Type 2 diabetes: All you need to know

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Last Updated on September 4, 2023 by Team THIP

Type 2 diabetes is a growing global health concern with substantial implications for both individuals and societies. It is a severe metabolic disorder that occurs when the body’s ability to manage blood sugar levels is compromised. This results in elevated glucose levels. 

The prevalence of type 2 diabetes has surged over the past few decades due to factors such as sedentary lifestyles, poor dietary choices, and genetic predisposition. Its impact extends beyond physical health, contributing to various complications like cardiovascular disease, kidney dysfunction, and neuropathy. Given its prevalence and associated complications, understanding the underlying mechanisms and effective management strategies is of paramount significance.

Type 2 diabetes is characterized by chronic hyperglycemia which is an excessive amount of glucose circulating in the blood plasma. This results from insulin resistance and improper insulin secretion leading to elevated blood sugar levels. The complexity of its pathogenesis involves intricate interactions between genetic, environmental, and lifestyle factors.

What is the difference between type 1 and type 2 diabetes?

Type 1 diabetes and type 2 diabetes share the common feature of elevated blood sugar levels. But they arise from distinct causal factors. Type 1 diabetes is an autoimmune condition wherein the body’s immune system attacks and destroys insulin-producing beta cells in the pancreas. This results in an absolute deficiency of insulin and requires lifelong insulin replacement therapy. In contrast, type 2 diabetes typically develops later in life and is characterized by insulin resistance, where the body’s cells become less responsive to insulin. Additionally, there is often impaired insulin secretion over time. While both types of diabetes require careful management, they necessitate different approaches due to their differing causes and underlying mechanisms.

What is the prevalence of type 2 diabetes?

Type 2 diabetes has reached epidemic proportions globally, making it one of the most pressing public health challenges of our time. Its prevalence has increased due to lifestyle changes, urbanization, and an ageing population. According to research published in Science Direct Journal, an estimated 463 million adults were living with diabetes in 2019, and approximately 90% of these cases were type 2 diabetes. This number is projected to escalate further if current trends persist, with predictions of over 700 million adults with diabetes by 2045.

The prevalence of type 2 diabetes exhibits significant regional variations. It is more prevalent in low- and middle-income countries, where rapid urbanization and shifts in dietary habits have led to a higher burden of obesity and sedentary lifestyles. Conversely, even in high-income countries, the prevalence remains substantial due to the pervasive nature of unhealthy lifestyles.

What are the implications of increasing type 2 diabetes cases?

The escalating prevalence of type 2 diabetes has far-reaching socioeconomic and health system implications that pose challenges at both individual and societal levels.

  • Healthcare costs: The economic burden of type 2 diabetes is substantial, driven by the costs of medical care, medications, and management of diabetes-related complications. This burden is shouldered not only by individuals but also by healthcare systems and governments. The costs extend beyond direct medical expenses to include indirect costs, such as lost productivity and disability.
  • Impact on quality of life: Individuals living with type 2 diabetes face a reduced quality of life due to the physical, psychological, and social challenges posed by the condition and its complications. The need for continuous self-management, dietary restrictions, and the risk of complications like cardiovascular disease, neuropathy, and retinopathy contribute to a diminished quality of life.
  • Health disparities: Socioeconomic factors play a significant role in the prevalence and management of type 2 diabetes. Vulnerable populations, including those with limited access to healthcare, lower socioeconomic status, and educational disparities, are at a higher risk of developing the condition and experiencing worse outcomes. Addressing health disparities is crucial for equitable diabetes prevention and management.
  • Healthcare systems strain: The increasing prevalence of type 2 diabetes places immense pressure on healthcare systems worldwide. The demand for diabetes-related care, including regular monitoring, medication, and specialized interventions, strains healthcare resources and facilities. Integrated and multidisciplinary approaches are required to effectively manage the growing burden.

What are the causes of type 2 diabetes?

Various factors contribute to the development of type 2 diabetes. They include genetic predisposition, family history, ethnicity, and age-related risk factors.

Genetic factors and susceptibility: Genetic factors play a significant role in causing type 2 diabetes. Evidence has shown a hereditary component, indicating that individuals with a family history of diabetes are at an increased risk of developing the condition. Specific genetic variants have been identified that influence susceptibility to type 2 diabetes by affecting insulin secretion, insulin sensitivity, and other metabolic pathways.

