Type 2 diabetes

Overview

Type 2 diabetes is a progressive disorder defined by the combination of insulin resistance and progressive beta-cell failure, producing chronic hyperglycaemia and its microvascular, macrovascular and neuropathic complications. It accounts for around 90% of all diabetes. An estimated 13% of US adults have diabetes and 34.5% meet criteria for prediabetes; prevalence rises with age.^[4]

The disease is usually detected by screening or incidentally years after onset, because hyperglycaemia is silent until complications appear. Early detection matters: simulation modelling of the ADDITION-Europe trial showed the intensity of glucose, blood pressure and cholesterol treatment after diagnosis is less important than the time of its initiation — a 3-year diagnostic delay forfeits a 29% relative reduction in cardiovascular risk that prompt treatment would have delivered.^[5]

Management is a lifelong cycle of lifestyle foundation, metformin-based pharmacotherapy escalated on individualised HbA1c targets, comorbidity-driven cardiorenal protection, and annual complication surveillance. The landmark trials of the last decade shifted the treatment goal from glucose alone to organ protection: empagliflozin reduced cardiovascular death by 38%, liraglutide reduced it by 22%, and canagliflozin cut kidney-failure progression by a third — benefits that are independent of the drugs' glucose-lowering effect.^[12][14][20]

References37ShowHide

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