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Type II diabetes (Type 2 diabetes)

See ((Diabetes))

Type two diabetes accounts for 90 to 95% of cases and is characterized by progressive loss of adequate insulin secretion, usually with insulin resistance.

Type two diabetes is caused by a constellation of genetic and epigenetic factors and molecular changes related to diet, lifestyle, lack of exercise and sleep, environmental influences, circadian rhythms, and gut microbiota: these factors, affect, systemic metabolism, which alters the morphologic features, metabolism, and function of adipose tissue.

Changes in adipocyte function affect systemic metabolism, including insulin sensitivity in the liver and muscle, insulin secretion from pancreatic beta cells, and food intake and energy expenditure, regulated by the brain and sympathetic nervous system, ultimately affecting body weight.

The relative risk of cardiovascular disease in type 2 diabetes increases approximate 16% for every percentage point increase in hemoglobin A-1 C.

Diabetes is a coronary artery disease equivalent with a 2-4 fold increase for its development and the prevalence of acute coronary syndrome is as high as 20% at seven years a follow up.

Type 2 diabetes is one of the most prevalent chronic conditions in older adults.

What was considered a disease of aging, is now observed at increasing rates in young people.

The prevalence of type two diabetes in children and adolescents has been increasing over the last few decades among youth age 10 to 19 years: relative increase of 95%.

The highest rate of type two diabetes occur among American Indian, Black and Hispanic youth.

Increasing diabetes in youth is related to unhealthy lifestyle of increased sedentary behavior, decreased physical activity, and weight gain.

Type 2 DM is among the most common metabolic disorders, with a prevalence ranging from 2.4 to 14.8% in the general population.

Lean, non-diabetic family members of persons with type two diabetes have at least a 30 to 50% increase risk of diabetes.

 

The International Diabetes Federation estimates that the T2DM prevalence among adults aged 20 to 79 years will increase from 9.3% in 2019 to 10.2% in 2030.

 

The number of individuals with T2DM 500 million worldwide.

 

The main complications of diabetes are microvascular disease (retinopathy, neuropathy, and the frothy) and macrovascular disease (coronary heart disease, peripheral vascular disease, and cerebrovascular disease).

 

Approximately 25-30% of older adults in the United States have diabetes and another 25%-30% have glucose intolerance, a prediabetic state.

The BLSA (Baltimore Longitudinal Study of Aging) showed a progressive decline in glucose tolerance from the third through the ninth decade of life.

Although the exact etiology is unknown, age-dependent decreases in pancreatic ?-cell function and insulin sensitivity are believed to play important roles in the deterioration of glucose homeostasis that occurs with advancing age.

Type two diabetes related microvascular complications increase steeply and asymptomatically as hemoglobin A-1 C values increased to grade an 8.5%.
Each one percent reduction in updated mean hemoglobin A-1 C is associated with the risk reduction of 21% for any endpoint related to diabetes.
Type two diabetes affects more than one third of a billion people worldwide and is leading cause of end stage renal disease, non-traumatic loss of limb, and blindness and estimated worldwide health care cost exceeding a half trillion dollars.

In the United States $245 billion every year is attributed to diabetes. 

Individuals diagnosed with diabetes have 2.3 times the health care costs as individuals who do not have diabetes.

 

One in ten health care dollars are spent on individuals with type 1 and 2 diabetes.

 

Other types of nonimmune mediated injury to beta cells include: cystic fibrosis, acute or chronic pancreatitis, partial or complete pancreatic resection,and hemochromatosis.

The degree of diabetes is usually proportional to the amount of injury to the pancreatic Beta cell mass.

At the time of diagnosis an average of only 50% of beta cell function remains. 

Ranked as the seventh leading cause of death in the U.S. in 2006.

Estimated 422 million people worldwide live with diabetes, and half are undiagnosed.

29 million adults (1 in 11) have type 2 DM and another 86 million have prediabetes.

Approximately 40% of US adults have insulin resistance.

Using data from more than 25 studies and 1 million patients, investigators concluded each 1-year increase in age at diabetes diagnosis was associated with a 4%, 3% and 5% lower risk of all-cause mortality, macrovascular disease, and microvascular disease, respectively.

Prevalence in adults over the age of 65 years is 26%.

Approximately 1 in 11 adults worldwide have type 2 DM.

Annual per capita healthcare expenditures are 2.3 times higher for people with diabetes compared with those without diabetes.

In 2014 type two diabetes affected approximately 9.3% of US adults and 36.4% are undiagnosed.

About one in two adults with diabetes are undiagnosed.

Accounts for almost 200,000 deaths annually worldwide.

With type two diabetes immediate follow up of 10 years revealed a risk of myocardial  infarction increases proportionally with hemoglobin A-1 C to a level of 9.5 to 10%.
Reducing hemoglobin A-1 C from 9.5 to 8.5% can result in an absolute reduction in microvascular disease by approximately 15% and myocardial infarction by approximately 10%.
 
At the time of diagnosis an average of only 50% of beta cell function remains. 

Ranked as the seventh leading cause of death in the U.S. in 2006.

Estimated 422 million people worldwide live with diabetes, and half are undiagnosed.

29 million adults (1 in 11) have type 2 DM and another 86 million have prediabetes.

Approximately 40% of US adults have insulin resistance.

Prevalence in adults over the age of 65 years is 26%.

Approximately 1 in 11 adults worldwide have type 2 DM.
Affects more than 30 million adults in the US, and more than 500 million people worldwide, with an annual incidence in the US of approximately 1.5 million cases.

One in nine healthcare dollars expended on diabetes and its complications.

Annual per capita healthcare expenditures are 2.3 times higher for people with diabetes compared with those without diabetes.

In 2014 type two diabetes affected approximately 9.3% of US adults and 36.4% are undiagnosed.

Accounts for almost 200,000 deaths annually worldwide.

Almost 14% of healthcare expenditures in US come from diabetes and more than 50% is due to complications of the disease. 
 
Myocardial infarction is the most common cause of death in patients with diabetes. 

The incidence of diabetes can be reduced by as much as 50% by lifestyle and pharmacological interventions. 

Patients with type two diabetes are at increased risk of developing atrial fibrillation , and patients with the combination of atrial fibrillation and diabetes are at high risk for stroke. 

Bariatric surgery reduces the long-term incidence to diabetes by 80% percent in the Swedish Obese Subject study.

In 2007 was estimated that diabetes was the underlying cause of more than 70,000 deaths, and a contributing factor to an additional 160,000 deaths in the US.

Most patients with diabetes do not have their hemoglobin A-1 C., blood pressure or low-density lipoprotein-cholesterol under control.

Third leading cause of death in women and fourth in men (Loyd-jones D et al).
 

Type 2 diabetes presents a greater risk for severe consequences of cardiovascular disease in women than in men, and that at the time of diagnosis, women with type 2 diabetes might have more advanced atherosclerosis than men at the same stage of disease. 

 

Progress in reducing type 2 diabetes mortality has been more effective in men than in women.

 

In reproductive-age women, the presence of type 2 diabetes largely negates this protection from cardiovascular disease, and diabetic women are more severely affected than men.

More than 40% of adults with diabetes are older than 65 years of age.

There is a strong association between diabetes and frailty. 

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