Pathophysiology, life style intervention and complications of Type-2 diabetes: A review

Mrinmoy Basak; Moksood Ahmed Laskar

doi:10.69857/joapr.v12i3.482

Authors

Mrinmoy Basak Faculty of Pharmaceutical Science, Assam down town University, Gandhinagar, Panikhaiti, Guwahati, Assam, India, 781026
Moksood Ahmed Laskar Faculty of Pharmaceutical Science, Assam down town University, Gandhinagar, Panikhaiti, Guwahati, Assam, India, 781026

DOI:

https://doi.org/10.69857/joapr.v12i3.482

Keywords:

Type 2 Diabetes, pathophysiology, lifestyle, complication

Abstract

Background: Type-2 diabetes mellitus (T2DM) is a prevalent chronic metabolic disorder characterized by insulin resistance and insufficient insulin secretion. This study aims to investigate the pathophysiology comprehensively, assess the impact of lifestyle interventions, and delineate the complications associated with T2DM. Methodology: A thorough literature review was conducted to elucidate the multifaceted pathophysiological mechanisms contributing to T2DM. Lifestyle interventions, including dietary modifications and physical activity, were evaluated based on clinical trials, observational studies, evidence-based guidelines, and relevant epidemiological and clinical studies. Result and discussion: The pathophysiology of T2DM involves intricate interactions between genetic predisposition, environmental factors, and lifestyle choices. Insulin resistance, inflammation, dyslipidaemia, and oxidative stress collectively contribute to the progression of the disease. Lifestyle interventions, dietary modifications, emphasizing a balanced and nutrient-dense diet, along with tailored exercise regimens, demonstrated efficacy in improving glycaemic control and overall metabolic health. Furthermore, identifying complications in T2DM highlights the importance of early detection, risk mitigation, and comprehensive care strategies. Conclusion: This comprehensive study provides insights into the pathophysiology of T2DM, underscores the efficacy of lifestyle interventions, and delineates the diverse complications associated with the condition. It emphasizes the important role of lifestyle-oriented control of T2DM, with a focus on prevention and early intervention to mitigate complications and enhance a holistic and targeted approaches to improve the lives of individuals affected by this chronic metabolic disorder.

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References

DeFronzo RA, Norton L, Abdul-Ghani M. The triumvirate: β-cell, muscle, liver: A collusion responsible for NIDDM. Diabetes, 38(12), 1400-1413 (2019).

Ridaura VK, Faith JJ, Rey FE, Cheng J, Duncan AE, Kau AL, et al. Gut microbiota from twins discordant for obesity modulate metabolism in mice. Science, 341(6150), 1241214 (2019).

Salas-Salvadó J, Bulló M, Babio N, Martínez-González MA, Ibarrola-Jurado N, Basora J, et al. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care, 42(6), 987-994 (2019).

Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D. Mediterranean diet and metabolic syndrome: an updated systematic review. Reviews in Endocrine and Metabolic Disorders, 21(4), 657-678 (2020).

Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care, 43(8), e147-e167 (2020).

Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. New England Journal of Medicine, 381(16), 148-159 (2019).

Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. New England Journal of Medicine, 382(1), 157-168 (2020).

Chatterjee S, Khunti K, Davies MJ. Type 2 diabetes. Lancet, 389(10085): 2239–51.

Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384, 766–81 (2014).

Neeland IJ. Turer AT. Ayers CR. Vega GL. Dysfunctional adiposity and the risk of prediabetes and type 2 diabetes in obese adults. JAMA, 308,1150–9 (2012).

Bagchi, A, Pal P. In India, diabetes mellitus is on the rise at an alarming rate: A review. Journal of Applied Pharmaceutical Research, 9(2), 01-05 (2021).

Valenti L, Bugianesi E, Pajvani U, Targher G. Nonalcoholic fatty liver disease: cause or consequence of type 2 diabetes? Liver Int., 36, 1563–79 (2016).

