Health and medical information

Type 2 diabetes is characterized by accelerated cardiovascular disease. The risk for myocardial infarction, cardiovascular death, strokes, and peripheral vascular insufficiency is increased at least 2- to 4-fold in people with type 2 diabetes. These risks are doubled in African, Hispanic, and Mexican Americans and are magnified in a profound way by hypertension, dyslipidemia, cigarette smoking, and a prothrombotic state, which often is seen in type 2 diabetes. In particular, before the appearance of fasting hyperglycemia, many type 2 patients have had years of a metabolic syndrome, which confers a high cardiovascular risk. In this syndrome, glucose intolerance may be mild (or absent), but hypertension, microalbuminuria, low plasma HDL-C and high triglyceride levels, increased concentrations of atherogenic small, dense LDL particles, altered platelet function, diminished fibrinolytic activity and insulin resistance with hyperinsulinemia are present in various combinations. The net effect is that people with type 2 diabetes have a high cardiovascular risk from a variety of factors that are active even before fasting hyperglycemia and frank diabetes are apparent. Thus, a program of prevention of progression of accelerated atherothrombosis, which starts even before the diagnosis of type 2 diabetes is made, is the hallmark of intensive management of type 2 diabetes. A multifactorial approach that not only includes intensive glycemic regulation but also aggressively addresses multiple cardiovascular risk factors is indicated.
The goals of therapy are the same as in type 1 diabetes (see previous section). However, testing and preventive therapy for accelerated cardiovascular disease must proceed at an earlier stage in type 2 than in type 1 diabetes.
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The most common type of diabetes (type 2 diabetes) is the result of insulin not working properly and usually affects people over the age of 40. Overeating, being overweight and not exercising enough are important factors (what we call lifestyle factors) which can lead to this type of diabetes, especially when there is someone else in the family with diabetes.

Many people who live in societies which are undergoing rapid westernisation are developing this type of diabetes. Why ?

It takes time for our bodies to adapt to such major changes in diet. Because our European ancestors had thousands of years to adapt to a diet with a lot of carbohydrate, they were in a better position to cope with the changes in the G.I. factor of foods. That is why people of European extraction have a lower prevalence of type 2 diabetes compared with people whose diets have recently changed to include lots of high G.I. foods.

However, there is only so much that our bodies can take. As we continue to consume increasing quantities of foods with a high G.I. factor plus excessive amounts of fatty foods, our bodies are coping less well. The result can be seen as a significant increase in the number of people developing diabetes.

But, the most dramatic increases in diabetes have occurred in populations which have been exposed to these changes over a very much shorter period of time. In some Australian Aboriginal communities up to one person in four now has diabetes. In some groups of native American Indians and in some populations within the Pacific region, up to one adult in two has diabetes because of the rapid dietary and lifestyle changes in the twentieth century.

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