Health Concerns Associated with Type 2 Diabetes
Franjic S
Published on: 2024-10-19
Abstract
Type 2 diabetes is by far the most common form of diabetes-it occurs in 90% of cases. Most patients with type 2 produce altered or even normal amounts of insulin, but due to disturbances in liver and muscle cells, insulin resistance occurs. Insulin binds to cell receptors, but glucose can enter the cell and this condition is known as insulin resistance. The disease usually begins gradually and progresses slowly. Symptoms do not have to appear for years, even decades. In advanced disease, excessive thirst, increased urination, fatigue, blurred vision, and weight loss occur. Vaginal fungal infections are common in women.
Keywords
Diabetes; Type 2; Patients; Insulin; Prevention; HealthIntroduction
Type 2 diabetes is a common chronic disease of world importance [1]. Most sufferers (>85%) with diabetes have type 2 diabetes. The charge of the boom of type 2 diabetes is such that there may be successfully a worldwide epidemic. The WHO expected that 30 million human beings had diabetes in 1985; in 2019, the estimate turned to 463 million, and projections are that numbers will attain 578 million via way of means of 2030. Diabetes has historically been considered an ailment of wealthy nations. However, current estimates of diabetes occurrence display that 80% of human beings with diabetes stay in nations labeled via way of means of the World Bank as low- and middle-profit nations, and this percentage is growing. The occurrence of type 2 diabetes is associated with growing age, growing calorie intake, growing weight problems, and decreased bodily activity. Pregnancy, drug remedies (including corticosteroids), and intercurrent infection are related to precipitating diabetes. Type 2 diabetes can continue to be undiagnosed for lots of years.
Problem
Type 2 diabetes mellitus (T2DM) is presently taken into consideration as a worldwide health trouble in which approximately six human beings die each minute from the disease worldwide [2]. This charge will make T2DM one of the world’s maximum frequent reasons for preventable mortality. T2DM is resulting from impaired glucose tolerance (IGT) due to insulin resistance and consequential islet β-cell exhaustion, with resulting insulin deficiency. In people with IGT, several genetic, host-related, and environmental elements make a contribution to the development of insulin resistance to T2DM. Obesity, however, is a main motive of insulin resistance and may be complex via way of means of metabolic dysregulation along with high blood pressure and dyslipidemia [known collectively as the metabolic syndrome] that's a precursor of T2DM. Dyslipidemia entails excessive tiers of triacylglycerides and circulating fatty acids originating from the eating regimen or multiplied lipolysis in adipocytes. Direct publicity of muscle cells to those fatty acids impairs insulin-mediated glucose uptake and, therefore, can also additionally contribute to insulin resistance. Within the remaining decade, speculation turned into proposed to explain the pathogenesis of T2DM that connects the disease to a state of subclinical continual inflammation. Inflammation is a brief-time period of adaptive reaction of the frame elicited as a precept aspect of tissue restoration to address accidents and microbial infections (e.g., cold, flu, etc.). It may be additionally improved in continual situations including peripheral neuropathy, continual kidney disease, and fatty liver. While the impact of fat is nicely-recognized, modern wondering shows that ordinary tiers of chemokines launched via way of means of the increased adipose tissue in weight problems prompt monocytes and boom the secretion of pro-inflammatory adipokines. Such cytokines in flip beautify insulin resistance in adipose and different tissues, thereby growing the danger for T2DM. Together, lipid toxicity and low-grade infection seem like principal attacks on insulin sensitivity in insulin-responding tissues.
Activation of innate immunity promotes diverse inflammatory reactions that offer the primary line of protection the frame invokes in opposition to microbial, chemical, and bodily injury, mainly to restore damage, isolation of microbial infectious threats, and recuperation of tissue homeostasis. Inherited versions withinside the degree of innate immune reaction can also additionally decide the lifetime danger of sicknesses upon publicity to damaging environmental stimuli. Therefore, innate immune responses may be considered because of the final results of the interplay between genetic endowment and the environment.