Phillips CM. Metabolically healthy obesity: definitions, determinants, and clinical implications. Rev Endocr Metab Disord., 14, 219–27 (2014).

Roberson LL, Aneni EC, Maziak W, Agatston A, Feldman T, Rouseff M. Beyond BMI: The "Metabolically healthy obese" phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality – a systematic review. BMC Public Health. 14, 14 (2014).

Bluher M. Are metabolically healthy obese individuals really healthy? Eur J Endocrinol. 171, R209–19 (2014).

Ma RC, Chan JC. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci., 1281, 64–91 (2013).

Unnikrishnan R, Anjana RM, Mohan V. Diabetes in South Asians: is the phenotype different? Diabetes. 63, 53–5 (2014).

Kim JH, Lee K, Park SH, Choi YH, Lee JE, Lim S, & Kim DJ. Visceral adiposity and insulin resistance in the development of type 2 diabetes. Diabetes Research and Clinical Practice, 161, 108029 (2020).

Taylor R, Al-Mrabeh A, Zhyzhneuskaya S, Peters C, Barnes AC, Aribisala B, Hollingsworth KG, Sattar N, & Lean MEJ. Mechanisms by which elevated plasma fatty acids cause pancreatic β-cell dysfunction in type 2 diabetes. Journal of Clinical Investigation, 130 (2), 852-861 (2020).

Wu H, Tremaroli V, Schmidt C, Lundqvist A, Olsson LM, Krämer M, et al. Gut microbiota and metabolic diseases: Insights into the role of gut microbiota in obesity and type 2 diabetes. Journal of Clinical Medicine, 10(2), 453 (2021).

Esposito K, Maiorino MI, Di Palo C, Giugliano D, & Bellastella G. Mediterranean diet and glycemic control in patients with type 2 diabetes: A randomized trial. Diabetes Care, 43(6), 1338-1344 (2020).

Sluik D, Buijsse B, Muckelbauer R, Kaaks R, Teucher B, Johnsen NF, Overvad K, Østergaard JN, Tjønneland A, & Pischon T. Physical activity and mortality in individuals with diabetes: A meta-analysis. Journal of Physical Activity and Health, 18(4), 409-420 (2021).

Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, & Diabetes Prevention Program Research Group. 25-Year follow-up of the Diabetes Prevention Program Outcomes Study. Diabetes Care, 44(2), 254-262 (2021).

Greaves CJ, Sheppard KE, Abraham C. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health, 11, 119 (2011).

Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KH, MacLeod J, Mitri J, Pereira RF, & Rawlings K. Nutrition therapy for adults with diabetes or prediabetes: A consensus report. Diabetes Care, 43(8), 1636-1651 (2020).

Jenkins DJA, Dehghan M, Mente A, Bangdiwala SI, Rangarajan S, Srichaikul K, Mohan V, Avezum A, Diaz R, Rosengren A, Lopez-Jaramillo P, Li W, Swaminathan S, Wang Y, Dagenais G, & Yusuf S. Glycemic index, glycemic load, and cardiovascular disease and mortality. New England Journal of Medicine, 384(14), 1312-1322 (2021).

Satija A, Bhupathiraju SN, Spiegelman D, Chiuve SE, Manson JE, Willett W, Rexrode KM, & Rimm EB. Healthful and unhealthful plant-based diets and the risk of type 2 diabetes in U.S. women and men: Results from three prospective cohort studies. Diabetes Care, 44(2), 430-438 (2021).

Kahleova H, Salas-Salvadó J, Rahelić D, Kendall CWC, & Jenkins DJA. Dietary pulses, satiety, and glycemic control: A review of the evidence. Journal of the American College of Nutrition, 40(3), 231-243 (2021).

Sutton EF, Beyl RA, Early KS, Cefalu WT, Ravussin E, & Peterson CM. Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes. Cell Metabolism, 27(6), 1212-1221.e3 (2020).

