Diabete mellito di tipo 2
Il diabete mellito di tipo 2, un tempo noto come diabete non insulino-dipendente dell’adulto, rappresenta un gruppo eterogeneo di disordini caratterizzati da gravi variabili d’insulino-resistenza, con aumentata produzione epatica e riduzione dell’uptake periferico di glucosio, oltre che da alterata secrezione insulinica. Questa forma di DM può non essere riconosciuta per anni, in quanto l’iperglicemia è frequentemente asintomatica. La diagnosi viene effettuata in corso di malattie intercorrenti e spesso le complicanze croniche del diabete sono già presenti. La maggioranza dei pazienti con DM di tipo 2 sono obesi: l’obesità stessa causa o peggiora l’insulino-resistenza. la chetoacidosi si verifica raramente. Probabilmente il DM di tipo 2 riconosce molteplici cause. Sebbene la specifica eziologia non sia nota, non vi sono segni di distruzione autoimmune delle cellule beta, né di altre cause note come DM e non è associato a particolari antigeni HL. Tuttavia il DM di tipo 2 è caratterizzato da una forte predisposizione genetica. Nei soggetti con suscettibilità genetica sviluppare il DM di tipo 2, lo sviluppo della malattia può essere favorito da fattori ambientali quali:
- obesità
- elevato apporto calorico
- sedentarietà
L’obesità: per lo più viscerale, è presente in oltre l’ 80% dei pazienti con DM di tipo 2. Essa si accompagna a insulino-resistenza e a iperinsulinismo, compensatorio all’ iperglicemia. Nei soggetti geneticamente predisposti a sviluppare il DM di tipo 2 l’insulino-resistenza rende clinicamente evidente il deficit della secrezione insulinica. L’iperinsulinismo di per sé comporta una riduzione del numero dei recettori per l’insulina, ma spesso coesistono difetti post-recettoriali che sono la causa principale dell’ insulino-resistenza.
Sedentarietà: l’esercizio fisico migliora il controllo glicemico ed è parte integrante del piano di trattamento del diabete.
Familiarità: rende il soggetto maggiormente predisposto a diventare diabetico.
Alimentazione: si può non essere obesi ma avere un’alimentazione ricca di grassi e zuccheri semplici che può favorire la comparsa del diabete.
SOGGETTI MAGGIORMENTE A RISCHIO
E’ necessario approfondire quando si presenta qualcuna di queste condizioni:
- Familiarità per diabete di tipo 2
- Sovrappeso e obesità (BMI > 25)
- Ipertensione arteriosa
- Cardiopatia ischemica
- Familiarità per cardiopatia ischemica Storia del diabete gestazionale
- Sindrome dell’ovaio policistico
In questi casi è necessario:
- Misurare lo zucchero del sangue (glicemia) a digiuno per scoprire se sono necessari esami più approfonditi
- Eseguire un prelievo per i livelli di colesterolo
- Misurare la circonferenza vita e peso corporeo
- Misurare la pressione arteriosa
MISURAZIONE GLICEMIA
Dopo almeno 12 ore di digiuno
MINORE DI 100 MG/DL Normale
TRA 100 E 126 MG/DL Alterata glicemia a digiuno
SUPERIORE A 126 MG/DL Possibile diabete
L’ insulino-resistenza non è un tratto fisiopatologico esclusivo
del diabete mellito di tipo 2. Si riscontra anche nell’ ipertensione
arteriosa, nell’obesità e nella disipidemia. Condizioni che sono
talvolta presenti contemporaneamente nella stessa persona e
contribuiscono a danneggiare i vasi sanguigni e quindi a
facilitare la comparsa di malattie come l’infarto e l’ictus.
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