Many of these genetic variants are associated with beta-cell dysfunction and insulin resistance, both of which are central to the development of type 2 diabetes. However, it is important to understand that genetic predisposition alone is not sufficient to cause diabetes. Environmental factors, including lifestyle choices, also contribute significantly.

Role of family history and ethnicity: Having a family history of type 2 diabetes is a well-established risk factor for the condition. Individuals with a first-degree relative (parent or sibling) who has diabetes are at a higher risk of developing diabetes themselves. This suggests a complex interplay between genetic susceptibility and shared environmental factors within families.

Moreover, ethnicity plays a role in diabetes risk. Certain ethnic groups, such as African Americans, Hispanic Americans, Native Americans, and South Asians, have a higher predisposition to type 2 diabetes. This could be attributed to a combination of genetic factors, cultural practices, dietary habits, and social determinants of health that vary across different ethnic populations.

What are the risk factors of type 2 diabetes?

The risk factors encompass environmental influences, lifestyle choices, obesity-related considerations, and demographic characteristics.

Age as a risk factor: Age is a significant risk factor for type 2 diabetes. While the condition can develop at any age, the risk increases with advancing age. This is partly due to changes in body composition, reduced physical activity, and declining insulin sensitivity that often accompanies ageing. As individuals grow older, the pancreas may also become less efficient at producing insulin, further contributing to the development of diabetes.

Type 2 diabetes was historically referred to as adult-onset diabetes due to its prevalence in older individuals. However, with the rise of childhood obesity and sedentary lifestyles, there has been an alarming increase in the diagnosis of type 2 diabetes in children and adolescents as well, prompting a shift in terminology.

Environmental contributors: Environmental factors play a crucial role in the development of type 2 diabetes. Modern lifestyles characterized by easy access to high-calorie, low-nutrient foods, as well as sedentary behaviours, contribute significantly to the rising prevalence of the condition. An environment that promotes unhealthy dietary patterns, such as excessive consumption of sugary beverages and processed foods, increases the risk of obesity and insulin resistance, key factors in the development of type 2 diabetes.

Obesity and metabolic syndrome: Obesity is a major risk factor for type 2 diabetes. Excess adipose tissue, especially abdominal or visceral fat, contributes to insulin resistance, where cells become less responsive to insulin’s actions. This forces the pancreas to produce more insulin to regulate blood sugar levels, eventually leading to beta-cell exhaustion and impaired glucose control. Metabolic syndrome, characterized by a cluster of conditions including obesity, high blood pressure, abnormal lipid profiles, and elevated blood sugar, further amplifies the risk of type 2 diabetes.

Sedentary lifestyle and physical inactivity: A sedentary lifestyle and lack of physical activity are key contributors to the development of type 2 diabetes. Regular physical activity helps improve insulin sensitivity, supports weight management, and enhances overall metabolic health. Conversely, a sedentary lifestyle promotes weight gain, disrupts glucose regulation, and increases the risk of metabolic dysfunction.

Gender, ethnic predisposition, and gestational diabetes: Certain demographic factors also influence the risk of developing type 2 diabetes. Gender plays a role, with men generally having a higher risk than women. However, the risk converges among older age groups. Moreover, specific ethnic groups, such as African Americans, Hispanic Americans, Native Americans, and certain Asian populations, have a heightened predisposition to type 2 diabetes due to a combination of genetic susceptibility and cultural/environmental factors.

Gestational diabetes, a form of diabetes that develops during pregnancy, is another risk factor. Women who experience gestational diabetes are at an increased risk of developing type 2 diabetes later in life. This risk extends to their children as well, highlighting the intergenerational impact of diabetes risk.

What causes type 2 diabetes?

The intricate pathophysiological mechanisms underlying type 2 diabetes include insulin resistance, beta-cell dysfunction, chronic inflammation, and oxidative stress.

Insulin resistance: Insulin resistance is a hallmark of type 2 diabetes, characterized by a diminished response of target tissues (such as muscle, liver, and adipose tissue) to the actions of insulin. This resistance disrupts the body’s ability to regulate glucose uptake and utilization, leading to elevated blood sugar levels. Adipose tissue, especially visceral fat, secretes adipokines and cytokines that contribute to insulin resistance. This condition forces the pancreas to produce higher levels of insulin to compensate, leading to eventual beta-cell exhaustion and impaired glucose regulation.

