Condition
Type 2 Diabetes
Type 2 diabetes is a chronic condition characterized by elevated blood glucose driven by a combination of insulin resistance and progressive beta-cell dysfunction.
Diagnosis
Diagnosis (ADA) requires any of:
- Fasting plasma glucose ≥ 126 mg/dL.
- 2-hour plasma glucose ≥ 200 mg/dL on a 75 g OGTT.
- A1C ≥ 6.5%.
- Random plasma glucose ≥ 200 mg/dL with classic symptoms or hyperglycemic crisis.
Confirmation typically requires repeat testing.
Why it develops
Type 2 diabetes typically reflects insulin resistance combined with relative insulin insufficiency as beta cells become unable to keep pace. Contributors include adiposity (especially visceral fat), physical inactivity, genetics, age, certain medications, and conditions such as MASLD and PCOS.
Complications
Long-term hyperglycemia increases risk of cardiovascular disease, kidney disease, retinopathy, neuropathy, and complications related to wound healing and infection. Risk is reduced by control of glucose, blood pressure, and lipids, smoking cessation, and appropriate use of guideline-directed therapy.
Treatment categories
- Lifestyle (nutrition, physical activity, sleep, behavioral support).
- Pharmacotherapy: metformin, GLP-1 receptor agonists, GIP/GLP-1 dual agonists, SGLT2 inhibitors, insulin, and others. Choice depends on individual factors.
- Metabolic surgery in selected patients (an option recognized in current ADA Standards of Care).
- Endoscopic therapies, where appropriate.
Remission
Some patients achieve remission — generally defined as A1C below the diabetes range without glucose-lowering medication for at least 3 months. Remission is more likely with substantial sustained weight loss and earlier in the disease course. Remission is not a cure; ongoing follow-up is essential.