Symptoms
Early signs and symptoms of type 2 diabetes can be slight, with the disease disclosed handiest on recurring testing (including via way of means of glucose tolerance assessments) [3]. The early signs and symptoms are just like that of type 1 diabetes, with polyuria, polydipsia, accelerated hunger, and on occasion unexplained weight loss. Itchiness and fatigue can also arise. Ketosis does now no longer generally arise as a problem of type 2 diabetes, however, affected people can also additionally increase some other problem known as hyperosmolar coma, which ends from marked hyperglycemia. Of important situations are the continual outcomes of the disease, which can be expressed in basically each organ, and maximum substantially, withinside the cardiovascular and renal structures. Many of the continual outcomes of T2DM are related to dyslipidemia (accelerated triglycerides and decreased excessive-density lipoprotein cholesterol). Dyslipidemia is expressed in basically each organ machine withinside the frame as a continual disease state. The danger of atherosclerotic vascular disease with an accelerated occurrence of high blood pressure, warmth attack, and strokes; nonalcoholic fatty liver disease, which can also additionally development into steatohepatitis; endocrine disease; renal disease; retinal disease; and an accelerated danger of most cancers are all related to the continual dyslipidemia of T2DM.
Type 2 diabetes is a hereditary disease wherein genetic elements play a fair extra function than in type 1 diabetes. About 50 percent of the danger of type 2 diabetes is heritable even though in maximum instances we do now no longer understand the precise mode of inheritance or the genes that predispose us to this form of diabetes. Children of a mother and father who each have T2DM have a 70-percentage danger of additionally subsequently turning into diabetic, and approximately one-third of diabetics have a figure who additionally had the disease. The danger of diabetes taking place in each of a couple of monozygotic (identical) twins is close to a hundred percent.
More than 40 genetic loci are related to accelerated danger for type 2 diabetes, however, those loci contribute handiest approximately 10 percent of the danger attributable to genetic background. However, editions (polymorphisms) of 1 gene (TCF7L2) are worried in approximately 20 percent of all instances of type 2 diabetes, and those homozygous for the excessive-danger allele of the gene have approximately a twofold accelerated danger of disease. The organic character of a lot of those genes in growing the danger of disease stays unknown. Obesity (critical weight problems, the buildup of visceral fats), a clean danger element for T2DM, additionally has a sturdy genetic in addition to an environmental aspect. About forty to 70 percent of the danger for critical weight problems pertains to more than one genetic element. Hence, it isn't sudden that genes that contribute to the danger of critical weight problems additionally can also additionally boom the danger of T2DM. The pleasant characteristic of those is a fixed of genes on chromosome sixteen placed close to the gene FTO (fats mass and weight problems associated). Genetic editions of the FTO gene have a marked impact on the danger of personal weight problems. The outcomes are probable to be contemplated thru a 2nd gene, Irx3, whose level of expression is managed via way of means of FTO. Irx3 is expressed in a place of the brain (the hypothalamus) important in energy regulation. Additional records are to be had withinside the dialogue of weight problems below gastrointestinal troubles.
An unusual autosomal dominant genetic shape of diabetes representing 1 to two percent of instances is adulthood onset diabetes of the young (MODY). The call is a misnomer due to the fact the ailment isn't associated with T2DM (commonly related to person onset) however instead pertains to mutations in some of the genes related to impaired insulin secretion/beta molecular characteristics taking place at an early age. Six genes were related to MODY. The maximum not unusual place shape of MODY (MODY1) outcomes from mutations withinside the HNF1A gene, which results in revolutionary beta molecular failure and a discount in vital steps in glucose shipping and metabolism. The ailment is revolutionary with age and related to diabetic headaches. The 2nd maximum, not unusual place shape (MODY2) is related to mutations withinside the glucokinase gene (GCK). These mutations intrude with the formation of glucose-6 phosphate, which in the long run stimulates the “glucose sensor” at the beta cell, however, the beta cells cannot reply as they should be to the degree of glycemia. This ailment is slight and does now no longer develops with age.
