2型糖尿病
Type 2 diabetes/ja
| Type 2 diabetes/ja | |
|---|---|
| Other names | 2型糖尿病; 成人型糖尿病; 非インスリン依存性糖尿病（NIDDM） |
 | |
| 青い円は糖尿病の世界共通のシンボルである | |
| Pronunciation | |
| Specialty | 内分泌学 |
| Symptoms | 喉の渇きが増す, 頻尿, 原因不明の体重減少, 空腹感の増大 |
| Complications | Hyperosmolar hyperglycemic state/ja, diabetic ketoacidosis/ja, heart disease/ja, stroke/ja, diabetic retinopathy/ja, kidney failure/ja, amputation/ja |
| Usual onset | 中高年 |
| Duration | 長期間 |
| Causes | 肥満, 運動不足, 遺伝学 |
| Diagnostic method | 血液検査 |
| Prevention | 標準体重の維持、エクササイズ、健康的な食事 |
| Treatment | 食生活の変化, metformin/ja, インスリン, bariatric surgery/ja |
| Prognosis | 平均寿命が10年短い。 |
| Frequency | 392百万 (2015) |
以前は成人型糖尿病として知られていた2型糖尿病（T2D）は、高血糖、インスリン抵抗性、およびインスリンの相対的な不足を特徴とする糖尿病の一形態である。一般的な症状には、喉の渇き、頻尿、疲労、原因不明の体重減少がある。症状には、空腹感の増加、ピンと針の感覚、および治癒しないただれ（傷）も含まれる。多くの場合、症状はゆっくりと現れる。高血糖による長期的な合併症には、心臓病、脳卒中、失明につながる可能性のある糖尿病網膜症、腎不全、手足の血流が悪くなり切断に至ることもある。高浸透圧高血糖状態が突然発症することがあるが、ケトアシドーシスはまれである。
2型糖尿病は主に肥満と運動不足の結果として起こる。遺伝的にリスクが高い人もいる。
2型糖尿病は糖尿病の症例の約90％を占め、残りの10％は主に1型糖尿病と妊娠糖尿病によるものである。1型糖尿病では、膵臓におけるインスリン産生β細胞の自己免疫誘発性喪失により、血糖を制御するためのインスリンの総レベルが低下する。糖尿病の診断は、空腹時血糖値、経口ブドウ糖負荷試験、糖化ヘモグロビン（A1C）などの血液検査によって行われる。
2型糖尿病は、標準体重を維持し、エクササイズを定期的に行い、健康的な食事（果物や野菜を多く摂り、砂糖や飽和脂肪酸を控える）を摂ることで、ほぼ予防可能である。治療には運動と食生活の改善が必要である。血糖値が十分に下がらない場合は、一般的にメトホルミンという医薬品が勧められる。多くの人は最終的にインスリン注射も必要となる。インスリン治療を受けている人では、（持続グルコースモニターなどを通じて）血糖値を日常的にチェックすることが勧められるが、インスリン治療を受けていない人ではその必要はないかもしれない。肥満手術は、肥満の人の糖尿病を改善することが多い。
2型糖尿病の罹患率は、肥満と並行して1960年以降著しく増加している。1985年には約3,000万人であったのに対し、2015年の時点で約3億9,200万人がこの病気と診断されている。一般的に糖尿病は中高年から発症するが、若年層でも2型糖尿病の割合は増加している。糖尿病は初めて記述された病気の一つであり、BCE1500年のエジプトの写本にまでさかのぼる。この病気におけるインスリンの重要性は、1920年代に決定された。
徴候と症状
糖尿病の典型的な症状は、頻尿（多尿）、口渇増加（多飲）、空腹増加（多食）、および体重減少である。診断時によくみられる他の症状としては、かすみ目、かゆみ、末梢神経障害、再発性の膣感染症、および疲労がある。その他の症状としては味覚障害がある。 しかし、多くの人は最初の数年間は症状がなく、定期的な検査で診断される。型糖尿病患者の少数が高スモ-ラ-高血糖状態（意識レベルの低下や血圧低下を伴う非常に高い血糖の状態）を発症することがある。
合併症
2型糖尿病は、一般的に10年寿命が短くなる慢性疾患である。 これは、以下のような多くの合併症を伴うことが一因である：虚血性心疾患や脳卒中を含む心血管系疾患のリスクが2～4倍になる； 下肢の切断の20倍増加、入院率の増加などである。先進国では、2型糖尿病は、非外傷性の失明や腎不全の最大の原因である。 また、アルツハイマー病や血管性認知症などの疾患過程を通じて、認知機能障害や認知症のリスク増加とも関連している。 その他の合併症としては、皮膚の色素沈着（黒色表皮腫）、性機能障害、頻繁な感染症などがある。2型糖尿病と軽度の難聴との関連もある。
原因
2型糖尿病の発症は、生活習慣と遺伝的要因の組み合わせによって引き起こされる。これらの要因の中には、食事や肥満のように個人でコントロールできるものもあるが、年齢が上がること、女性の性別、遺伝など、そうでない要因もある。アフリカの多くの地域では、肥満は男性よりも女性に多い。胎児の発育過程における母親の栄養状態も関与している可能性があり、そのメカニズムの1つとしてDNAメチル化が提案されている。腸内細菌プレボテラ・コプリとバクテロイデス・ブルガータス'は2型糖尿病と関連している。
ライフスタイル
