Type 2 diabetes mellitus
Also called: type 2 diabetes, T2DM, adult-onset diabetes, non-insulin dependent diabetes, sugar (diabetes)
Type 2 diabetes is a long-term condition in which the body does not use insulin properly, so sugar (glucose) builds up in the blood. It is the most common form of diabetes. Healthy eating, activity and medicines such as metformin help control it and protect the heart, kidneys, eyes and feet.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Type 2 diabetes mellitus is a lifelong condition in which the level of sugar (glucose) in the blood stays too high. Insulin is a hormone (chemical messenger) made by the pancreas, an organ behind the stomach. It moves glucose from the blood into the body's cells, where it is used for energy. In type 2 diabetes the cells stop responding properly to insulin (this is called insulin resistance). The pancreas makes more insulin to cope, but over time it cannot keep up and blood glucose rises.
More than 95 in every 100 people with diabetes have the type 2 form. It used to be called adult-onset diabetes because it mostly started after the age of 45, but it is now seen more and more in children, teenagers and young adults. Worldwide, the number of people living with diabetes rose from about 200 million in 1990 to about 830 million in 2022, and it is rising fastest in low- and middle-income countries.
Symptoms are often mild and can go unnoticed for years, so many people are only diagnosed after a complication (a problem caused by the disease) has already started. The good news is that type 2 diabetes can often be prevented or delayed, and once diagnosed it can be controlled with a healthy lifestyle and, when needed, medicines. Good control lowers the risk of heart attack, stroke, kidney failure, blindness and foot ulcers.
In Pakistan: what studies show
In Pakistan's 2016-2017 national diabetes survey, 26.3% of adults had diabetes and 14.4% had pre-diabetes, and 7.1% only found out because of the survey. A 2024 review of older studies gave a lower figure of 10.0%, so estimates differ.
- In a national survey of adults in all four provinces in 2016-2017, 26.3% had diabetes.[1] (national survey, data 2016-2017)
- In the same 2016-2017 national survey, 7.1% of adults had diabetes that had never been diagnosed before the survey tested them.[1] (national survey, data 2016-2017)
- The 2016-2017 national survey also found that 14.4% of adults had pre-diabetes (blood sugar higher than normal but not yet diabetes).[1] (national survey, data 2016-2017)
- Diabetes was a little more common in cities than in villages in the 2016-2017 national survey: 28.3% in urban areas and 25.3% in rural areas.[1] (national survey, data 2016-2017)
- A 2024 review that pooled 17 Pakistani studies done between 1995 and 2018 estimated that 10.0% of people had type 2 diabetes and 11.0% had pre-diabetes.[2] (systematic review/meta-analysis, data 1995-2018 (studies included))
- A 2024 review of 45 Pakistani studies found that in different studies between 44.7% and 86.4% of people with type 2 diabetes had poorly controlled blood sugar.[3] (scoping review of observational studies, data not stated (studies published 2000-2024))
- The same 2024 review found that eye damage from diabetes (retinopathy) was reported in between 14.5% and 43.0% of patients in different Pakistani studies.[3] (scoping review of observational studies, data not stated (studies published 2000-2024))
- A 2022 review that pooled 12 Pakistani studies of 14,201 people with diabetes found that 12.16% had a foot ulcer.[4] (systematic review/meta-analysis, data studies published 1999-2022)
Pakistan guidance: Adult diabetes mellitus management guidelines for a Pakistani context (adapted from the American Diabetes Association Standards of Medical Care 2021, abridged for primary care; screening age lowered from 45 to 30 years) (Aga Khan University, Karachi (Center for Clinical Best Practices and Section of Endocrinology), 2023)[5]
What we do not know yet: The only national survey (NDSP) is from 2016-2017, and its 26.3% is much higher than the 10.0% from a 2024 review that pooled older studies (1995-2018), so the true current figure is uncertain. Data on blood sugar control and complications come mostly from single hospitals, and an IDF Diabetes Atlas country page could not be opened for this file.
