Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus (T2D) is a chronic progressive metabolic disorder characterized by systemic insulin resistance and relative progressive pancreatic beta-cell dysfunction, resulting in persistent hyperglycemia. If left unmanaged, chronic hyperglycemia triggers severe macrovascular (coronary artery disease, stroke, peripheral vascular disease) and microvascular (diabetic retinopathy, nephropathy, and neuropathy) complications.

• Increased thirst (Polydipsia) and frequent urination (Polyuria, especially at night)
• Persistent fatigue, weakness, and generalized lethargy
• Unexplained unintentional weight loss despite normal or increased appetite (Polyphagia)
• Blurred vision due to lens swelling from hyperosmolar shifts
• Slow-healing cutaneous sores, cuts, or recurrent fungal infections (candidiasis)
• Tingling, burning sensation, or numbness in the feet or hands (Diabetic Peripheral Neuropathy)

A complex interplay of genetic predisposition and lifestyle factors. Peripheral insulin resistance in muscle, liver, and adipose tissue is exacerbated by visceral adiposity, sedentary behavior, high intake of ultra-processed carbohydrates, and chronic systemic low-grade inflammation. Pancreatic beta cells gradually lose their capacity to secrete sufficient compensatory insulin.

Diagnosed using standardized laboratory criteria confirmed on repeat testing:

• Fasting Plasma Glucose (FPG): ≥126 mg/dL (7.0 mmol/L) after an 8-hour fast
• 2-Hour Postprandial Glucose (OGTT): ≥200 mg/dL (11.1 mmol/L) following a 75g glucose load
• Glycated Hemoglobin (HbA1c): ≥6.5% (48 mmol/mol)
• Random Plasma Glucose: ≥200 mg/dL in a patient with classic symptoms of hyperglycemia

Comprehensive management requires a foundational lifestyle approach paired with individualized pharmacotherapy:

• Lifestyle Modifications: Medical nutrition therapy emphasizing low-glycemic, fiber-rich whole foods; at least 150 minutes of moderate-to-vigorous aerobic exercise weekly plus resistance training; target 5-10% weight loss.
• First-Line Pharmacotherapy: Metformin hydrochloride remains the primary initial pharmacological agent due to its proven efficacy, safety profile, and lack of hypoglycemia.
• Cardiorenal Protective Agents: SGLT2 inhibitors (Dapagliflozin, Empagliflozin) or GLP-1 receptor agonists are strongly indicated for patients with established atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease.
• Additional Agents: DPP-4 inhibitors (Sitagliptin), Sulfonylureas (Glimepiride), and basal/bolus Insulin regimens for advanced beta-cell failure.