What is type 2 diabetes?

What is type 2 diabetes? Type 2 diabetes is a chronic and progressive disorder of glucose metabolism. The diagnosis is made when blood sugar is higher than normal. However, type 2 diabetes is not only a disease limited to high blood sugar. In many cases there are other chronic metabolic disorders such as obesity, dyslipidaemia and high blood pressure. What proportion of all diabetes cases is type 2? Type 2 diabetes accounts for 90–95% of all diabetes cases. What are the causes of type 2 diabetes? Three main factors play a role: genetic predisposition, unhealthy lifestyle and increasing age. People with obesity are at high risk of developing diabetes. Increasingly unhealthy eating habits and physical inactivity pose a major risk for the development of diabetes. The risk rises markedly in people with an unhealthy diet and prolonged inactivity, especially when genetic predisposition is present. What are the symptoms of type 2 diabetes? Clinical symptoms appear due to complications of high blood sugar or chronic hyperglycaemia. Drinking a lot of water and frequent urination are the main complaints caused by high blood glucose. In many people, however, blood sugar may not be high enough to cause symptoms; they may have no complaints even though their glucose is above normal limits. It is estimated that about half of people with type 2 diabetes worldwide are undiagnosed because they have no symptoms. Chronically high blood sugar paves the way for diabetes‑related vascular disease. Vision loss is one of the most feared complications. Many people with diabetes also suffer from distressing nerve symptoms. Numbness, tingling, chills or burning in the feet – and sometimes in the hands – can be the main reason for seeking care. Autonomic nerve involvement due to diabetes may lead to erectile dysfunction in men and sexual problems with painful intercourse in women. Because large vessels are affected, chest pain with exertion or leg pain while walking can occur. Type 2 diabetes is a leading cause of coronary heart disease, stroke and peripheral arterial disease. How is type 2 diabetes diagnosed? Diagnosis is straightforward. High blood glucose is established using several measurements. Fasting plasma glucose ≥126 mg/dL on two separate days, 2‑h plasma glucose >200 mg/dL during a 75‑g oral glucose tolerance test, Random plasma glucose >200 mg/dL in patients with symptoms of hyperglycaemia (polydipsia, polyuria, weight loss, etc.), HbA1c ≥6.5%, commonly referred to as the 3‑month average blood sugar. How is type 2 diabetes treated? Key components of treatment: 1 – Healthy lifestyle Balanced and healthy nutrition Regular physical activity Smoking cessation 2 – Glycaemic control with appropriate therapies Oral antidiabetic medications Injectable antidiabetic medications 3 – Treating comorbidities and other risk factors Overweight/obesity Hypertension Dyslipidaemia Which complications can uncontrolled type 2 diabetes cause? Diabetes is the most common cause worldwide of non‑traumatic vision loss and non‑traumatic amputations. It is the most frequent cause among people with end‑stage kidney disease. The risk of coronary heart disease, stroke, peripheral arterial disease and heart failure is at least doubled compared with people without diabetes. When diabetes is controlled, these complications are much less frequent. What is the importance of healthy lifestyle habits in type 2 diabetes? Nine out of ten people with type 2 diabetes are overweight. Studies show diabetes can be controlled by appropriate weight loss in those with obesity. With attention to healthy nutrition and sufficient physical activity, blood sugar can reach normal values without medication or with reduced medication needs. Such behaviour change not only improves glucose control but also prevents cardiac/renal consequences and dysfunction in other organs related to diabetes. In many people, the risk of type 2 diabetes can be prevented or reduced by regular nutrition and healthy habits. However, because of the strong genetic basis, diabetes may still develop despite all efforts. Even then, in individuals with established healthy habits, diabetes is easier to control. In short, establishing healthy living habits should be a priority for everyone. Type 2 diabetes is treatable and even preventable. Treatment is not only about taking medicines regularly. It is essential that patients change unhealthy lifestyle habits. If we eat healthily and increase physical activity, we can make major progress in fighting type 2 diabetes. For this reason, it is very important for people to build health literacy and take the right steps by obtaining correct information from reliable sources. People with type 2 diabetes who are overweight can largely avoid complications if they return to a healthy weight. Even if type 2 diabetes has a genetic basis, having diabetes is not destiny. With a healthy lifestyle you can prevent its development; if it has developed, you can facilitate its treatment. Are there “miracle foods” that control or lower blood sugar? Contrary to popular belief, there is no miracle food that lowers blood sugar. Healthy eating patterns, not miracle foods, help control glucose. Likewise, high‑protein or low‑carbohydrate diets do not work miracles. The advantage is the regular intake of high‑quality, lower‑calorie nutrients. Foods rich in fibre and quality carbohydrates (e.g. whole grains, legumes) should be encouraged. Added sugar should not be used as a carbohydrate source, and added sugars should contribute less than 10% of total daily energy intake. A similar approach applies to fat and protein choices: rather than just proportions of total calories, the type and quality of protein and fat sources matter. Today animal proteins are often consumed in excess and it is forgotten that plants can be valuable protein sources. Excessive red meat consumption is harmful to cardiovascular health because it increases intake of saturated fatty acids. Regarding fats, trans fats should ideally be avoided entirely (less than 1% of total energy), and saturated fats should be under 10% of total calories. The dietary pattern most often cited as exemplary is the Mediterranean diet. The Mediterranean diet emphasises frequent consumption of fresh fruits and vegetables, whole grains, legumes, nuts and seeds. Fish is preferred as the animal protein, and olive oil is recommended as the main fat.