Pakistan studies cited
- Basit A, Fawwad A, Qureshi H, et al. Prevalence of diabetes, pre-diabetes and associated risk factors: second National Diabetes Survey of Pakistan (NDSP), 2016-2017. BMJ Open 2018;8(8):e020961. Open source
- Hasan SU, Siddiqui R Nationwide prevalence of type 2 diabetes mellitus and pre-diabetes in Pakistan: A systematic review and meta-analysis. Diabetes Research and Clinical Practice 2024;216:111815. doi:10.1016/j.diabres.2024.111815. Open source
- Taimur H, Ahmad I, Khan H, et al. Type 2 diabetes in Pakistan: a scoping review of glycemic control, awareness, treatment adherence, complications and cost (title paraphrased; check exact wording via DOI). Frontiers in Endocrinology 2024;15:1441591. doi:10.3389/fendo.2024.1441591. Open source
- Akhtar S, Ali A, Ahmad S, et al. The prevalence of foot ulcers in diabetic patients in Pakistan: A systematic review and meta-analysis. Frontiers in Public Health 2022;10:1017201. doi:10.3389/fpubh.2022.1017201. Open source
- Martins RS, Masood MQ, Mahmud O, et al. Adolopment of adult diabetes mellitus management guidelines for a Pakistani context: Methodology and challenges. Frontiers in Endocrinology 2023;13:1081361. doi:10.3389/fendo.2022.1081361. Open source
Symptoms
- Feeling very thirsty and drinking more than usual
- Passing urine more often, including at night
- Feeling hungrier than usual
- Tiredness and lack of energy
- Blurred vision
- Losing weight without trying
- Cuts, sores or infections (skin, bladder, gums) that heal slowly or keep coming back
- Numbness, tingling or pain in the hands or feet
- No symptoms at all: many people feel well and are found on a routine blood test
Causes and risk factors
Causes
- Insulin resistance: fat, liver and muscle cells stop responding properly to insulin, so glucose stays in the blood
- The pancreas gradually makes less insulin than the body needs
- Carrying extra weight, especially around the waist, which makes insulin resistance worse
- Too little physical activity
- Genes and family history: the condition runs in families
What makes it more likely
- Being overweight or obese
- Age 45 or older (but younger people can get it too)
- A parent, brother or sister with type 2 diabetes
- Physical activity less than three times a week
- Prediabetes (blood glucose above normal but below the diabetes level)
- Diabetes during pregnancy (gestational diabetes) or giving birth to a very large baby
- High blood pressure, heart disease, stroke, polycystic ovary syndrome or fatty liver disease
- South Asian and some other ethnic backgrounds carry a higher risk
- Low HDL (good) cholesterol and high triglycerides (a type of blood fat)
Complications
High blood glucose over many years damages blood vessels and nerves. This raises the risk of heart attack, stroke and poor blood flow to the legs. Damage to the small blood vessels at the back of the eye (retinopathy) can cause permanent loss of sight, and cataracts are more common. Kidney damage (nephropathy) can progress to kidney failure needing dialysis. Nerve damage (neuropathy) causes pain, tingling or numbness in the feet, as well as stomach, bladder and erection problems. Numb feet and poor circulation together lead to foot ulcers and infections that heal slowly and can end in amputation. People with diabetes also get more infections, including serious skin and fungal infections, and gum disease. Very high or very low blood glucose can both become emergencies.
