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Dia­betes mel­li­tus type 2 (for­mer­ly non­in­sulin-depen­dent dia­betes mel­li­tus (NIDDM) or adult-onset dia­betes) is a meta­bol­ic dis­or­der that is char­ac­ter­ized by hyper­glycemia (high blood sug­ar) in the con­text of insulin resis­tance and rel­a­tive lack of insulin. This is in con­trast to dia­betes mel­li­tus type 1, in which there is an absolute lack of insulin due to break­down of islet cells in the pan­creas. The clas­sic symp­toms are excess thirst, fre­quent uri­na­tion, and con­stant hunger. Type 2 dia­betes makes up about 90% of cas­es of dia­betes, with the oth­er 10% due pri­mar­i­ly to dia­betes mel­li­tus type 1 and ges­ta­tion­al dia­betes. Obe­si­ty is thought to be the pri­ma­ry cause of type 2 dia­betes in peo­ple who are genet­i­cal­ly pre­dis­posed to the dis­ease (although this is not the case in peo­ple of East-Asian ances­try). Type 2 dia­betes is ini­tial­ly man­aged by increas­ing exer­cise and dietary changes. If blood sug­ar lev­els are not ade­quate­ly low­ered by these mea­sures, med­ica­tions such as met­formin or insulin may be need­ed. In those on insulin, there is typ­i­cal­ly the require­ment to rou­tine­ly check blood sug­ar lev­els. Rates of type 2 dia­betes have increased marked­ly since 1960 in par­al­lel with obe­si­ty. As of 2010 there were approx­i­mate­ly 285 mil­lion peo­ple diag­nosed with the dis­ease com­pared to around 30 mil­lion in 1985. Long-term com­pli­ca­tions from high blood sug­ar can include heart dis­ease, strokes, dia­bet­ic retinopa­thy where eye­sight is affect­ed, kid­ney fail­ure which may require dial­y­sis, and poor blood flow in the limbs lead­ing to ampu­ta­tions. The acute com­pli­ca­tion of ketoaci­do­sis, a fea­ture of type 1 dia­betes, is uncom­mon, how­ev­er hyper­os­mo­lar hyper­glycemic state may occur.