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Measures such as diet and weight loss that reduce the demand for insulin may delay or reverse the metabolic abnormality, but beta cell failure is typically progressive, with declining insulin production and increasing reliance on medication.Lifestyle change is the mainstay of treatment, backed by a range of oral therapies, although patients frequently progress to insulin.
It therefore lacks a precise definition, and its clinical features vary widely within and between populations.
It is best considered as a syndrome rather than a disease.
If one member of a twin pair develops diabetes, however, the risk of diabetes in the unaffected twin is much greater in monozygotic (identical) than in dizygotic (non-identical) twin pairs, underlining the importance of the genetic contribution.
The extent to which the genes conferring susceptibility to type 2 diabetes will be expressed depends upon environmental factors such as obesity.
Type 2 diabetes has achieved pandemic proportions and affects some 300 million people worldwide.
It arises because insulin production is inadequate relative to the demands of the body, which may be increased by obesity or other factors.
Its prevalence is particularly striking in societies that have made a rapid transition from a traditional to an affluent lifestyle, a process sometimes referred to as 'Coca-Colonisation'.
The rapid development of diabetes in previously undernourished populations gave birth to the 'thrifty gene' hypothesis, which postulated that genes predisposing to diabetes are helpful when food is in short supply.
Attractive though the hypothesis undoubtedly is, this has never been confirmed.
Major risk factors for type 2 diabetes other than obesity are family history, age and ethnicity.