Type 2 diabetes was also linked with poorer performance on certain cognitive tests. The strength of these associations dropped by almost 50% when adjusted for hippocampal and total gray-matter volumes but was unchanged when adjusted for cerebrovascular lesions or white-matter volume. [31, 32] Patients with type 2 diabetes were more likely to have gray-matter atrophy in several bilateral regions of the cortices, especially in the left hemisphere, similar to the distribution of cortical atrophy described in early Alzheimer disease. [31]

^ Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M, Lafont S, Bergeonneau C, Kassaï B, Erpeldinger S, Wright JM, Gueyffier F, Cornu C (July 2011). "Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials". BMJ. 343: d4169. doi:10.1136/bmj.d4169. PMC 3144314. PMID 21791495.

These benefits are weighed against the risk of hypoglycemia and the short-term costs of providing high-quality preventive care. Studies have shown cost savings due to a reduction in acute diabetes-related complications within 1-3 years after starting effective preventive care. Some studies suggest that broad-based focus on treatment (eg, glycemia, nutrition, exercise, lipids, hypertension, smoking cessation) is much more likely to reduce the burden of excess microvascular and macrovascular events.
Yamasaki et al found that abnormal results on single-photon CT myocardial perfusion imaging in asymptomatic patients with type 2 diabetes indicated a higher risk for cardiovascular events (13%), including cardiac death. Smoking and low glomerular filtration rate were significant contributing factors. [80] However, an earlier study questioned the merit of routine screening with adenosine-stress radionuclide myocardial perfusion imaging (MPI) in otherwise asymptomatic type 2 diabetic patients (the Detection of Ischemia in Asymptomatic Diabetics [DIAD] study). [81]
Low blood sugar, or hypoglycemia, is a syndrome in which a person's blood sugar is dangerously low. People with type 1 and type 2 diabetes are at risk for this condition. There are other diseases that can cause a person's blood sugar levels to go too low, for example, pancreatitis, Cushing's syndrome, and pancreatic cancer. Symptoms and signs that your blood sugar levels are too low include:

In a 40-month study of 2977 middle-aged and older adults with long-standing type 2 diabetes, depression at baseline was associated with accelerated cognitive decline. [33, 34] The 531 subjects with scores of 10 or higher on the Patient Health Questionnaire Depression Scale at baseline had significantly lower scores on the Digit Symbol Substitution Test (DSST), the Rey Auditory Verbal Learning Test (RAVLT), and the modified Stroop test. Adjustment for other risk factors did not affect the association.
Type 2 diabetes was also linked with poorer performance on certain cognitive tests. The strength of these associations dropped by almost 50% when adjusted for hippocampal and total gray-matter volumes but was unchanged when adjusted for cerebrovascular lesions or white-matter volume. [31, 32] Patients with type 2 diabetes were more likely to have gray-matter atrophy in several bilateral regions of the cortices, especially in the left hemisphere, similar to the distribution of cortical atrophy described in early Alzheimer disease. [31]
Diabetes is a chronic disease and is medically defined by having abnormally high blood glucose (sugar) levels in the body. This may be due to lack of insulin (in Type 1 diabetes, usually in younger patients), or due to a combination of lack of insulin production and increased resistance to insulin in the rest of the body’s tissues (in Type 2 diabetes, usually older patients). Insulin is an important hormone produced by the pancreas that allows glucose to enter our cells from the bloodstream. Our cells use glucose as a source of energy.

