Unraveling Type 2 Diabetes: A Comprehensive Exploration

Today, we embark on a fascinating journey through the intricate landscape of Type 2 Diabetes Mellitus (T2DM), a widespread metabolic condition impacting millions across the globe.

A Closer Look:

Imagine your body as a finely tuned orchestra, with glucose playing the lead role and insulin acting as the maestro. But in T2DM, this harmonious symphony hits a discordant note. Either the orchestra is playing too softly, or the maestro's signals are being ignored, resulting in high glucose levels.

In other words, An individual with T2DM has elevated blood glucose levels due to insufficient insulin production or insulin resistance, which decreases the body's ability to utilize insulin effectively. T2DM accounts for 90% of all diabetes cases worldwide. It typically manifests in adulthood, though it can occur at any age (Ogurtsova et al., 2022; IDF, 2019Globally, T2DM accounts for 90% of all diabetes cases, it is the most prevalent form of diabetes and typically manifests in adulthood, though it can occur at any age (Ogurtsova et al., 2022; IDF, 2019).

The Numbers:

Prepare to be blown away!

There are approximately 537 million adults worldwide with T2DM, making it a global problem.

The prevalence of T2DM has reached remarkable proportions in the United Kingdom, affecting around 7.4% of adults. About 4.3 million individuals have been diagnosed as diabetics, accounting for approximately one in ten adults (Public Health England, 2014, 2015; World Health Organization (WHO), 2021).

There are also 850,000 people who don't know they have diabetes, which makes five million people affected by the disease in the UK (Valabhji et al., 2020; Whicher, O’Neill and Holt, 2020).

In the last 10 years, the prevalence of T2DM has steadily increased, with more than 13.6 million individuals now at risk. What a shocking thought, isn't it?

Diabetes Risk: what do we know?

Ethnicity and the Spotlight:

But here's where it gets genuinely intriguing – T2DM doesn't play favorites. Different ethnic groups have a starring role in this narrative. Picture a diverse stage with different groups taking their place under the spotlight. Factors such as genetics, lifestyle choices, and even historical influences join forces, creating a unique story for each ethnicity.

Genes: The Script of Life:

The genes are like the script for life, and they play a big part in T2DM's story. You can imagine a script with certain lines highlighted, which indicate a T2DM predisposition. It's not just genes that matter - other factors also play a role. Lifestyle choices and environmental factors collaborate to make it a true ensemble.

BMI, Ethnicity, and Health Risks:

Let's take a closer look at the concept of body composition, where ethnic diversity plays a significant role in shaping our vulnerability to T2DM. Consider each ethnic group as a piece of artwork, with its own distribution of body fat that contributes to its susceptibility to type 2 diabetes. It is not uncommon for some individuals to build body fat around the waistline, which increases their risk of metabolic complications. As with a tailor-made suit, health risks are not one-size-fits-all.

In 2019, Pham et al. conducted a cross-sectional analysis of the Health Improvement Network Primary Care Database to support this idea. T2DM prevalence is notably higher among Asian and Black ethnic groups in the UK than among Whites. The result aligns with the 2004 Health Survey for England (HSfE), which revealed that specific populations have substantially higher rates of T2DM. The Black Caribbean community had a rate of 9.5% for men and 7.6% for women, while the Indian community had a rate of 9.2% for men and 5.9% for women. Pakistani and Bangladeshi populations showed similar rates of 7.3% and 8.4% in men, and 8.0% and 4.5% in women, respectively, compared with the general population's 3.8% in men and 3.1% in women (NHS Digital Health Survey for England, 2006).

There is indeed an alarming contrast between minority ethnic groups and white British people, with minority ethnic groups having three to five times the prevalence of T2DM. An eye-opening projection from the London 'SABRE' multi-ethnic cohort suggests between 40% and 50% of South Asian and African-Caribbean men and women will develop type 2 diabetes by the age of 80. This proportion is at least double that of their white European counterparts of the same age (Tillin et al., 2013).

What factors have led to this rise in prevalence?

