Disease of aging
Type 2 Diabetes
Last updated Sun May 17 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
What it is
Chronic insulin resistance combined with progressive pancreatic β-cell failure, producing hyperglycaemia. Diagnostic criteria: HbA1c ≥6.5%, fasting glucose ≥126 mg/dL, OGTT 2-h glucose ≥200 mg/dL, or random glucose ≥200 with symptoms.
Why it matters for longevity
T2D shortens life expectancy by ~6–10 years if untreated, primarily via cardiovascular disease, but also via:
- Chronic kidney disease.
- Retinopathy, neuropathy, lower-limb amputation.
- Higher cancer risk (several sites).
- Higher dementia incidence.
- Frailty acceleration.
Remission, not just management
The DiRECT trial showed that a structured very-low-calorie programme led to type-2 diabetes remission (HbA1c <6.5% off medication) in ~46% of adults at 1 year. The PREVIEW trial and bariatric surgery data confirm: T2D can be reversed in early stages with sufficient weight loss.
Current treatment landscape
- First-line: metformin, lifestyle.
- For weight + cardiovascular benefit: GLP-1 / GIP agonists (semaglutide, tirzepatide).
- For heart-failure / kidney benefit: SGLT2 inhibitors.
- Insulin when needed.
- Bariatric surgery for selected patients.
Prevention
The Diabetes Prevention Program showed lifestyle (7% weight loss + 150 min/week exercise) reduced incidence by 58% in pre-diabetics — better than metformin (31%).
Related entries
References
- Lean, M. E. J. et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT). Lancet 391, 541–551 (2018).