Per the WHO, people with fasting glucose levels from 6.1 to 6.9 mmol/l (110 to 125 mg/dl) are considered to have impaired fasting glucose.[70] people with plasma glucose at or above 7.8 mmol/l (140 mg/dl), but not over 11.1 mmol/l (200 mg/dl), two hours after a 75 gram oral glucose load are considered to have impaired glucose tolerance. Of these two prediabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus, as well as cardiovascular disease.[71] The American Diabetes Association (ADA) since 2003 uses a slightly different range for impaired fasting glucose of 5.6 to 6.9 mmol/l (100 to 125 mg/dl).[72]
This happens because constantly high levels of sugar in the blood stream can damage the blood vessels of the penis, or the blood vessels supplying the nerves to the penis. When the blood vessels and nerves are damaged, the blood flow to the penis is significantly reduced, resulting in erectile dysfunction. Other causes of erectile dysfunction include smoking, heart disease, high blood pressure and high cholesterol levels.
The prognosis in people with type 2 diabetes varies. It depends on how well an individual modifies his or her risk of complications. Heart attack, stroke and kidney disease can result in premature death. Disability due to blindness, amputation, heart disease, stroke and nerve damage may occur. Some people with type 2 diabetes become dependent on dialysis treatments because of kidney failure.
This happens because constantly high levels of sugar in the blood stream can damage the blood vessels of the penis, or the blood vessels supplying the nerves to the penis. When the blood vessels and nerves are damaged, the blood flow to the penis is significantly reduced, resulting in erectile dysfunction. Other causes of erectile dysfunction include smoking, heart disease, high blood pressure and high cholesterol levels.

For type 2 diabetes mellitus to occur, both insulin resistance and inadequate insulin secretion must exist. For example, all overweight individuals have insulin resistance, but diabetes develops only in those who cannot increase insulin secretion sufficiently to compensate for their insulin resistance. Their insulin concentrations may be high, yet inappropriately low for the level of glycemia.


Diabetes mellitus is a chronic disease that requires long-term medical attention to limit the development of its devastating complications and to manage them when they do occur. It is a disproportionately expensive disease; in the United States in 2012, the direct and indirect costs of diagnosed diabetes were estimated to be $245 billion; people with diagnosed diabetes had average medical expenditures 2.3 times those of people without diabetes. [10, 11]
When it comes to prediabetes, there are no clear symptoms—so you may have it and not know it. Here’s why that’s important: before people develop type 2 diabetes, they almost always have prediabetes—blood sugar levels that are higher than normal but not yet high enough to be diagnosed as diabetes. You may have some of the symptoms of diabetes or even some of the complications.
A randomized, controlled trial found that for patients with poorly controlled diabetes, individual attention and education is superior to group education. [96] Similarly, a diabetes education and self-management group program in the UK for newly diagnosed patients failed to yield significant benefits. [97] Nonphysician health professionals are usually much more proficient at diabetes education and have much more time for this very important activity.
Another diabetes-related sexual dysfunction symptom in men is reduced amounts of ejaculation, or retrograde ejaculation. Retrograde ejaculation is a condition in which the semen goes into the bladder, rather than out of the body through the urethra. Diabetes and damage to the blood vessels causes nerve damage to the muscles that control the bladder and urethra, which results in this problem.
Other potentially important mechanisms associated with type 2 diabetes and insulin resistance include: increased breakdown of lipids within fat cells, resistance to and lack of incretin, high glucagon levels in the blood, increased retention of salt and water by the kidneys, and inappropriate regulation of metabolism by the central nervous system.[10] However, not all people with insulin resistance develop diabetes, since an impairment of insulin secretion by pancreatic beta cells is also required.[13]
Diabetes occurs throughout the world but is more common (especially type 2) in more developed countries. The greatest increase in rates has however been seen in low- and middle-income countries,[104] where more than 80% of diabetic deaths occur.[108] The fastest prevalence increase is expected to occur in Asia and Africa, where most people with diabetes will probably live in 2030.[109] The increase in rates in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the "Western-style" diet).[104][109] The global number of diabetes cases might increase by 48% between 2017 and 2045.[9]
Retinopathy . People with type 2 diabetes may already have abnormalities in the eyes related to the development of diabetes. Over time more and more people who initially do not have eye problems related to the disease will develop some form of eye problem. It is important to control not only sugars but blood pressure and cholesterol to prevent progression of eye disease. Fortunately, the vision loss isn't significant in most.
Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin; however, the insulin their pancreas secretes is either not enough or the body is unable to recognize the insulin and use it properly. This is called insulin resistance. When there isn't enough insulin or the insulin is not used as it should be, sugar (glucose) can't get into the body's cells to be used for fuel. When sugar builds up in the blood instead of going into cells, the body's cells are not able to function properly. Other problems associated with the build up of sugar in the blood include:
If you have this symptom, you’re not alone. In fact, the prevalence of erectile dysfunction rises with age, and rises to over 70% of men over the age of 70. Interestingly, a study by John Hopkins University found that people with diabetes had increased levels of a particular simple sugar that interferes with the events needed to achieve and maintain an erection.