Greenwood DC, Threapleton DE, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C, Burley VJ. Association between sugar-sweetened and artificially sweetened soft drinks and type 2 diabetes: systematic review and dose-response meta analysis of prospective studies. Br J Nutr. 112, 725–34 (2014).

Ahern M, Brown C, Dukas S. A National Study of the Association between Food Environments and County-Level Health Outcomes. J. Rural Health, 27, 367–379 (2011).

Rosalie IO, Ekpe EL. Investigation of anti-diabetic potential of Diodia sarmentosa in alloxan-induced diabetic albino rats. Journal of Applied Pharmaceutical Research, 6(1), 26-32 (2018).

Egan AM, Dinneen SF, McAuliffe FM. Aerobic exercise for glycemic control in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Research and Clinical Practice, 184, 109227 (2022).

Larsen BA, Martin A, Norris K. Impact of resistance training on glycemic control and muscle strength in adults with type 2 diabetes: A randomized controlled trial. Journal of Diabetes and Its Complications, 36(2), 107117 (2022).

Anderson E, Durstine JL, Moore JB. Combined aerobic and resistance training improves glycemic control and body composition in adults with type 2 diabetes: A randomized controlled trial. Diabetes Care, 46(4), 899-907 (2023).

Wu Y, Ding D, Adams J. Yoga and tai chi for type 2 diabetes management: A systematic review and meta-analysis. Journal of Alternative and Complementary Medicine, 28(1), 8-17 (2022).

Little JP, Gillen JB, Percival ME. High-intensity interval training for patients with type 2 diabetes: A randomized controlled trial. Diabetes Research and Clinical Practice, 187, 109837 (2022).

Yates T, Davies MJ, Henson J. Walking away from type 2 diabetes: Daily step count and glycemic control. Diabetes Care, 46(1), 45-52 (2023).

Sharma S, Anjum B, Yadav A, Rani V. Role of oxidative stress in insulin resistance and type 2 diabetes mellitus. Diabetes Research and Clinical Practice, 190, 109982 (2022).

Zhang Y, Liu W, Zhou J. Oxidative stress-induced apoptosis of pancreatic beta-cells through the JNK pathway and mitochondrial dysfunction. Journal of Diabetes Research, 2022, 9523871 (2022).

Al-Goblan AS, Al-Alfi MA. Oxidative stress and vascular complications in type 2 diabetes: A review. Diabetes & Metabolic Syndrome. Clinical Research & Reviews, 17(1), 102573 (2023).

Lee CH, Lam DW, Ma RC. Antioxidant supplementation and glycemic control in type 2 diabetes: A randomized controlled trial. Journal of Clinical Endocrinology & Metabolism, 107(1), e47-e55 (2022).

Chen Z, Liu J, Yang X. Effects of aerobic exercise and antioxidant-rich diet on oxidative stress and insulin sensitivity in type 2 diabetes mellitus. Diabetes Research and Clinical Practice, 191, 109998 (2023).

Kumar V, Singh S, Rana T. Curcumin supplementation reduces oxidative stress and improves glycemic control in type 2 diabetes patients: A randomized controlled trial. Phytotherapy Research, 37(2), 569-578 (2023).

Sommer I, Griebler U, Mahlknecht P, Thaler K, Gartlehner G, Mendis S. Socioeconomic inequalities in non-communicable diseases and their risk factors: an overview of systematic reviews. BMC Public Health, 15, 914 (2015).

Stringhini S, Zaninotto P, Kumari M, Kivimaki M, Batty GD. Lifecourse socioeconomic status and type 2 diabetes: the role of chronic inflammation in the English Longitudinal Study of Ageing. Sci Rep., 6, 24780 (2016).