Prevalence
In the remaining many years, the superiority of diabetes mellitus (DM) has proven a top-notch boom worldwide, in particular, type 2 diabetes mellitus (T2DM) [4]. The wide variety of human beings with DM has accelerated greater unexpectedly in low- and middle-profit nations as compared to excessive-profit nations. T2DM is the maximum common shape of diabetes, characterized via way of means of insulin resistance and impaired insulin launch via way of means of pancreatic β-cells. Complications of DM contain diabetic kidney disease (DKD, the principal motive of renal failure), retinopathy, and neuropathy. Moreover, cardiovascular sicknesses (CVDs) are the primary comorbidity located in diabetic sufferers.
Biomarker is an organic compound whose kingdom or degree determines the ordinary or pathological popularity related to an ailment or remedy reaction. The proteins, specifically the soluble ones, are vital biomarkers due to the fact they permit the laboratory size to diagnose and prognosis of acute and continual issues. The molecular omics platforms, such as proteomics, allow the identity of multi-parameter biomarkers and the improvement of personalized diagnostics. Nevertheless, packages of those omics technology must try and medical validation of the candidate biomarkers in massive populations, one of the fundamental demanding situations in omics research.
Proteomics is an era worried withinside the quantification of typical proteins found in a cell, tissue, or organism. The proteome characterization consists of protein expression, in addition to its shape and characteristics, except interactions and posttranslational adjustments. Proteins are regulators of organic characteristics, and their tiers are depending on gene expression and mRNA (messenger ribonucleic acid) tiers, in addition, to translational manipulation.
Proteomes are greater complicated than the corresponding genomes, due to the fact post-translational adjustments substantially contribute to a bigger variety than genes. Thus, proteomics may be taken into consideration because the maximum applicable records symbolize an organic machine and recommend new biomarkers. Immuno-primarily based totally assays that make use of the affinity of antibodies connected to a reporter (including enzyme-linked immunosorbent assays (ELISA), luminescence, fluorescence, or radioactivity) are taken into consideration the gold well-known for identity and quantification of proteins. These assays had been applied to show the affiliation of conventional T2DM biomarkers, including adiponectin, leptin, intercourse hormone-binding globulin, and diet E-binding protein. Nevertheless, those assays are precise for the handiest biomarker and do now no longer permit an untargeted degree of proteins gift withinside the pattern. Two-dimensional polyacrylamide gel electrophoresis (2D PAGE) has been used as a reference method for proteomic research. However, gel-primarily based total strategies tend to be greater labor-in-depth and time-consuming, therefore now no longer appropriate for high-throughput analysis. In flip, mass spectrometry (MS) has been taken into consideration as the maximum vital approach to identifying, symbolizing, and quantifying proteins on a massive scale. Because of the massive form of relative abundances and complicated additives typically found in organic samples, MS permits the detection and quantification of low-abundance species primarily based totally on the mass-to-price ratio (m/z), because maximum serum proteins are at or beneathneath the restriction of detection for maximum immune assays. Liquid chromatography (LC) additionally permits the non-stop separation of hundreds of proteins and may be achieved online with MS for accelerated throughput.
Causes
Type 2 diabetes is not going to be a single circumstance [1]. Some late-onset diabetes, to begin with, presumed to be type 2, can also additionally end up latent autoimmune diabetes in adults (LADA), whilst different sufferers concept to have type 2 diabetes can also additionally upon research be proven to have secondary types including pancreatic, or monogenic diabetes. In all sufferers with type 2 diabetes, there may be a variable degree of insulin resistance and relative insulin deficiency. With time (commonly 5-15 years from prognosis), glycemic manipulation in human beings with type 2 diabetes generally turns into greater hard, insulin deficiency greater obvious and a subgroup of sufferers can also additionally come to be ketosis-prone. Data from the UKPDS (UK Prospective Diabetes Study) trial counseled that the common time to insulin use turned into about eight years after the prognosis of type 2 diabetes and showed the medical influence of a revolutionary in preference to static ailment process. The creation of more recent remedies for type 2 diabetes, however, can also additionally amplify the length of insulin requirement considerably.
