2001.112658. PMID11295707.

9 External links Diabetes mellitus type 2 (http://www.dmoz.org/Health/Conditions_and_Diseases/End ocrine_Disorders/ Pancreas/Diabetes/Type_2/) at the Open Directory Project Type 2 Diabetes - General Information (http://www.diabetes.co.uk/type2-diabetes.html) National Diabetes Information Clearinghouse (http://diabetes.niddk.nih.gov/) Ce nters for Disease Control (Endocrine pathology) (http://www.cdc.gov/diabetes/)

Article Sources and Contributors 10 Article Sources and Contributors Diabetes mellitus type 2 Source: http://en.wikipedia.org/w/index.php?oldid=431524 143 Contributors: 07parsonse, 4wajzkd02, 7, A3camero, Abaute, Abcd1234123, Afapro f01, Agoodmansen, Alansohn, AlistairMcMillan, Ammubhave, Anaxial, Andy Marchbank s, Andybiddulph, AnjaManix, Anthony Keats, Antonio Lopez, Arcadian, Artephius, A sbartle, Asbestos, Ash, Avs dps, AxelBoldt, Axl, Ayvah, Badgettrg, Baobabtree, B arek, Benbest, Bennybp, Bentogoa, Berian, Bernard Marx, Bernfarr, Bing11, Biodie seller, Blackeyebeans, BlueEarth, Bluezy, Bob horn, Bobblewik, Bobdewhirst, Bobo 192, Boghog, Bollar, Brett dixon metallica, Brsekar, Brusegadi, Bubba73, Bunnyho p11, Burlywood, Bytwerk, CambridgeBayWeather, Canthusus, Catgut, Cathy88, Cbanks 88, Chaos MD, Chargersbruh21, Chi 271, Chris Capoccia, ChristianH, CliffC, Cm320 8708, Cmcnicoll, Coldbringer, Conny, Coro, Corpx, Cubssuperfan29, DChauritonayna y, DPG1993, DRTllbrg, DVdm, Daigoji Gai, Damian Yerrick, DanMS, Danielcrockett, Danwarne, Dararivera, DarkFalls, Darrylthered, Davegomes, Daviddaniel37, Davidru ben, Delldot, Derek Ross, Diderot, DocWatson42, Doctorfluffy, Doczilla, Dominus, Dondli, DragonflySixtyseven, Dth1112, Eden Thinker, Edgar181, Edward321, Enquir e, EoGuy, Eric Kvaalen, Esperant, Ewawer, ExoSynth, Ezeu, Facts707, Falcon8765, Femto, Fireworks, Fleetham, FrancoGG, Frank Lofaro Jr., Frankg, Froth, Frumosi, Fuzzy510, Fvasconcellos, Gandydancer, Gavron, Grafen, Graham87, GrammarNaziMJ, G uy0307, Gwernol, Gzuckier, Hadal, Hairy Dude, Hbent, Healthabetic, Healthbuff, H istorymike, Hontogaichiban, Hydrargyrum, Iggy248, Inhaliburton, Introvert, Iride scent, Ispy1981, Iushad, J.delanoy, Jacob1318, Jatlas, Jediwizardspy, Jfdwolff, Jmarchn, Jmh649, Jmundo, Jnb, JoeSmack, Jonwjonw, Joseph Solis in Australia, Jot hydev, Jpviolette, Jusdafax, Jussi tilen, Karen Johnson, Katka193, Keeshu, Kingp in13, Kl4m, Kochipoik, Kpjas, Krisandie, Kvorakir, Kyle1278, LOL, Labastar, Lamb iam, Lauk, LeadSongDog, Leafyplant, Leon7, Letatcestmoi94, LicenseFee, Lilac Sou l, LizzardKitty, LoopTel, Loumalnati, Lowsugarguy, Manscher, Manuelhp42, Marek69 , Marknen, Marokwitz, Maxis ftw, Merope, Michellecrisp, MightyWarrior, Mikael Hgg strm, Mikec000, Miketedesco, Mm40, Mnbitar, Mononomic, Mr Stephen, MrRadioGuy, Mu ffledThud, Murrayhuntington, Mwanner, NIDDM CUKOR, Natural life 76, Neodop, NewE nglandYankee, NickPenguin, Nikai, Noctibus, Northcoastmed, Notepadpage, Nsaa, Oc camzRazor, Ohnoitsjamie, Oxymoron83, Oyoyoy (usurped), PA-C6, Papa November, Pet er Grey, Petersam, Pharaoh of the Wizards, Philip Trueman, Piperh, Pleonastic, P loniAlmoni, Pne, Povlsen, Ppeetteerr, Princess LJ, Prodego, Prof. Campbell, Psr4 z4, Quercus solaris, RandomP, Realm of Shadows, Rebeccadk, Rich Farmbrough, Rich honcho, Rjwilmsi, Rodandjoyce, Rogermw, Rror, Ruslik0, SURIV, SacTu, Sahilmehta9 9, SandyGeorgia, Sarrus, Sbmehta, Scholariusx, Scientizzle, Seans Potato Busines s, Shadowjams, Shimon Yanowitz, Silivrenion, Silly rabbit, Silversin, Sketchmoos e, Snigbrook, Soarhead77, Sophie1226, Southafricanguy, Stevenbehnke, Student7, S ynergyBlades, Tabletop, Tarek, Tdvance, Teamabby, Tehranpars, Tempshill, Testost erone vs diabetes, Thatcher, The Equilibrium, The Thing That Should Not Be, The Transhumanist, Thehelpfulone, Tide rolls, Timotheus Canens, Tlabshier, Tony1, To ughpigs, Trafford09, Tritium6, UKMatt123, Unconcerned, Useight, Utcursch, Verbum Veritas, Virobin, Voyagerfan5761, Watchmann1, WhatamIdoing, Whirlwind.maze, Why whenwhohow, Wikipelli, Wilmar ArthurB, Winston365, Witchzilla, WizardFusion, Wou terstomp, Wtmitchell, Ww, Xodarap00, Yaris678, Zigger, Zilla3, Zzuuzz, 638 anony mous edits Image Sources, Licenses and Contributors File:Blue circle for diabetes.svg Source: http://en.wikipedia.org/w/index.php?tit le=File:Blue_circle_for_diabetes.svg License: Public Domain Contributors: User:Rem ember the dot Image:Metformin 500mg Tablets.jpg Source: http://en.wikipedia.org/w /index.php?title=File:Metformin_500mg_Tablets.jpg License: Public Domain Contribut ors: User:Ash License

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