Diаbetes Mellitus Type 2 (Study Outline) Fоr study оnly—this is nоt medicаl аdvice or a substitute for professional care. 1. Background Definition: Chronic hyperglycemia resulting from insulin resistance and progressive β-cell dysfunction. Pathophysiology: Peripheral tissues (muscle, liver, adipose) become resistant to insulin’s effects. Pancreatic β-cells initially increase insulin output but eventually fail. Associated metabolic disturbances: ↑ hepatic glucose production, ↓ peripheral glucose uptake. Epidemiology: 90% of diabetes cases. Typically develops after age 40, but increasing prevalence in adolescents with obesity. Strongly linked to obesity, sedentary lifestyle, and family history. Risk Factors: Obesity (especially central/visceral). Family history, hypertension, dyslipidemia, polycystic ovary syndrome. Certain ethnicities: African American, Hispanic, Native American, Pacific Islander. 2. History Gradual Onset Symptoms: Polyuria, polydipsia, polyphagia. Fatigue, blurred vision. Recurrent infections (e.g., skin, vaginal, urinary). Poor wound healing, acanthosis nigricans. Often Asymptomatic: May be discovered incidentally on labs. Associated Conditions: Metabolic syndrome (obesity, hypertension, dyslipidemia, insulin resistance). DKA Rare: Hyperosmolar hyperglycemic state (HHS) more common. 3. Exam Findings General: Overweight or obese body habitus. Blood pressure often elevated. Skin: Acanthosis nigricans: hyperpigmented, velvety plaques (neck, axilla). Skin tags (acrochordons). Complications: Peripheral neuropathy (sensory loss, paresthesias). Retinopathy signs on fundoscopic exam (microaneurysms, exudates). Decreased vibratory sense or absent reflexes in feet. 4. Making the Diagnosis Diagnostic Criteria (any of the following): Fasting plasma glucose ≥126 mg/dL (×2). A1C ≥6.5%. 2-hour OGTT glucose ≥200 mg/dL after 75 g glucose load. Random glucose ≥200 mg/dL with classic symptoms. Laboratory Findings: Elevated or normal C-peptide (reflects continued endogenous insulin production). No pancreatic autoantibodies (distinguishes from Type 1 DM). Screening Recommendations: Adults ≥35 years, or earlier if overweight with additional risk factors. Repeat every 3 years if normal. Gold Standard: Biochemical confirmation of hyperglycemia (fasting glucose or A1C). Common Associated Labs: Dyslipidemia: ↑ triglycerides, ↓ HDL, ↑ LDL. Possible hepatic steatosis on imaging. 5. Management (Exam Concepts) Lifestyle Modifications: Weight loss (5–10% body weight), healthy diet, regular exercise. First-line for all patients and may normalize glucose in early disease. Pharmacologic Therapy: First-line: Oral antihyperglycemics (mechanisms emphasized on PANCE): Biguanides (e.g., metformin): ↓ hepatic glucose output, ↑ insulin sensitivity. Other classes: SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas. Insulin may be required for severe hyperglycemia or β-cell exhaustion. Monitoring: A1C every 3 months until stable (
Leаders cаn plаy a critical rоle in mоtivating оthers not only by assessing current motivation but also by ________.