2型糖尿病の発症には、肥満や過体重（肥満度指数が25以上で定義される）、運動不足、食生活の乱れ、心理的ストレス、都市化などの生活習慣要因が重要である。過剰な体脂肪は、中国系および日本系では30％、ヨーロッパ系およびアフリカ系では60～80％、ピマ・インディアンおよび太平洋諸島民では100％の症例と関連している。肥満でない人では、高いウエスト・ヒップ比を示すことが多い。喫煙は2型糖尿病のリスクを高めるようである。 睡眠不足も2型糖尿病に関連している。実験室での研究では、短期間の睡眠不足が、グルコース代謝、神経系の活動、または糖尿病につながる可能性のあるホルモン因子の変化と関連している。
食事要因も2型糖尿病の発症リスクに影響する。砂糖入り飲料の過剰摂取はリスクの上昇と関連している。食事中の脂肪の種類は重要であり、飽和脂肪酸とトランス脂肪酸はリスクを増加させ、多価不飽和脂肪酸と一価不飽和脂肪酸はリスクを減少させる。白米を多く食べることはリスク上昇に一役買っているようである。運動不足は症例の7％を引き起こすと考えられている。残留性有機汚染物質も一役買っている可能性がある。
遺伝
糖尿病のほとんどの症例には多くの遺伝子が関与しており、それぞれが2型糖尿病になる確率を高める小さな要因となっている。糖尿病の遺伝の割合は72％と推定されている。型糖尿病のリスクに寄与する36以上の遺伝子と80以上の一塩基多型（SNP）が見つかっている。これらの遺伝子を全部合わせても、まだこの病気の遺伝的要素の10％に過ぎない。例えば、TCF7L2対立遺伝子は、糖尿病の発症リスクを1.5 倍に増加させ、一般的な遺伝子変異の中で最大のリスクである。糖尿病に関連する遺伝子のほとんどは、膵臓のβ細胞の機能に関与している。
単一の遺伝子の異常によって生じる糖尿病（単発性型糖尿病または"その他の特異的な型糖尿病"として知られる）のまれな症例が数多くある。これには若年成熟型糖尿病（MODY）、ドノヒュー症候群、ラブソン・メンデンホール症候群などが含まれる。若年性成熟期発症糖尿病は、若年者における糖尿病の全症例の1～5％を占める。
エピジェネティクス
エピジェネティックな制御は、(1)DNA中のシトシン残基とアデニン残基の直接的なメチル化、(2)クロマチン中のヒストンタンパク質の共有結合修飾、(3)非コードマイクロRNAの作用など、複数のレベルで起こる（他の例については、Wikipediaの記事「エピジェネティクス」を参照）。 2017年11月17日から19日にかけて、米国糖尿病学会は "Epigenetics and Epigenomics: Implications for Diabetes and Obesity "と題する研究シンポジウムを開催した。 このシンポジウムの結果として、この分野の状況の概要が発表され、その中で、糖尿病とエピジェネティクスまたはエピゲノミクスの交わりを扱った研究論文が1,000本以上発表されていることが指摘された。この分野の知識の現状は、Wikipediaの「2型糖尿病のエピジェネティクス」に記載されている。
医学的条件
糖尿病になりやすい医薬品やその他の健康問題は数多くある。医薬品には以下のようなものがある： グルココルチコイド剤、サイアザイド剤、βブロッカー剤、非定型抗精神病薬剤、スタチン剤などである。以前に妊娠糖尿病にかかったことのある人は、2型糖尿病を発症するリスクが高い。関連するその他の健康問題には以下のものがある： 先端巨大症、クッシング症候群、甲状腺機能亢進症、褐色細胞腫、グルカゴノーマなどの特定のがんなどがある。がんに罹患している人は、糖尿病も併発している場合、死亡リスクが高くなる可能性がある。テストステロン欠乏症も2型糖尿病と関連している。摂食障害も2型糖尿病と相互作用することがあり、神経性過食症はリスクを増加させ、神経性食欲不振症はリスクを減少させる。
病態生理学
2型糖尿病は、インスリン抵抗性の設定におけるβ細胞からの不十分なインスリン産生に起因する。インスリン抵抗性とは、正常レベルのインスリンに対して細胞が十分に反応できないことであり、主に筋肉、肝臓、脂肪組織で起こる。肝臓では、インスリンは通常グルコース放出を抑制する。しかし、インスリン抵抗性の状況では、肝臓は不適切にグルコースを血液中に放出する。インスリン抵抗性とβ細胞機能不全の割合は個人差があり、インスリン抵抗性が主体でインスリン分泌にわずかな欠陥があるだけの人もいれば、インスリン抵抗性がわずかでインスリン分泌が主体でない人もいる。
Other potentially important mechanisms associated with type 2 diabetes and insulin resistance include: increased breakdown of lipids within fat cells, resistance to and lack of incretin, high glucagon levels in the blood, increased retention of salt and water by the kidneys, and inappropriate regulation of metabolism by the central nervous system. However, not all people with insulin resistance develop diabetes since an impairment of insulin secretion by pancreatic beta cells is also required.