Imagine a web interconnected with ageing, sedentary lifestyles, unhealthy eating habits, and an obesity epidemic that is on the rise. As a result, T2DM cases have increased alarmingly. We are undergoing a transformation in our society, marked by changing habits and an evolving environment that encourages less physical activity and unhealthy eating.

As we get older, our bodies change, and sometimes that can lead to T2DM. But there's more to it than just age. Imagine a world where people are glued to screens

and couches instead of moving around. That lack of activity can set the stage for T2DM. And then there's our food. Think of processed and sugary foods as the villains here. They've become a big part of our diets, and they're not doing us any favours when it comes to T2DM.

Ever noticed how more people are struggling with weight? It's not a coincidence. Our world is changing. Cities are getting bigger, and everyone's connected through technology. While that's cool, it also means we're moving less and eating more junk. This combo has led to a rise in obesity, a major player in the T2DM story.

Imagine your surroundings influencing your choices without you even realizing it. That's the obesogenic environment. It's like a setup that makes unhealthy choices easy and tempting. Fast food is everywhere, and finding a place to exercise is a struggle. This environment is part of why we're leaning towards T2DM.

Obesity and T2DM are like buddies in this situation. Unhealthy living and poor diet can lead to both. It's like a cycle: one feeds the other, and it's hard to break free.

We're not stuck. It's time for a change. Let's make healthier choices, move our bodies more, and give those sugary snacks a break. By understanding how our lifestyle and surroundings play into T2DM, we can take charge and turn the tide.

It's like flipping the script on this puzzle. Let's swap out those sugary pieces for healthier ones and build a picture of better health for everyone.

Spot the Signs:

Imagine your body as a sharp detective, on a mission to uncover the mystery of T2DM. Your body is like a detective story - it leaves you clues to figure out what is going on.

Thirst and Urination:

Your body drops hints when things are off. Excessive thirst (polydipsia) and needing to pee more often (polyuria) are like breadcrumbs left behind. It's your body's way of signalling that something isn't quite right.

Acanthosis Nigricans:

Ever heard of acanthosis nigricans? It's like a secret code that your skin reveals. Dark patches on certain areas are your body's unique way of saying, "Pay attention; something's going on here." It typically affects the armpits, groin and neck.

Keep an eye out for these signs:

1. Overwhelming tiredness that just won't go away.

2. Weight loss and muscles seem to disappear.

3. Cuts and wounds take forever to heal.

4. Unwanted guests: frequent genital thrush.

5. Blurry vision, like looking through a foggy window.

Why It Matters:

If left untreated, T2DM will not play nicely. Ignoring diabetes can lead to a cascade of health problems.

Blood Vessel Sabotage:

Imagine your bloodstream like a busy highway system, with red blood cells as vehicles carrying vital supplies. Now, envision pouring sticky syrup, or excess glucose, into this system. High blood sugar turns the smooth flow into a sluggish mess, causing traffic jams that harm blood vessels, nerves, and organs.

This glucose invasion is like a destructive force. Even mild sugar increases can have long-term consequences, weakening blood vessel walls and increasing the risk of blockages. Imagine blood vessels blocked by glucose buildup, leaving your body vulnerable to heart disease and stroke – imminent threats when blood flow is compromised.

Problems with the nervous system:

Diabetic retinopathy is like a fog that clouds your vision. Blood vessels in your eyes misbehave, potentially leading to vision loss. Blocked and leaky blood vessels in your kidneys can compromise their efficiency. This often goes hand in hand with high blood pressure. In severe cases, kidney disease might progress to kidney failure, requiring drastic measures. Foot problems could be a subplot you didn't expect. Nerve damage and poor circulation might create ulcers and infections. Vigilance is key – watch out for sores, puffiness, and changes in your feet.

Intimacy Issues:

T2DM might try to meddle with your intimate moments. In men, it could lead to erection problems, while women might experience reduced pleasure, dryness, or pain during sex.

Diagnosing T2DM:

Diagnosing type 2 diabetes involves spotting persistent high blood sugar levels and the potential symptoms described above.

Fasting plasma glucose of 7.0 mmol/L or more, or random plasma glucose of 11.1 mmol/L or more with symptoms.

If symptoms are absent, a single abnormal result isn't enough; repeat the test. Note that temporary hyperglycemia during stress or illness isn't diagnostic.