When to see a doctor
- Chest pain or pressure, or sudden shortness of breath: call emergency services
- Fainting, confusion, fits (seizures) or being hard to wake up: this may be dangerously high or low blood glucose
- Very high blood glucose with vomiting, stomach pain, fast breathing or a fruity smell on the breath
- Signs of low blood glucose (shaking, sweating, racing heart, confusion) that do not get better after taking sugar
- A red, hot, painful area of skin that is spreading quickly
- A new foot sore, blister or wound, or a foot that is red, swollen or smells bad
- Sudden change in vision
Diagnosis
Type 2 diabetes is diagnosed with simple blood tests, which are cheap and widely available. The HbA1c test shows the average blood glucose over the past two to three months and does not need fasting; a result of 6.5% or higher points to diabetes. A fasting glucose test is taken after not eating for at least 8 hours; a level of 7.0 mmol/L or higher on two separate days confirms diabetes. An oral glucose tolerance test measures glucose two hours after a sugary drink. If a person has clear symptoms, a random blood glucose test can be done at any time without waiting. Results from a pharmacy or health camp should always be confirmed at a clinic.
Because symptoms are often absent, adults who are overweight or have other risk factors should be tested regularly, and all adults from around the age of 35 are advised to be checked every three years. Once diabetes is diagnosed, routine checks follow: HbA1c every three to six months, blood pressure and cholesterol, a yearly urine and blood test for the kidneys, a yearly eye examination and a yearly foot check. People taking metformin may also need their vitamin B12 level checked.
Treatment
- Learn about the condition: structured diabetes education, a personal eating plan, regular physical activity, weight loss if overweight and stopping tobacco are the foundation of treatment and continue even when medicines are added.
- Start glucose-lowering medicine: for most adults the first choice is metformin combined with an SGLT2 inhibitor, which also protects the heart and kidneys. If metformin cannot be used, an SGLT2 inhibitor alone is offered.
- Tailor medicines to other conditions: people with heart disease, heart failure, kidney disease or obesity may be offered a GLP-1 receptor agonist as well; those with reduced kidney function or frailty may be given a DPP-4 inhibitor instead; pioglitazone or sulfonylureas are options when these are unsuitable.
- Add insulin when needed: insulin is used if symptoms are severe, blood glucose is very high, or there is weight loss, and also when other medicines are no longer enough. A GLP-1 receptor agonist is usually tried before insulin, and a basal (once-daily background) insulin such as NPH or a long-acting analogue is the usual first insulin. Your doctor decides the dose.
- Protect the heart and kidneys: most people also need blood pressure medicine and a statin to lower cholesterol, and antiplatelet medicine if they already have heart or blood vessel disease.
- Review regularly: the treatment plan is reviewed every three to six months and changed without delay if targets are not met; medicines that cause low blood glucose or side effects are reduced first when treatment is simplified.
- Screen for complications every year (eyes, kidneys, feet, gums) and treat problems such as painful neuropathy, foot ulcers or erectile dysfunction early.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Biguanides | first-choice tablet for most people; does not cause low blood glucose, is weight-neutral and inexpensive; may upset the stomach at first | Metformin (152 brands) |
| SGLT2 inhibitors | given with metformin as first-line treatment for most adults; also protect the heart and kidneys; combination tablets with metformin are available | Dapagliflozin (14 brands), Empagliflozin (162 brands), Canagliflozin (7 brands), Dapagliflozin + Metformin (8 brands), Empagliflozin + Metformin (139 brands) |
| DPP-4 inhibitors (gliptins) | option when kidney function is low or in frail people, or when other drugs are unsuitable; lower glucose only modestly | Vildagliptin (5 brands), Vildagliptin + Metformin (4 brands), Sitagliptin + Metformin (8 brands) |
| Sulfonylureas | older, low-cost tablets used when other options are unsuitable; can cause low blood glucose and weight gain, so used with care | Gliclazide (61 brands), Glimepiride (4 brands), Glibenclamide (8 brands), Glimepiride + Metformin (4 brands), Glibenclamide + Metformin (4 brands) |
