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.
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