In the early stages of insulin resistance, the mass of beta cells expands, increasing the output of insulin to compensate for the insulin insensitivity. But when type 2 diabetes has become manifest, a type 2 diabetic will have lost about half of their beta cells. Fatty acids in the beta cells activate FOXO1, resulting in apoptosis of the beta cells.
The causes of the aging-related insulin resistance seen in obesity and in type 2 diabetes are uncertain. Effects of intracellular lipid metabolism and ATP production in liver and muscle cells may contribute to insulin resistance. New evidence also points to a role of a brain region called the hypothalamus in the development of insulin resistance. A gene called Dusp8 is linked with an increased risk for diabetes. This gene codes for a protein that regulates neuronal signaling in the hypothalamus. Also, infusions into the hypothalamus of a hormone called leptin normalize blood glucose and diminish insulin resistance in diabetic animals. Activation of hypothalamic cells by leptin has an important role in maintaining normal levels of blood glucose. Thus, both the endocrine cells of the pancreas AND cells in the hypothalamus may have a role in the etiology of type 2 diabetes.
Hypothalamic cells regulate blood glucose via projections to the autonomic nervous system. Autonomic innervation of liver and muscle cells stimulates an increased uptake of glucose. In diabetic humans, the control of blood glucose by the autonomic nervous system is abnormal. Leptin-sensitive, glucose regulating neurons become resistant to leptin during aging or during exposure to a high-fat diet. These leptin-resistant neurons fail to restrain food intake, obesity, and blood glucose. The reasons for this lowered responsiveness to leptin are uncertain and are part of the puzzle of the causes of type 2 diabetes.
Blood glucose levels can also be normalized in diabetic rodents by a single intrahypothalamic infusion of Fibroblast Growth Factor 1 (FGF1), an effect that persists for months even in severely diabetic animals. This remarkable cure of diabetes is accomplished by a stimulation of accessory brain cells called astrocytes. Hypothalamic astrocytes that produce Fatty Acid Binding Protein 7 (FABP7) are targets of FGF1; these cells are also in close contact with leptin-sensitive neurons, influence their function, and regulate leptin sensitivity. An abnormal function of FABP7+ astrocytes thus may contribute to the resistance to leptin and insulin that appear during aging and during exposure to high-fat diets.