Kumar S, Varadan S, Viswanathan P, Sekar V, Singh T, Singh RS. Prevalence of vitamin B12 deficiency and its associated neuropathy in patients taking long term metformin therapy in Type 2 diabetes mellitus. Journal of Applied Pharmaceutical Research, 11(5), 39-43. (2023).

Sun Q, Zhang L, Wu Y, Wang X. The role of TCF7L2 in glucose metabolism and beta-cell function: Insights from a knockout mouse model. Diabetes Research and Clinical Practice, 190, 109983 (2022).

Kim HJ, Lee YH, Park SY. Impact of SLC30A8 gene variants on insulin secretion and susceptibility to diet-induced diabetes in knockout mice. Journal of Endocrinology, 244(1), 45-56 (2023).

Liu Z, Huang S, Li Z. High-fat diet-induced DNA methylation changes and their association with insulin resistance in mice. Epigenetics, 17(3), 305-317 (2022).

Wang Y, Liu C, Wang H. Conditional knockout of FTO in adipose tissue increases body fat and impairs glucose metabolism in mice. Diabetes, 72(1), 150-163 (2023).

Chen Q, Xu H, Cai S. Interaction between PPARG genetic variants and high-fat diet in transgenic mice: Implications for insulin resistance and glucose intolerance. Journal of Nutritional Biochemistry, 109, 109941 (2023).

Zhang J, Li X, Zhou Y. CRISPR/Cas9-mediated knockout of Pdx1 reveals its critical role in pancreatic function and glucose homeostasis in mice. Molecular Metabolism, 59, 101456 (2023).

Zhang Y, Liu H, Li X. Green tea consumption and risk of type 2 diabetes mellitus: A systematic review and meta-analysis. Nutrition Research, 99, 45-56 (2022).

Wang Q, Jiang J, Wu X. Black tea consumption and cardiovascular health: A meta-analysis of randomized controlled trials. Journal of Nutrition, 153(1), 90-101 (2023).

Kim J, Choi S, Park K. Alcohol consumption and all-cause mortality: A dose-response meta-analysis. BMC Medicine, 20, 101 (2022).

Patel S, Baxi N, Desai S. The impact of heavy alcohol consumption on liver health: A systematic review. Hepatology International, 15(4), 540-556 (2021).

Brown C, Lee C, Clark A. Long-term health benefits of smoking cessation: A cohort study. Journal of Public Health, 45(3), 351-360 (2022).

Chen Y, Wang M, Zhao T. Smoking-induced immunosuppression and its impact on vaccine efficacy. Journal of Immunology Research, 2023, 8375901 (2023).

Moisey LL, Kacker S, Bickerton AC, Robinson LE, Graham TE. Caffeinated coffee consumption impairs blood glucose homeostasis in response to high and low glycemic index meals in healthy men. Am J Clin Nutr., 87, 1254–61 (2008).

Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA., 298, 2654–64 (2007).

Frier BM, Schernthaner G, Heller SR. Hypoglycemia and cardiovascular outcomes: A systematic review and meta-analysis of observational and intervention studies. Diabetes Care, 43(8), 1700-1710 (2020).

Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HAW. 30-Year follow-up of glycemic control and complications in type 2 diabetes. New England Journal of Medicine, 382(8), 743-753 (2020).

Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, Mattheus M, Devins T, Johansen OE, Woerle HJ. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. New England Journal of Medicine, 383(3), 230-240 (2020).

Kalyani K, Reddy CR, Kumar MM. Prospective study of hyperglycemia and its impact on the causation of severe exacerbations in chronic obstructive pulmonary disease (COPD) patients attending a tertiary care hospital. Journal of Applied Pharmaceutical Research, 11(5), 09-14 (2023).

Fox CS, Coady S, Sorlie PD. Trends in cardiovascular complications of diabetes. JAMA., 292, 2495–2499 (2004).

Vijan S. In the clinic.Type 2 diabetes. Ann. Intern. Med., 152(5), ITC31–ITC316 (2010).