| Insulins | injected when glucose is very high, symptoms are severe or other medicines are not enough; a once-daily basal insulin is usually started first, with mealtime or premixed insulin added later if needed | Human insulin (isophane/NPH) (12 brands), Insulin glargine (19 brands), Insulin degludec (2 brands), Insulin detemir (rDNA) (2 brands), Regular human insulin (12 brands), Insulin lispro (3 brands), Human insulin premix 30/70 (30% regular + 70% NPH) (3 brands) |
| Statins and blood pressure medicines | lower the risk of heart attack and stroke; most people with type 2 diabetes need them alongside glucose-lowering treatment | Atorvastatin (86 brands), Rosuvastatin (6 brands), Simvastatin (121 brands), Lisinopril (21 brands), Losartan (129 brands) |
Also used (not yet in our price list): Semaglutide (GLP-1 receptor agonist), Liraglutide (GLP-1 receptor agonist), Dulaglutide (GLP-1 receptor agonist), Tirzepatide (dual GIP/GLP-1 receptor agonist), Pioglitazone (thiazolidinedione), Sitagliptin (DPP-4 inhibitor, single-ingredient)
Self-care and prevention
Self-care
- Follow a balanced eating plan agreed with your doctor or dietitian; limit sugary drinks, sweets and fried or fatty food and watch portion sizes
- Be active for at least 150 minutes a week (for example brisk walking) and sit less
- Lose weight if you are overweight; even modest weight loss improves blood glucose
- Check your blood glucose as often as your doctor advises and keep a record for your visits
- Take your medicines every day as prescribed and ask what to do on days when you are ill or cannot eat (sick day rules)
- Check your feet every day for cuts, blisters or redness, keep them clean and dry, and wear comfortable closed shoes
- Do not smoke or use tobacco in any form
- Learn the signs of low blood glucose and keep a sugary snack or glucose with you if you take insulin or sulfonylureas
- Attend your yearly eye, kidney, foot and dental checks and keep vaccinations up to date
Prevention
- Reach and keep a healthy body weight
- Do at least 150 minutes of moderate physical activity each week
- Eat a healthy diet with less sugar and saturated fat
- Avoid tobacco
- If you have prediabetes or had diabetes in pregnancy, get your blood glucose checked regularly; lifestyle changes at this stage can delay or prevent diabetes
Common questions
Can type 2 diabetes be cured?
There is no cure, but it can be well controlled. Some people who lose a lot of weight are able to stop their diabetes medicines and keep normal glucose levels, which doctors call remission. The condition can return, so regular checks continue.
Will I have to take insulin?
Not everyone does. Many people manage for years with healthy eating, activity and tablets. Insulin is started when glucose is very high, symptoms are severe, or other medicines are no longer enough. Needing insulin is not a failure; it is a normal step for some people.
What is the difference between type 1 and type 2 diabetes?
In type 1 the pancreas makes little or no insulin, so insulin injections are needed from the start. In type 2 the body makes insulin but cannot use it properly. Type 2 is far more common, develops slowly and is strongly linked to weight, inactivity and family history.
What is a normal HbA1c and how often should it be checked?
HbA1c shows your average glucose over about three months. Your doctor will set a personal target for you; a level of 6.5% or higher is used to diagnose diabetes. It is usually checked every three to six months, more often when treatment is being changed.
Can children get type 2 diabetes?
Yes. It used to be rare in children, but it is now seen more often in children and teenagers, usually those who are overweight and have a family history. The same lifestyle advice applies, and treatment is guided by a doctor.
Sources
- WHO fact sheet. Diabetes (2024).
- NICE. Initial medicines (Type 2 diabetes in adults: management, NG28) (2026).
- NICE. Person-centred medicine (Type 2 diabetes in adults: management, NG28) (2026).
- American Diabetes Association (Diabetes Care, via PubMed Central). 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2026 (2026).
- MedlinePlus. Type 2 Diabetes | Diabetes Type 2 | MedlinePlus (2026).
- MedlinePlus. Type 2 diabetes: MedlinePlus Medical Encyclopedia (2025).
- CDC. Type 2 Diabetes | Diabetes | CDC (2024).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.