Karakterističan je za osobe starije od 35 godina, a najčešće je posledica različitih abnormalnosti na nivou perifernih tkiva. Zbog toga se javlja smanjenje osetljivosti ovih tkiva na delovanje insulina. U lečenju osoba sa dijabetesom tip 2 nije neophodna primena insulina, pa se ovaj tip pre zvao insulin nezavisan oblik, mada se suplementarna insulinska terapija pokazala kao jedno od efektivnih rešenja. Ovaj oblik se se javlja daleko češće, tj. čini preko 80% svih obolelih. Faktori rizika za javljanje ovog tipa dijabetesa su: porodična anamneza o dijabetesu tip 2, gojaznost, starost, hipertenzija, povećan holesterol itd.
Dijagnoza se postavlja ako se uz tipične simptome za dijabetes (povećan unos tečnosti i potreba za mokrenjem, malaksalost…) utvrdi glikemija pre obroka ≥ 7 mmol/l ili ako je glikemija merena u bilo koje doba dana ≥ 11,1 mmol/l. Ako se izvodi OGTT (oralni test tolerancije na glukozu) dijagnoza se postavlja kada je glikemija u roku od 2h po uzimanju glukoze ≥ 11,1 mmol/l. Aktivan pristup u dijagnostici rane faze poremećaja tolerancije glikoze je neophodan. Epidemiološke studije su pokazale da se godinama pre jasnog ispoljavanja bolesti mogu utvrditi poremećaji u toleranciji glikoze. Takođe je utvrđeno da u trenutku kada se postavlja dijagnoza dijabetesa tip 2 oko 50% bolesnika imaju jednu ili čak više tipičnih dijabetesnih komplikacija. Zato je sprovođenje pravovremenih pregleda važno.
U lečenju diabetes mellitus tip 2 ostaje pravilo da, primenom dijete, redukcione po kalorijama i fizičke aktivnosti, treba smanjiti telesnu težinu i popraviti senzitivnost na insulin i iskorišćavanje glikoze.
Primenom peroralnih sredstava treba da se iz beta-ćelija dobije veća količina insulina, delovanjem na receptore otklone receptorski, a na postreceptorske enzimske intercelularne reakcije, otklone postreceptorski defekti. Ciljeve terapije i u dijabetesu tip 2 su isti kao i u dijabetesu uopšte:
• postizanje normalne ili skoro normalne glikoregulacije, ali i normalnog lipidnog metabolizma.
• održavanje normalne telesne mase
• održavanje normalne arterijske tenzije ili normalizovanje arterijske hipertenzije i na toj sprovođenje primarne i sekudarne prevencije diabetesne mikroangiopatije i makroangiopatije.
Treba izneti i ranije mišljenje, da je u nekim slučajevima teško postići normalnu metaboličku kontrolu dijabetesa tip 2. Danas se taj broj pacijenata smanjio sa primenom najnovijih saznanja iz etiopatogeneze dijabetesa tip 2. Prema preporukama Evropske grupe za dijabetes kriterijumi za dobru metaboličku kontrolu DM tip 2 su: pre doručka 4,4-6,1. mmol/l, posle obroka 4,4-8,0 mmol/l, hemoglobin A1c ili A1 u granicama normale za primenjeni metod. Nezadovoljavajuća glikoregulacija postoji ako je glikemija pre obroka veća od 7,8 mmol/l, postprandijalno od 10,0 mmol/l, a hemoglobin A1c takođe iznad gornje granice normale. Važno je znati i primenjivati kriterijume iz više razloga. Prvo, jer hiperglikemija do 10,0 mmol/l, zbog toga što nije dostignut tubularni maksimum za reapsorpciju glikoze iz primarne mokraće, ne dovodi do glikozurije, poliurije i drugih klasičnih simptoma i znakova dijabetesa. U toku tog oligosimptomatskog perioda, koji može da potraje godinama, dešavaju se svi etiopatogenetski događaji koji dovode do mikro- i makroangiopatije.
Teorijski posmatrano, idealno peroralno sredstvo trebalo bi da ima sledeće karakteristike: da omogući postizanje fiziološkog dnevnog profila insulinemija i glikemija, da onemogući naglo oslobađenje ili nedovoljno oslobađenje insulina; da ima metabolička dejstva slična insulinu; da omogućava stabilnu i dugotrajnu metaboličku kontrolu; da ima što manji procenat primarnog i sekudarnog neuspeha; da se željeni efekt dostigne sa što manjom količinom leka, jer što je manja, manja su i ne željena dejstva; da je način upotrebe u toku dana jednostavan i prihvatljiv za bolesnika; da izaziva što manje neželjenih dejstava, naročito hipoglikemiju. Naravno, da takvo sredstvo za sada ne postoji. Ovi parametri treba da omoguće lekaru da se lakše odluči koje će sredstvo izabrati za svaku osobu sa dijabetesom pojedinačno.
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