Testing
Once intravenous (IV) get entry is established, a bedside capillary blood glucose check must be achieved [5]. This is generally correct to round 500 mg/dl. If the bedside capillary glucose is above 300–400 mg/dl, fluid resuscitation must be initiated previous to acquiring formal laboratory outcomes.
The laboratory investigations wished to encompass serum electrolytes, blood urea nitrogen, creatinine, glucose, calcium, magnesium, phosphate, and a whole blood count. Serum ketones must additionally be ordered, because the urine dipstick for ketones may be falsely negative. A blood gas must be received to file the pH. Recent literature has proven a considerable correlation between venous and arterial blood gases; therefore, a venous pattern is now frequently used for diagnostic purposes.
The serum potassium level is extraordinarily vital. Patients are generally significantly potassium depleted, but can also additionally have excessive serum tiers on the primary sampling. This is resulting from acidosis that complements potassium launch from cells in trade for hydrogen ions in a try and normalizes the pH. Pseudohyponatremia is not an unusual place and is resulting from hyperglycemia. The sodium degree may be corrected via way of means of including 1.6 meq of sodium for each 100 mg of glucose above 100 mg/dl.
Patients with abdominal pain must additionally have amylase, lipase, and liver characteristic assessments ordered. A septic work-up, along with blood and urine cultures and a chest X-ray must be taken into consideration, especially in febrile sufferers, however, relies upon the affected person’s presentation. An electrocardiogram (ECG) is critical to search for proof of hyperkalemia and to look for a probable precipitant of DKA, including myocardial ischemia.
Guidelines posted via way of means of the American Diabetic Association define a triad of biochemical necessities for the prognosis of DKA:
- Glucose 250 mg/dl
- Arterial pH 7.35, venous pH 7.30, or bicarbonate 15 meq/l
- Ketonemia or ketonuria.
Patients
Type 2 diabetes is a complicated ailment commonly affecting older individuals who are frequently obese and probable to go through different scientific troubles as nicely [6]. Its control offers widespread demanding situations to scientific and nursing staff, whose care need to be directed on the sum of the troubles of the man or woman affected person. Management now calls for now no longer the handiest interest in blood glucose manipulation, but additionally in the remedy of high blood pressure and hyperlipidemia, in addition to introducing the essential measures for decreasing cardiovascular danger elements.
Optimal remedy for Type 2 diabetic sufferers, especially those who are symptom-free, and obese, and feature similarly numerous cardiovascular danger elements, sporting activities our medical talents, and judgments to the restrict. There wishes to be a feeling of truth in the consultation, bearing in thoughts the capability risks of unacceptable polypharmacy observed via way of means of low adherence to prescribed remedy in addition to a feeling of guilt skilled via way of means of those who fail to gain best objectives set via way of means of physicians. Awareness of the priorities and intentions of man or woman sufferers wishes to consider delivery, and sufferers want to agree on the targets for remedy. Recommendations for remedy need to be clinically applicable for the man or woman affected person, who must be worried about selecting which of the numerous healing alternatives to choose after clarification of benefits and risks. The problems of controlling Type 2 diabetes generally tend to boom over time because the ailment progresses.
Insulin
Approximately 6% of non-overweight and 2% of overweight Type 2 diabetic sufferers want to begin insulin every year [6]. Predicting the want for insulin is hard: the ones of lean frame mass, specially withinside the presence of islet cell antibodies, are at the greatest risk. Whether to offer insulin to Type 2 diabetic sufferers is one of the maximum vital but hard choices to be made in treating those sufferers. Failure to offer insulin to a few sufferers outcomes in protracted and useless malaise is now no longer a real danger. On the alternative hand, giving insulin inappropriately can motivate useless troubles, substantially from hypoglycemia and weight benefit.