Diabetes mellitus is classified into four broad categories: type 1, type 2, gestational diabetes, and "other specific types".[11] The "other specific types" are a collection of a few dozen individual causes.[11] Diabetes is a more variable disease than once thought and people may have combinations of forms.[37] The term "diabetes", without qualification, refers to diabetes mellitus.
Genome-wide association studies of single-nucleotide polymorphisms (SNPs) have identified a number of genetic variants that are associated with beta-cell function and insulin resistance. Some of these SNPs appear to increase the risk for type 2 diabetes. Over 40 independent loci demonstrating an association with an increased risk for type 2 diabetes have been shown. [16] A subset of the most potent are shared below [17] :
Diabetes mellitus (DM), commonly known as diabetes, is a group of metabolic disorders characterized by high blood sugar levels over a prolonged period.[10] Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger.[2] If left untreated, diabetes can cause many complications.[2] Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death.[3] Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.[2]
Fat distribution. If you store fat mainly in the abdomen, you have a greater risk of type 2 diabetes than if you store fat elsewhere, such as in your hips and thighs. Your risk of type 2 diabetes rises if you're a man with a waist circumference above 40 inches (101.6 centimeters) or a woman with a waist that's greater than 35 inches (88.9 centimeters).
Indigestion (dyspepsia) can be caused by diseases or conditions that involve the gastrointestinal (GI) tract, and also by some diseases and conditions that do not involve the GI tract. Indigestion can be a chronic condition in which the symptoms fluctuate infrequency and intensity. Signs and symptoms that accompany indigestion include pain in the chest, upper abdominal pain, belching, nausea, bloating, abdominal distention, feeling full after eating only a small portion of food, and rarely, vomiting.
Insulin resistance is associated with increased lipid accumulation in liver and smooth muscle, but not with increased myocardial lipid accumulation. [27] Persistent lipid abnormalities remain in patients with diabetes despite the use of lipid-modifying drugs, although evidence supports the benefits of these drugs. Statin dose up-titration and the addition of other lipid-modifying agents are needed. [28]
In 2017, 425 million people had diabetes worldwide,[9] up from an estimated 382 million people in 2013[18] and from 108 million in 1980.[104] Accounting for the shifting age structure of the global population, the prevalence of diabetes is 8.8% among adults, nearly double the rate of 4.7% in 1980.[9] [104] Type 2 makes up about 90% of the cases.[17][19] Some data indicate rates are roughly equal in women and men,[19] but male excess in diabetes has been found in many populations with higher type 2 incidence, possibly due to sex-related differences in insulin sensitivity, consequences of obesity and regional body fat deposition, and other contributing factors such as high blood pressure, tobacco smoking, and alcohol intake.[105][106]
The WHO estimates that diabetes resulted in 1.5 million deaths in 2012, making it the 8th leading cause of death.[13][104] However another 2.2 million deaths worldwide were attributable to high blood glucose and the increased risks of cardiovascular disease and other associated complications (e.g. kidney failure), which often lead to premature death and are often listed as the underlying cause on death certificates rather than diabetes.[104][107] For example, in 2017, the International Diabetes Federation (IDF) estimated that diabetes resulted in 4.0 million deaths worldwide,[9] using modeling to estimate the total number of deaths that could be directly or indirectly attributed to diabetes.[9]
Also called diabe·tes mel·li·tus [mel-i-tuh s, muh-lahy-] . a disorder of carbohydrate metabolism, usually occurring in genetically predisposed individuals, characterized by inadequate production or utilization of insulin and resulting in excessive amounts of glucose in the blood and urine, excessive thirst, weight loss, and in some cases progressive destruction of small blood vessels leading to such complications as infections and gangrene of the limbs or blindness.
Diabetes mellitus is classified into four broad categories: type 1, type 2, gestational diabetes, and "other specific types".[11] The "other specific types" are a collection of a few dozen individual causes.[11] Diabetes is a more variable disease than once thought and people may have combinations of forms.[37] The term "diabetes", without qualification, refers to diabetes mellitus.