Beta-cell dysfunction and impaired insulin secretion: Beta-cell dysfunction is a crucial component of type 2 diabetes progression. Over time, high demand for insulin due to insulin resistance can lead to beta-cell dysfunction and reduced insulin secretion. Additionally, chronic exposure to elevated blood glucose levels can impair beta-cell function and survival. As a result, the pancreas becomes less capable of responding adequately to changes in blood sugar levels, further increasing hyperglycemia.

Chronic low-grade inflammation in diabetes: Inflammation is like the body’s way of responding to problems, like when you get a cut and your skin turns red and swollen. But in some cases, like with type 2 diabetes, there’s a kind of inflammation that doesn’t go away easily. This long-lasting inflammation is a big part of why diabetes gets worse. It happens because the fat in the body releases chemicals that cause trouble. These chemicals make it hard for a hormone called insulin to do its job properly, and that leads to problems with sugar in the blood. This inflammation also makes the body release things that stop insulin from working well. Additionally, this inflammation messes up how different cells in a specific part of the body work together, and this can cause some of the cells to not work right and even die.

Oxidative stress and cellular damage: Oxidative stress is like a kind of trouble in the body. It happens when there’s an upset in the balance between something called reactive oxygen species (which are like tiny troublemakers) and antioxidants (which are like helpers that fix things). This trouble can damage cells in type 2 diabetes.

When there’s a lot of sugar and fatty stuff in the body, it causes this trouble to happen. This trouble can hurt different parts of the body, like the pancreas, blood vessels, and nerves. It also makes it hard for insulin to work and causes more inflammation, which makes diabetes even worse.

What are the symptoms of type 2 diabetes?

The clinical presentation of type 2 diabetes can vary widely. However, there are several common symptoms that individuals may experience. These include excessive thirst (polydipsia), frequent urination (polyuria), unexplained weight loss, fatigue, and increased hunger (polyphagia). However, some individuals with type 2 diabetes may remain asymptomatic for a significant period, leading to delayed diagnosis.

Diagnostic criteria for type 2 diabetes involve measuring fasting plasma glucose levels, oral glucose tolerance tests, and HbA1c levels. The American Diabetes Association (ADA) defines diabetes as fasting plasma glucose levels ≥ 126 mg/dL (7.0 mmol/L), a two-hour plasma glucose level ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test, or an HbA1c level ≥ 6.5%. These criteria help identify individuals who require intervention to manage their blood sugar levels.

Cardiovascular Disease: Type 2 diabetes is associated with an increased risk of cardiovascular disease. Individuals with diabetes are more likely to develop atherosclerosis, which can lead to conditions such as coronary artery disease, heart attacks, strokes, and peripheral artery disease. Chronic hyperglycemia, insulin resistance, inflammation, and dyslipidemia contribute to the development and progression of these cardiovascular complications.

Retinopathy, Nephropathy, Neuropathy: Type 2 diabetes can affect small blood vessels and can impact various organs. Diabetic retinopathy, a leading cause of blindness, results from damage to the blood vessels in the retina. Diabetic nephropathy involves kidney damage due to altered blood flow and inflammation, potentially leading to kidney failure. Diabetic neuropathy refers to nerve damage that can lead to sensory and motor deficits, affecting limbs and organs. All of these complications are influenced by prolonged exposure to elevated blood sugar levels, and they emphasize the importance of glycemic control.

Diabetic Foot and Ulcerations: Diabetic foot complications are a result of a combination of neuropathy, peripheral arterial disease, and impaired wound healing. Neuropathy reduces sensation in the feet, making it difficult to detect injuries or infections. Peripheral arterial disease limits blood flow to the feet, hampering wound healing. Together, these factors can lead to foot ulcers, infections, and, in severe cases, amputations. Regular foot care and vigilant monitoring are crucial to prevent these complications.

What are some diagnostic tools and screening for type 2 diabetes?

Type 2 diabetes is a long-lasting problem with how your body processes food for energy. Sometimes, type 2 diabetes is tricky because it does not show significant signs. This is why finding it early and checking regularly is really important. Because of better medical knowledge, there are many tools that doctors have to figure out if someone might get this type of diabetes or already have it.

