Endocrinology
Type 2 Diabetes Mellitus
2형당뇨
Chronic hyperglycemia from insulin resistance and progressive β-cell dysfunction
- How common
- 11–14% of Korean adults
- Typical age
- Mostly age ≥40
What is it?
Peripheral insulin resistance plus progressive β-cell failure cause hyperglycemia.
Commonly affected: Muscle, liver, adipose + pancreatic β-cells
How it develops
- Insulin resistanceObesity, visceral fat, inflammatory cytokines reduce muscle/liver insulin sensitivity
- Compensatory hyperinsulinemiaβ-cells secrete more insulin to compensate
- β-cell dysfunctionGlucotoxicity/lipotoxicity exhaust β-cells
- Chronic hyperglycemia + complicationsMicro (retina, kidney, nerves) and macrovascular complications
Symptoms
- Fatigue/weight changesWeight gain or loss possible
- Recurrent infectionsFungal/UTI more common
- Vision changesRetinopathy may progress
- Mild polyuria/polydipsiaSlower onset than T1DM
- Acanthosis nigricansVelvety dark patches (insulin resistance)
How it is examined
- Fasting glucose / HbA1cFasting ≥126, HbA1c ≥6.5% diagnostic
- Metabolic syndrome evalWaist circumference, BP, lipids, HDL
- Complication screeningRetinal exam, microalbumin, foot exam
Imaging
No diagnostic imaging; vascular imaging for complications.
- Vascular calcifications
MRI for diabetic foot/neuropathy assessment.
- Soft tissue infection
- Osteomyelitis
Non-surgical care
- Metformin (first-line)500 mg BID start, max 2 g/day
- SGLT2i (empagliflozin)Cardio-renal protective benefits
- GLP-1 RA (semaglutide)Weight loss + CV protection
- Basal insulin (glargine)If HbA1c >9% or oral failure
- Lifestyle (DASH/exercise)5–10% weight loss, 150 min exercise/wk
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Severe obesity (BMI ≥35) with diabetes, medication failure
Procedures that may be discussed
- Roux-en-Y gastric bypass
- Sleeve gastrectomy
- Pancreas transplant (rare)
Outlook
Complications preventable with early aggressive management; target HbA1c <7%.