In a cross-sectional study of 350 patients aged 55 years and older with type 2 diabetes and 363 control participants aged 60 years and older without diabetes, diabetic individuals were more likely to have brain atrophy than cerebrovascular lesions, with patterns resembling those of preclinical Alzheimer disease. [31, 32] Type 2 diabetes was associated with hippocampal atrophy; temporal, frontal, and limbic gray-matter atrophy; and, to a lesser extent, frontal and temporal white-matter atrophy.
The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rd century CE). He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the "Pneumatic School". He hypothesized a correlation between diabetes and other diseases, and he discussed differential diagnosis from the snakebite, which also provokes excessive thirst. His work remained unknown in the West until 1552, when the first Latin edition was published in Venice.[113]
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
Insulin resistance is associated with increased lipid accumulation in liver and smooth muscle, but not with increased myocardial lipid accumulation. [27] Persistent lipid abnormalities remain in patients with diabetes despite the use of lipid-modifying drugs, although evidence supports the benefits of these drugs. Statin dose up-titration and the addition of other lipid-modifying agents are needed. [28]
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Abnormal cholesterol and triglyceride levels. If you have low levels of high-density lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is higher. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know what your cholesterol and triglyceride levels are.
Two types of diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400–500 CE with one type being associated with youth and another type with being overweight.[111] The term "mellitus" or "from honey" was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus, which is also associated with frequent urination.[111] Effective treatment was not developed until the early part of the 20th century, when Canadians Frederick Banting and Charles Herbert Best isolated and purified insulin in 1921 and 1922.[111] This was followed by the development of the long-acting insulin NPH in the 1940s.[111]
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Fat distribution. If you store fat mainly in the abdomen, you have a greater risk of type 2 diabetes than if you store fat elsewhere, such as in your hips and thighs. Your risk of type 2 diabetes rises if you're a man with a waist circumference above 40 inches (101.6 centimeters) or a woman with a waist that's greater than 35 inches (88.9 centimeters).
^ Saenz A, Fernandez-Esteban I, Mataix A, Ausejo M, Roque M, Moher D (July 2005). "Metformin monotherapy for type 2 diabetes mellitus". The Cochrane Database of Systematic Reviews (3): CD002966. doi:10.1002/14651858.CD002966.pub3. PMID 16034881. (Retracted, see doi:10.1002/14651858.cd002966.pub4. If this is an intentional citation to a retracted paper, please replace {{Retracted}} with {{Retracted|intentional=yes}}.)
It would be advisable to see a doctor for further evaluation, if you experience one of these diabetes symptoms in men. Generally, retrograde ejaculation doesn’t need formal treatment unless fertility is a problem. Treatment options may include medications that help keep the bladder neck muscle closed during ejaculation – however these only work if the problem is caused by nerve damage, such as in diabetes.

A number of different healthcare professionals treat diabetes. A good first step is to talk to your primary care doctor about testing if you’re at risk for diabetes or if you begin experiencing symptoms associated with the disease. While you may work with your primary care doctor to manage your diabetes, it’s also possible to rely on another doctor or specialist to monitor your condition.

Identified genetic variants account for only about 10% of the heritable component of most type 2 diabetes. [17] An international research consortium found that use of a 40-SNP genetic risk score improves the ability to make an approximate 8-year risk prediction for diabetes beyond that which is achievable when only common clinical diabetes risk factors are used. Moreover, the predictive ability is better in younger persons (in whom early preventive strategies could delay diabetes onset) than in those older than 50 years. [45]

People may see a primary care doctor or a family practitioner when they get sick or when having general checkups. A specialist called an endocrinologist has special training in diagnosing and treating diabetes. However, if you cannot find an endocrinologist in your area, you can alternatively look for a primary care doctor, who can either be an internist or a family practitioner. 

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