Gestational diabetes is diagnosed with:

• Fasting plasma glucose ≥ 5.6 mmol/l, or

• Two-hour plasma glucose ≥ 7.8 mmol/l.

HbA1c testing can diagnose diabetes with an HbA1c of 48 mmol/mol (6.5%). Finger-prick HbA1c must match lab quality. For non-symptomatic cases, if HbA1c is <48 mmol/mol, repeat in 6 months or if symptoms arise.

HbA1c isn't suitable for children, with suspected Type 1 diabetes, short symptom duration, acute illness, pancreatic damage, or pregnancy.

If HbA1c is unclear, a fasting plasma glucose level of 7.0 mmol/L or more suffices.

Be cautious with HbA1c interpretation in certain groups (children, pregnant/postpartum women, recent symptoms, high-risk illness, medication use, pancreatic issues, end-stage kidney disease, HIV, altered red blood cell turnover) (WHO, 2011; Kilpatrick and Atkin, 2014; Davies, 2018; Milne, 2020; NICE, 2020).

Preventing T2DM:

Lifestyle changes play the role in preventing T2DM, with healthy habits like eating well, staying active, and maintaining a healthy weight forming a powerful trio against T2DM.

Maintaining a healthy weight is vital, as there are numerous benefits to shedding extra pounds. Excess weight, especially around the waist, can lead to insulin resistance. Losing this weight can improve the function of insulin and enhance blood sugar management. As you lose weight and become more active, adjustments to your medication may be necessary, particularly if you're using insulin or other diabetes medications. Your healthcare team can guide you through this process, and for some individuals, needing less medication becomes a motivating factor for weight loss.

For women, a healthy waist size is below 80 cm (31.5 inches), and for men, it's 94 cm (37 inches) or less (90 cm for South Asian men). Around half of those at risk can reduce or delay the onset of T2DM through healthy eating, weight management, and a healthy waist size.

For type 1 diabetes, weight doesn't directly influence its development, but it does impact your risk of complications and insulin requirements. For type 2 diabetes, losing around 5% of body weight offers health benefits. If you have obesity, losing a larger amount of weight (e.g., 15 kg or 2 stone 5 lbs) rapidly and safely after diagnosis increases your chances of diabetes remission and potentially discontinuing the medication.

Getting physically active is crucial too. Strive for 30 minutes of brisk activity at least five days a week, or break it down into three 10-minute bursts. It's equally important to avoid prolonged periods of sitting, as this is associated with increased T2DM risk. If you're sitting for extended periods, take breaks to stretch or move around.

Quitting smoking and adhering to alcohol guidelines also contribute to reducing T2DM risk.

A healthy diet is essential. Opt for whole grains over refined ones, avoid sugary drinks, and choose healthy fats. Limit red and processed meats while incorporating nuts, beans, whole grains, poultry, or fish. While there's no exclusive "diabetes diet," achieving a calorie deficit and consuming nutrient-rich foods is key.

Don't underestimate the emotional aspect of weight loss. Recognize your relationship with food and address emotional eating patterns.

A Final Take on T2DM

I've unravelled its secrets, from the genes in the mix to the lifestyle we lead, all the way to the spotlight. It's like a dance between sugar and insulin, with prevention playing the lead role, ready to save the day.

T2DM doesn't have to steal the show. The real power lies with us. By making some smart choices, we can be the heroes of our own story, steering clear of T2DM's grip. Armed with this newfound knowledge, let's dive into a journey of better understanding and healthier living.

Imagine a world where T2DM isn't the star of the show anymore. It's up to us to change the script, focusing on wellness and vitality. So, let's team up, rewrite the ending, and make sure T2DM gets its ticket out of the limelight for good. Cheers to a future where our health takes centre stage, and T2DM is just a distant memory.

Let's make it happen!

And hey, speaking of support, I'm thrilled to let you know that I am here for you and your loved ones. It's all about providing that extra boost to help you thrive on your path to well-being. Whether you're seeking more information, personalized tips, or just a friendly chat, I'm here for you.

William Stivaletta Afn; RD2Be