Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder marked by elevated blood glucose levels attributed to defects in insulin secretion or the body's inability to effectively use insulin. It represents a significant global health concern, requiring a comprehensive understanding of its symptoms, diagnostic processes, and effective management strategies.

Symptoms

The symptoms of diabetes can vary depending on the type and the stage of the condition. The symptoms of T2DM often develop slowly, and they may include:

• Increased thirst

• Frequent urination

• Increased hunger

• Unexplained weight loss

• Fatigue

• Blurred vision

• Slow-healing sores

• Frequent infections

• Numbness or tingling sensation in the hands or feet.

• Areas of darkened skin, usually in the armpits and neck.

• Yeast infections keep coming back.

Diagnosis

Accurate diagnosis of T2DM involves a series of blood tests including fasting blood glucose, oral glucose tolerance tests, and HbA1C tests. These assessments help clinicians determine the severity of insulin resistance and guide the development of tailored treatment plans.

• HbA1C test: This blood test indicates average blood glucose level over the past 2 to 3 months. HbA1C greater than 6.5% is suggestive of T2DM.

• Fasting blood glucose test: A blood sample is drawn following an overnight fast of 8 hours. According to the American Diabetes Association, a fasting blood glucose level greater than 126 mg/dL (7.0 mm/L) indicates the presence of diabetes.

• Random blood glucose test: It measures blood glucose level at any time of the day. A reading of 200 mg/dL (11.1 mmol/L) or higher may suggest diabetes, particularly if patients are experiencing symptoms like frequent urination and extreme thirst.

• Oral glucose tolerance test: This test is less commonly used than the others. This test measures the blood glucose level before and 2 hours after the ingestion of 75 gms of glucose. T2DM is diagnosed if the plasma glucose level in the 2-hour sample is more than 11.1 mmol/L (200 mg/dL). 

Management

There is no cure for T2DM, but it can be managed with lifestyle modifications, medication, and sometimes insulin therapy. The goal of managing T2DM is to maintain good glycemic control (optimal blood glucose level). Here are key aspects of T2DM treatment and management of blood glucose levels.

Lifestyle modifications

It includes a balanced and healthy diet, with regular exercise, maintaining a healthy weight, and smoking cessation.

Medications

There are several types of medications available to treat T2DM, which include:

• Metformin: This is the first-line therapy, usually prescribed for T2DM patients. It helps the body to use insulin more effectively and lowers glucose production in the liver.

• Sulfonylureas: It helps the pancreas to produce more insulin and lowers blood glucose levels.

• Glucagon-like peptide 1 (GLP-1) and dual GLP-1/gastric inhibitory peptide (GIP) receptor agonists: These medications mimic the effects of naturally occurring GLP-1 and GIP in the body. However, they are designed to resist being broken down by the DPP-4 enzyme. These drugs have a significant positive impact on reducing body weight and blood glucose levels.

• Dipeptidyl peptidase-4 (DPP-4) inhibitors: DPP-4 inhibitors increase the amounts of GLP-1 and GIP. This, in turn, boosts insulin secretion, helping to lower high blood glucose levels after meals and during fasting.

• Sodium-glucose cotransporter 2 (SGLT2) inhibitors: By enhancing the excretion of glucose in the urine, SGLT2 inhibitors improve blood glucose levels, induce weight loss, and slightly lower blood pressure.

• Thiazolidinediones (TZDs): TZDs enhance insulin effectiveness in muscle and fat while reducing glucose production in the liver. One advantage of TZDs is their ability to lower blood glucose without posing a high risk of causing low blood sugar.

• Insulin: If lifestyle modifications and other medications are not enough to control blood glucose levels, patients may need to take insulin injections. Insulin is a hormone that helps the body move glucose from the bloodstream into cells.

Less commonly used medications

Apart from the commonly discussed classes of drugs, there are less frequently used medications that can be effective for some individuals:

• α-glucosidase inhibitors: These drugs slow down the breakdown of food into glucose, helping to reduce blood glucose levels after meals.

• Bile acid sequestrants: Typically used for lowering cholesterol, these drugs also have the benefit of decreasing blood glucose levels in diabetic patients.

• Dopamine-2 agonists: Bromocriptine (Cycloset) is an FDA-approved dopamine-2 agonist that lowers blood glucose in people with type 2 diabetes.

• Meglitinides: These drugs stimulate beta cells to release insulin, aiding in the control of blood glucose levels.

Combination therapy

Since the listed drugs operate through various mechanisms to lower blood glucose levels, they can be combined to achieve better outcomes. For instance, a combination of metformin and a DPP-4 inhibitor may be prescribed shortly after a diagnosis of T2DM to achieve treatment goals.

Monitoring and Self-Care

Monitoring and self-care for T2DM involve monitoring blood glucose levels at home, practicing stress management, and ensuring adequate sleep.

Regular Check-ups

Regular medical check-ups are crucial for monitoring diabetes-related complications.

Education and Support

Education and support through diabetes education programs offer valuable information on managing the condition. Healthcare professionals, dietitians, and diabetes educators provide essential support.

Treatment for T2DM is a lifelong commitment, however, with careful management, patients can lead a long and healthy life.