During aging, FABP7+ astrocytes develop cytoplasmic granules derived from degenerating mitochondria. This mitochondrial degeneration is partly due to the oxidative stress of the heightened amounts of fatty acids that are taken up by these cells and oxidized within mitochondria. A pathological degeneration of mitochondria in these cells may compromise their normal functions and contribute to abnormalities in the control of blood glucose by the hypothalamus.
Diagnosis
| Condition | 2-hour glucose | Fasting glucose | HbA1c | |||
|---|---|---|---|---|---|---|
| Unit | mmol/L | mg/dL | mmol/L | mg/dL | mmol/mol | DCCT % |
| Normal | < 7.8 | < 140 | < 6.1 | < 110 | < 42 | < 6.0 |
| Impaired fasting glycaemia | < 7.8 | < 140 | 6.1–7.0 | 110–125 | 42–46 | 6.0–6.4 |
| Impaired glucose tolerance | ≥ 7.8 | ≥ 140 | < 7.0 | < 126 | 42–46 | 6.0–6.4 |
| Diabetes mellitus | ≥ 11.1 | ≥ 200 | ≥ 7.0 | ≥ 126 | ≥ 48 | ≥ 6.5 |
The World Health Organization definition of diabetes (both type 1 and type 2) is for a single raised glucose reading with symptoms, otherwise raised values on two occasions, of either:
- fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dL)
- or
- with a glucose tolerance test, two hours after the oral dose a plasma glucose ≥ 11.1 mmol/L (200 mg/dL)
A random blood sugar of greater than 11.1 mmol/L (200 mg/dL) in association with typical symptoms or a glycated hemoglobin (HbA1c) of ≥ 48 mmol/mol (≥ 6.5 DCCT %) is another method of diagnosing diabetes. In 2009 an International Expert Committee that included representatives of the American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) recommended that a threshold of ≥ 48 mmol/mol (≥ 6.5 DCCT %) should be used to diagnose diabetes. This recommendation was adopted by the American Diabetes Association in 2010. Positive tests should be repeated unless the person presents with typical symptoms and blood sugars >11.1 mmol/L (>200 mg/dL).
| Diabetes mellitus | Prediabetes | |
|---|---|---|
| HbA1c | ≥6.5% | 5.7–6.4% |
| Fasting glucose | ≥126 mg/dL | 100–125 mg/dL |
| 2h glucose | ≥200 mg/dL | 140–199 mg/dL |
| Random glucose with classic symptoms | ≥200 mg/dL | Not available |
Threshold for diagnosis of diabetes is based on the relationship between results of glucose tolerance tests, fasting glucose or HbA1c and complications such as retinal problems. A fasting or random blood sugar is preferred over the glucose tolerance test, as they are more convenient for people. HbA1c has the advantages that fasting is not required and results are more stable but has the disadvantage that the test is more costly than measurement of blood glucose. It is estimated that 20% of people with diabetes in the United States do not realize that they have the disease.
Type 2 diabetes is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. This is in contrast to type 1 diabetes in which there is an absolute insulin deficiency due to destruction of islet cells in the pancreas and gestational diabetes that is a new onset of high blood sugars associated with pregnancy. Type 1 and type 2 diabetes can typically be distinguished based on the presenting circumstances. If the diagnosis is in doubt antibody testing may be useful to confirm type 1 diabetes and C-peptide levels may be useful to confirm type 2 diabetes, with C-peptide levels normal or high in type 2 diabetes, but low in type 1 diabetes.
Screening
Universal screening for diabetes in people without risk factors or symptoms is not recommended. Screening is recommended by the World Health Organization, the United States Preventive Services Task Force (USPSTF), and the American Diabetes Association for high-risk adults. Risk factors considered by the USPSTF include adults over 35 years old who are overweight or have obesity and adults without symptoms whose blood pressure is greater than 135/80 mmHg. For those whose blood pressure is less, the evidence is insufficient to recommend for or against screening. The American Diabetes Society recommends screening for adults with a body mass index (BMI) over 25. For people of Asian descent, screening is recommended if they have a BMI over 23. Other high risk groups include people with a first degree relative with diabetes; some ethnic groups, including Hispanics, African-Americans, and Native-Americans; a history of gestational diabetes; polycystic ovary syndrome; excess weight; and conditions associated with metabolic syndrome. There is no evidence that screening changes the risk of death and any benefit of screening on adverse effects, incidence of type 2 diabetes, HbA1c or socioeconomic effects are not clear.