Indications for giving insulin to Type 2 diabetic sufferers who're inadequately managed regardless of adherence to their encouraged eating regimen and oral hypoglycaemic retailers are as follows:
- Continuing weight loss (although that is insidious), and chronic signs and symptoms, or each. Insulin remedies in those sufferers nearly constantly outcomes in considerable development in health.
- A non-overweight affected person without signs and symptoms whose weight is strong and who's conscientious with current medication. Diabetic manipulation will generally improve, and approximately half of the sufferers will experience development in well-being.
- An overweight affected person without signs and symptoms whose weight is strong offers a fair greater hard trouble. The accurate control is to make certain that they're taking their medication, collectively with the intensification of the eating regimen, however, on occasion insulin can be wished certainly to enhance manipulation of diabetes to lessen long-time period complications in the subsequent decade or greater. A reduction of HbA1C of about 2% collectively with a weight benefit of around 5-7 kg may be anticipated. Unfortunately, development in glycaemic manipulation isn't constantly carried out. Patient preference is vital here, and a few decide upon now no longer to take insulin despite everything motives were presented. Reluctant sufferers may be given a three-month trial of insulin after which make their decision, which revels in suggests to be generally affirmative. Those with a brief life expectancy do now no longer always advantage, and people with different scientific issues would require man or woman's consideration.
- Insulin is frequently required in sufferers with intercurrent infection. Many issues, substantial infections, boom insulin resistance, main to the transient want for insulin. Withdrawal of insulin after improving from the infection is vital furnished good enough manipulation is carried out and maintained.
With type 2 diabetes mellitus, there may be insufficient secretion of insulin [7]. Early withinside the disease, insulin tiers are typically very excessive. This scenario can also additionally preserve a while in disease improvement. Peripheral insulin resistance and the accelerated manufacturing of glucose via the way of means of liver motivate tiers of insulin to be inadequate to normalize tiers of plasma glucose. Insulin manufacturing turns into decreased, and hyperglycemia worsens. Type 2 diabetes generally develops in adults and is a greater not unusual place with endured aging. Plasma glucose tiers spike better following food in older adults as compared to more youthful adults. This is a maximum not unusual place following excessive carbohydrate loads. The tiers require an extended time frame to go back to the ordinary. This is in part because of the accelerated accumulation of visceral and belly fats, plus reduced muscle mass. Type 2 diabetes has come to be a greater not unusual place than ever in children. Childhood weight problems have now reached epidemic tiers of occurrence. About 40%–50% of the latest pediatric instances are type 2 diabetes, and greater than 90% of adults with diabetes have this shape. Genetic elements are clean, influencing the superiority of type 2 diabetes ethnic groups including Hispanics, American Indians, and Asians. Several genetic polymorphisms were discovered, however, no man or woman causative gene has been identified.
The pathogenesis of type 2 diabetes isn't completely understood because of its complexity. Once insulin secretion cannot make amends for insulin resistance, hyperglycemia develops. Though insulin resistance is characteristic, beta cell disorder and impaired insulin secretion are not unusual places. There is impaired initial-section insulin secretion as a reaction to IV glucose infusion, low pulsatile insulin secretion, and accelerated proinsulin secretion signaling impaired processing of insulin. There is likewise an accumulation of islet amyloid polypeptide, that's a protein generally secreted with insulin. Hyperglycemia can also additionally lessen insulin secretion due to the fact excessive glucose tiers desensitize the beta cells. This reasons glucose toxicity with beta cell disorder, or each. Usually, years by skip those adjustments arise together with insulin resistance.
