Type2 Diabetes Mellitus

							Type 2 diabetes(T2DM) is the most common type of diabetes.Type 2 diabetes is polygenic and
the genetic influence is powerful.About four-tenths of siblings and one-third of offsprings
develop abnormal glucose tolerance or dibetes in future.T2DM is caused by combined effect of
relative insulin deficiency and insulin resistance,however insulin resistance preceeds insulin
deficiency.Insulin deficiency results from loss of beta cells by apoptosis(programmed cell
death).Insulin resistance refers to decreased responsiveness of muscle cells ,fat cells and liver
cells to insulin which leads to elevated sugar levels in the blood.The most important
environmental factor contributing to increased insulin resistance is obesity (abdominal
obesity).The abdominal fat is directly proportional to the visceral fat which inturn is strongly
correlated to insulin resistance.The waist-hip ratio of more than 0.95 in males and 0.85 in
females is regarded as abnormal.Type 2 diabetes can initially be managed by life style changes
(diet and exercise) and anti diabetic medication.Sulphonylureas are secretagogues which increase
the production of insulin from beta cells.Another group of anti diabetic medication , Biguanides
eg; metformin decrease the insulin resistance.As the disease progresses beta cells get exhausted
and can no longer produce required amount of insulin even with secretagogues and exogenous
insulin has to be given ,however other drugs like metformin continue to work.