In the UK, NICE guidelines suggest taking action to prevent diabetes for people with a body mass index (BMI) of 30 or more. For people of Black African, African-Caribbean, South Asian and Chinese descent the recommendation to start prevention starts at the BMI of 27,5. A study based on a large sample of people in England suggest even lower BMIs for certain ethnic groups for the start of prevention, for example 24 in South Asian and 21 in Bangladeshi populations.
Prevention
Onset of type 2 diabetes can be delayed or prevented through proper nutrition and regular exercise. Intensive lifestyle measures may reduce the risk by over half. The benefit of exercise occurs regardless of the person's initial weight or subsequent weight loss. High levels of physical activity reduce the risk of diabetes by about 28%. Evidence for the benefit of dietary changes alone, however, is limited, with some evidence for a diet high in green leafy vegetables and some for limiting the intake of sugary drinks. There is an association between higher intake of sugar-sweetened fruit juice and diabetes, but no evidence of an association with 100% fruit juice. A 2019 review found evidence of benefit from dietary fiber.
In those with impaired glucose tolerance, a 2019 systematic review found moderate-quality evidence that Metformin, when compared to diet and exercise or a placebo intervention, appeared to delay or reduce the risk of developing type 2 diabetes. This same review found moderate-quality evidence that when compared to intensive diet and exercise, Metformin did not reduce risk of developing type 2 diabetes, as well as very low-quality evidence that combining Metformin with intensive diet and exercise does not appear to have any effect on risk of developing type 2 diabetes when compared to intensive diet and exercise alone. This systematic review only found one suitable trial comparing Metformin with Sulphonylurea in reducing risk of type 2 diabetes but it did not report any patient-relevant outcomes.
A Cochrane systematic review assessed the effect of alpha-glucosidase inhibitors in people with impaired glucose tolerance, impaired fasting blood glucose, elevated glycated hemoglobin A1c (HbA1c). It was found that Acarbose appeared to reduce incidence of diabetes mellitus type 2 when compared to placebo, however there was no conclusive evidence that acarbose compare to diet and exercise, metformin, placebo, no intervention improved all-cause mortality, reduced or increased risk of cardiovascular mortality, serious or non-serious adverse events, non-fatal stroke, congestive heart failure, or non-fatal myocardial infarction. The same review found that there was no conclusive evidence that voglibose compared to diet and exercise or placebo reduced incidence of diabetes mellitus type 2, or any of the other measured outcomes.
A 2017 review found that, long term, lifestyle changes decreased the risk by 28%, while medication does not reduce risk after withdrawal. While low vitamin D levels are associated with an increased risk of diabetes, correcting the levels by supplementing vitamin D3 does not improve that risk.
Management
Management of type 2 diabetes focuses on lifestyle interventions, lowering other cardiovascular risk factors, and maintaining blood glucose levels in the normal range. Self-monitoring of blood glucose for people with newly diagnosed type 2 diabetes may be used in combination with education, although the benefit of self-monitoring in those not using multi-dose insulin is questionable. In those who do not want to measure blood levels, measuring urine levels may be done. Managing other cardiovascular risk factors, such as hypertension, high cholesterol, and microalbuminuria, improves a person's life expectancy. Decreasing the systolic blood pressure to less than 140 mmHg is associated with a lower risk of death and better outcomes. Intensive blood pressure management (less than 130/80 mmHg) as opposed to standard blood pressure management (less than 140-160 mmHg systolic to 85–100 mmHg diastolic) results in a slight decrease in stroke risk but no effect on overall risk of death.
Intensive blood sugar lowering (HbA1c<6%) as opposed to standard blood sugar lowering (HbA1c of 7–7.9%) does not appear to change mortality. The goal of treatment is typically an HbA1c of 7 to 8% or a fasting glucose of less than 7.2 mmol/L (130 mg/dL); however these goals may be changed after professional clinical consultation, taking into account particular risks of hypoglycemia and life expectancy. Hypoglycemia is associated with adverse outcomes in older people with type 2 diabetes. Despite guidelines recommending that intensive blood sugar control be based on balancing immediate harms with long-term benefits, many people – for example people with a life expectancy of less than nine years who will not benefit, are over-treated.