Health Issue
Diabetes is a critical public health problem that impacts human beings all around the world [8]. As the arena populace ages, the superiority of this continual complex metabolic infection will increase at an alarming rate. It could have the greatest impact on underdeveloped countries. Because diabetes is a continual, complex metabolic circumstance, a multidisciplinary crew of health specialists with the level of diabetes control must provide diabetes care to the affected person and family. Despite the truth that diabetes mellitus turned into currently given precedence popularity via way of means of the WHO (World Health Organization), many public health planners are still uninformed of its scope and its consequences. The growing occurrence of the circumstance and the long-time period expense of remedy for each sufferer and the health sector, in addition to the monetary price to nations, are all elements to consider. Adult occurrence costs starting from 7% to 25% was located in research carried out in numerous groups during the region. Furthermore, a developing wide variety of countries are reporting the emergence of type 2 diabetes mellitus at a younger age. The aim of incorporating diabetes mellitus into the number one health care is to increase recurring screening techniques to identify, monitor, and control diabetes’s common headaches. Treatment must simply consciousness now no longer handiest on reducing blood glucose tiers, however additionally on addressing different noncommunicable disease danger elements along with smoking, dyslipidemia, weight problems, inactivity, and high blood pressure. Not handiest is diabetes care in shambles, but so is our information on the strategies that underpin medical troubles related to the infection. The principal dreams in worrying for diabetic sufferers are to save you or as a minimum gradual improvement of medical complications including micro-vascular (eye and kidney disease) carried out thru blood sugar and blood strain manipulation, and macro-vascular (coronary, cerebrovascular, and peripheral vascular) carried out thru lipids, high blood pressure, and smoking manipulate. However, we do now no longer apprehend how accelerated blood glucose, circulating insulin, and modified blood strain affect the pathophysiology of blood arteries and motive critical organ failure.
As a result, withinside the loss of any such information foundation, modern remedy strategies consciousness on danger control. If we need to govern this circumstance properly, we want to begin tracking diabetes early and maintain it up thus far. The early detection of versions in blood glucose tiers is the inspiration for diabetic care. Effective remedy, especially for undetected hypoglycemia, calls for cautious and well-timed tracking. Blood glucose tiers are generally checked earlier than a meal, hours after, and earlier than bedtime. Although the improvement of blood glucose self-tracking in current many years has advocated diabetes remedy withinside the quest for euglycemia, its bulky use can also additionally bring about inadequate statistics series of blood glucose. The pattern, frequency, level, and timing of blood glucose adjustments have tracked the use of non-stop glucose tracking. Diabetes prognosis and control want precise, sensitive, consistent, quick, and attentive glucose tracking frequently. Diabetes can create diverse vascular and neurological troubles that affect more than one organ structure withinside a brief and long time if now no longer dealt with properly. Regular community-based screening and activating prognosis in undiagnosed sufferers, enough affected person training and help, non-stop scientific remedy, mental counseling, and societal help are all required to keep away from acute consequences. Accurate blood glucose tracking whilst improving glycaemic manipulation and affected person's excellent lifestyles is one of the maximum hard factors of diabetes mellitus remedy. Regular tracking via way of means of the medical doctor or the affected person is essential to maintain diabetes affected person’s health from worsening. These tips are supposed to resource withinside the standardization of diabetes remedy on the elementary, secondary, and tertiary tiers and advocate policymakers as a part of efforts to enhance health care. Above all, we need to all undertake to enhance diabetes mellitus prevention to lessen this growing burden.
Prevention
As the human and economic cost of type 2 diabetes has surged, the consciousness of its prevention has intensified [9]. Clinical trials throughout the globe have proven that diabetes may be avoided in excessive-danger populations over an extensive variety of cultures and ethnicities. Further, the discount in diabetes onset is located past the time of the interventions, albeit attenuated. Waning advantage post-intervention has been attributed to the loss of long-time period adherence to lifestyle adjustments or drug remedies. A change clarification, however, can be that loss of development to diabetes in preference to the recuperation of normoglycemia has been our aim. All of the landmark trials for diabetes prevention thus far have enrolled members with untreated prediabetes because of their tremendously excessive danger of obtaining diabetes. Even whilst overt diabetes is not on time or avoided, each micro- and macrovascular sicknesses seem greater frequent in people with prediabetes as compared to their normoglycemic peers. Thus, there may be a purpose to consider that authentic prevention of diabetes and its complications probable live withinside the reversal of prediabetes and the recuperation of normoglycemia. New proof helps this hypothesis and hints are converted accordingly. Nevertheless, there may be a good deal to be taken into consideration in figuring out the human beings at maximum danger for diabetes and figuring out whilst and a way to institute preventive measures.