It is recommended that all people with type 2 diabetes get regular eye examinations. There is moderate evidence suggesting that treating gum disease by scaling and root planing results in an improvement in blood sugar levels for people with diabetes.
Lifestyle
Exercise
A proper diet and regular exercise are foundations of diabetic care, with one review indicating that a greater amount of exercise improved outcomes. Regular exercise may improve blood sugar control, decrease body fat content, and decrease blood lipid levels.
Diet
Calorie restriction to promote weight loss is generally recommended. Around 80 percent of obese people with type 2 diabetes achieve complete remission with no need for medication if they sustain a weight loss of at least 15 kilograms (33 lb), but most patients are not able to achieve or sustain significant weight loss. Even modest weight loss can produce significant improvements in glycemic control and reduce the need for medication.
Several diets may be effective such as the Dietary Approaches to Stop Hypertension (DASH), Mediterranean diet, low-fat diet, or monitored carbohydrate diets such as a low carbohydrate diet. Other recommendations include emphasizing intake of fruits, vegetables, reduced saturated fat and low-fat dairy products, and with a macronutrient intake tailored to the individual, to distribute calories and carbohydrates throughout the day. A 2021 review showed that consumption of tree nuts (walnuts, almonds, and hazelnuts) reduced fasting blood glucose in diabetic people. 2015年現在[update], there is insufficient data to recommend nonnutritive sweeteners, which may help reduce caloric intake. An elevated intake of microbiota-accessible carbohydrates can help reducing the effects of T2D. Viscous fiber supplements may be useful in those with diabetes.
Culturally appropriate education may help people with type 2 diabetes control their blood sugar levels for up to 24 months. There is not enough evidence to determine if lifestyle interventions affect mortality in those who already have type 2 diabetes.
Stress management
Although psychological stress is recognized as a risk factor for type 2 diabetes, the effect of stress management interventions on disease progression are not established. A Cochrane review is under way to assess the effects of mindfulness‐based interventions for adults with type 2 diabetes.
Medications
Blood sugar control
There are several classes of anti-diabetic medications available. Metformin is generally recommended as a first line treatment as there is some evidence that it decreases mortality; however, this conclusion is questioned. Metformin should not be used in those with severe kidney or liver problems. The American Diabetes Association and European Association for the Study of Diabetes recommend using a GLP-1 receptor agonist or SGLT2 inhibitor as the first-line treatment in patients who have or are at high risk for atherosclerotic cardiovascular disease, heart failure, or kidney disease. The higher cost of these drugs compared to metformin has limited their use.
A second oral agent of another class or insulin may be added if metformin is not sufficient after three months. Other classes of medications include: sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists. A 2018 review found that SGLT2 inhibitors and GLP-1 agonists, but not DPP-4 inhibitors, were associated with lower mortality than placebo or no treatment. Rosiglitazone, a thiazolidinedione, has not been found to improve long-term outcomes even though it improves blood sugar levels. Additionally it is associated with increased rates of heart disease and death.
Injections of insulin may either be added to oral medication or used alone. Most people do not initially need insulin. When it is used, a long-acting formulation is typically added at night, with oral medications being continued. Doses are then increased to effect (blood sugar levels being well controlled). When nightly insulin is insufficient, twice daily insulin may achieve better control. The long acting insulins glargine and detemir are equally safe and effective, and do not appear much better than neutral protamine Hagedorn (NPH) insulin, but as they are significantly more expensive, they are not cost effective as of 2010. In those who are pregnant, insulin is generally the treatment of choice.
Blood pressure lowering
Many international guidelines recommend blood pressure treatment targets that are lower than 140/90 mmHg for people with diabetes. However, there is only limited evidence regarding what the lower targets should be. A 2016 systematic review found potential harm to treating to targets lower than 140 mmHg, and a subsequent review in 2019 found no evidence of additional benefit from blood pressure lowering to between 130–140mmHg, although there was an increased risk of adverse events.
2015 American Diabetes Association recommendations are that people with diabetes and albuminuria should receive an inhibitor of the renin-angiotensin system to reduce the risks of progression to end-stage renal disease, cardiovascular events, and death. There is some evidence that angiotensin converting enzyme inhibitors (ACEIs) are superior to other inhibitors of the renin-angiotensin system such as angiotensin receptor blockers (ARBs), or aliskiren in preventing cardiovascular disease. Although a more recent review found similar effects of ACEIs and ARBs on major cardiovascular and renal outcomes. There is no evidence that combining ACEIs and ARBs provides additional benefits.