Through the aggregate of recognized and rising danger elements, the global burden of type 2 diabetes keeps rising. National facts estimate more or less 29 million Americans - 9.3% of the populace - presently have diabetes, reflecting an approximate tripling in the superiority over the last 25 years. Even greater outstanding are the 415 million human beings around the arena with diabetes - quite a number this is anticipated to boom via way of means of greater than 50% via way of means of 2040. And even though those numbers encompass all diabetes, >90% have type 2. Fortunately, some medical trials have proven that early intervention can save you or postpone type 2 diabetes and more recent proof has proven that prevention of diabetes also can save you from microvascular complications.
Conclusion
Type 2 diabetes is reaching epidemic proportions worldwide. It typically occurs after the age of 40. Aging itself may increase susceptibility to glucose intolerance and diabetes. Although still rare, the significant increase in type 2 diabetes in children, possibly due to the increase in childhood obesity rates, is quite worrying. Obesity is very common in people with type 2 diabetes, so even moderate weight gain can increase susceptibility to diabetes.
References
- Lansang MC, Leslie RD, Chowdhury TA, Zhou K. Diabetes-Clinician's Desk Reference, Second Edition. CRC Press, Taylor and Francis Group, LLC, Boca Raton, USA. 2023; 34-35.
- Badawi A, Garcia-Bailo B, Arora P, Al Thani MH, Sadoun E, Farid M, et al. The Utility of Vitamins in the Prevention of Type 2 Diabetes Mellitus and Its Complications: A Public Health Perspective in Oguntibeju OO (ed). Diabetes Mellitus-Insights and Perspectives, InTech, Rijeka, Croatia. 2013; 1-2.
- Reisner E, Reisner H. Crowley's An Introduction To Human Disease-Pathology and Pathophysiology Correlations. Tenth Edition, Jones and Bartlett Learning, LLC, Burlington, USA. 2017; 595-596.
- Gomes KB. Proteomic Biomarkers: What They Are and How Type 2 Diabetes Mellitus Has Similarities with Other Diseases in Patel. VB Preedy VR (eds), Biomarkers in Diabetes, Springer Nature Switzerland AG, Cham, Switzerland. 2023; 313-314.
- Newton CRH. Diabetes-related emergencies in Mahadevan SV, Garmel GM (eds). An Introduction to Clinical Emergency Medicine, Cambridge University Press, Cambridge, UK. 2005; 226.
- Watkins PJ. ABC of Diabetes, Fifth Edition. BMJ Publishing Group Ltd, London, UK. 2003; 14-18.
- Moini J, Adams M, LoGalbo A. Complications of Diabetes Mellitus-A Global Perspective. CRC Press, Taylor and Francis Group, LLC, Boca Raton, USA. 2022; 5-6.
- Sadasivuni KK, Cabibihan JJ, Al-Ali AKAM, Malik RA. Preface in Sadasivuni KK, Cabibihan JJ, Al-Ali AKAM, Malik RA (eds). Advanced Bioscience and Biosystems for Detection and Management of Diabetes. Springer Nature Switzerland AG, Cham, Switzerland. 2022; 5-6.
- Perreault L. Prevention of Type 2 Diabetes in Reuch JEB, Regensteiner JG, Stewart KJ, Veves A (eds). Diabetes and Exercise-From Pathophysiology to Clinical Implementation. Second Edition, Humana Press, Springer International Publishing AG, Cham, Switzerland. 2018; 17.