Other
The use of aspirin to prevent cardiovascular disease in diabetes is controversial. Aspirin is recommended in people at high risk of cardiovascular disease, however routine use of aspirin has not been found to improve outcomes in uncomplicated diabetes. 2015 American Diabetes Association recommendations for aspirin use (based on expert consensus or clinical experience) are that low-dose aspirin use is reasonable in adults with diabetes who are at intermediate risk of cardiovascular disease (10-year cardiovascular disease risk, 5–10%).
Vitamin D supplementation to people with type 2 diabetes may improve markers of insulin resistance and HbA1c.
Sharing their electronic health records with people who have type 2 diabetes helps them to reduce their blood sugar levels. It is a way of helping people understand their own health condition and involving them actively in its management.
Surgery
Weight loss surgery in those who are obese is an effective measure to treat diabetes. Many are able to maintain normal blood sugar levels with little or no medication following surgery and long-term mortality is decreased. There however is some short-term mortality risk of less than 1% from the surgery. The body mass index cutoffs for when surgery is appropriate are not yet clear. It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.
Epidemiology
The International Diabetes Federation estimates nearly 537 million people lived with diabetes worldwide in 2021, 90–95% of whom have type 2 diabetes. Diabetes is common both in the developed and the developing world.
Some ethnic groups such as South Asians, Pacific Islanders, Latinos, and Native Americans are at particularly high risk of developing type 2 diabetes. Type 2 diabetes in normal weight individuals represents 60 to 80 percent of all cases in some Asian countries. The mechanism causing diabetes in non-obese individuals is poorly understood.
Rates of diabetes in 1985 were estimated at 30 million, increasing to 135 million in 1995 and 217 million in 2005. This increase is believed to be primarily due to the global population aging, a decrease in exercise, and increasing rates of obesity. Traditionally considered a disease of adults, type 2 diabetes is increasingly diagnosed in children in parallel with rising obesity rates. The five countries with the greatest number of people with diabetes as of 2000 are India having 31.7 million, China 20.8 million, the United States 17.7 million, Indonesia 8.4 million, and Japan 6.8 million. It is recognized as a global epidemic by the World Health Organization.
History
Diabetes is one of the first diseases described with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine." The first described cases are believed to be of type 1 diabetes. Indian physicians around the same time identified the disease and classified it as madhumeha or honey urine noting that the urine would attract ants. The term "diabetes" or "to pass through" was first used in 230 BCE by the Greek Apollonius Memphites. The disease was rare during the time of the Roman empire with Galen commenting that he had only seen two cases during his career.
Type 1 and type 2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400–500 AD with type 1 associated with youth and type 2 with being overweight. Effective treatment was not developed until the early part of the 20th century when the Canadians Frederick Banting and Charles Best discovered insulin in 1921 and 1922.This was followed by the development of the long acting NPH insulin in the 1940s.
In 1916, Elliot Joslin proposed that in people with diabetes, periods of fasting are helpful. Subsequent research has supported this, and weight loss is a first line treatment in type 2 diabetes.
Research
Researchers developed the Diabetes Severity Score (DISSCO), a tool that might better than the standard blood test at identify if a person's condition is declining. It uses a computer algorithm to analyse data from anonymised electronic patient records and produces a score based on 34 indicators.
引用文献
- Kahn CR, Ferris HA, O'Neill BT (2020). "Pathophysiology of Type 1 Diabetes Mellitus". Williams Textbook of Endocrinology (14 ed.). Elsevier. pp. 1349–1370.
- International Diabetes Federation (2021). IDF Diabetes Atlas (PDF) (10 ed.). International Diabetes Federation. ISBN 9782930229980. Retrieved 18 March 2022.
外部リンク
Definitions from Wiktionary
Media from Commons
News from Wikinews
Quotations from Wikiquote
Texts from Wikisource
Textbooks from Wikibooks
Resources from Wikiversity
- IDF Diabetes Atlas 2015
- National Diabetes Information Clearinghouse Archived 2010-02-21 at the Wayback Machine
- Centers for Disease Control (Endocrine pathology)
- ADA's Standards of Medical Care in Diabetes 2019