Fasting Plasma Glucose Test: The fasting plasma glucose (FPG) test is a common diagnostic tool used to assess an individual’s blood sugar level after an overnight fast. A blood sample is taken in the morning before consuming any food or drinks. A fasting glucose level of 126 milligrams per deciliter (mg/dL) or higher is indicative of diabetes. This test helps identify individuals with impaired fasting glucose (pre-diabetes) or overt diabetes. It provides a snapshot of blood sugar control at a specific point in time and is particularly useful for individuals who may be asymptomatic.

Oral Glucose Tolerance Test: The oral glucose tolerance test (OGTT) involves consuming a sugary beverage after an overnight fast, followed by blood sugar level measurements at intervals. This test provides information about how the body processes glucose over time. A two-hour plasma glucose level of 200 mg/dL or higher during the OGTT indicates diabetes. The OGTT is useful for diagnosing diabetes in situations where fasting glucose levels may not be conclusive, as well as for identifying impaired glucose tolerance, another precursor to diabetes.

Haemoglobin A1c Measurement: Hemoglobin A1c (HbA1c) measurement offers insight into average blood sugar levels over the past two to three months. Glucose molecules bind to haemoglobin in red blood cells, and the level of HbA1c reflects the extent of this binding. An HbA1c level of 6.5% or higher is indicative of diabetes. This test is valuable because it doesn’t require fasting and provides a longer-term picture of blood sugar control. It’s particularly beneficial for individuals who may find fasting tests challenging or for whom frequent testing is impractical.

Importance of early detection and regular screening: Early detection of type 2 diabetes is crucial for several reasons. Firstly, it allows for prompt initiation of management strategies, which can significantly delay or prevent the onset of complications. Secondly, early intervention can help individuals adopt lifestyle changes that improve their blood sugar control, reducing the need for medications and enhancing overall well-being.

Regular screening is equally important, especially for individuals with risk factors such as obesity, a family history of diabetes, or a sedentary lifestyle. Routine screening helps identify pre-diabetes or early stages of diabetes, enabling timely interventions that can prevent or mitigate its progression.

How to manage type 2 diabetes?

Effectively managing type 2 diabetes requires a multifaceted approach that addresses various aspects of the condition, including blood sugar control, lifestyle modifications, and individualized treatment plans. In this answer, we will explore the key management strategies for type 2 diabetes.

Diet and exercise: Lifestyle modifications are the cornerstone of type 2 diabetes management. Dietary changes play a critical role in regulating blood sugar levels. 

Regular physical activity is equally important. Exercise improves insulin sensitivity, aids weight management, and enhances cardiovascular health. 

Medications for glycemic control: When lifestyle modifications alone are insufficient to manage blood sugar levels, medications may be prescribed. Several classes of medications are available, each targeting different aspects of glucose regulation.

  • Metformin and sulfonylureas: Metformin is often the first-line medication for type 2 diabetes. It improves insulin sensitivity and reduces glucose production by the liver. Sulfonylureas stimulate insulin secretion from the pancreas. These medications can be effective in lowering blood sugar levels, but they can have side effects such as hypoglycemia and weight gain.
  • Insulin therapy: Insulin therapy is essential for individuals with advanced type 2 diabetes or when other medications fail to maintain adequate blood sugar control. It helps regulate blood sugar levels by providing the body with the insulin it lacks. Insulin therapy may involve multiple injections or the use of insulin pumps. Regular monitoring and careful dosing adjustments are crucial to preventing hypoglycemia and optimizing glycemic control.
  • GLP-1 receptor agonists: GLP-1 receptor agonists are injectable medications that mimic the action of GLP-1, a hormone that enhances insulin secretion, slows down digestion, and reduces appetite. These medications can promote weight loss, improve blood sugar control, and have cardiovascular benefits.
  • SGLT-2 inhibitors: SGLT-2 inhibitors work by blocking the reabsorption of glucose by the kidneys, leading to increased glucose excretion in urine. They also have beneficial effects on blood pressure and weight. These medications are particularly useful for individuals with heart and kidney disease.

Patient-centred approach to treatment selection: Choosing the most appropriate treatment strategy should be a collaborative effort between healthcare providers and patients. Each individual’s unique characteristics, preferences, lifestyle, and medical history should be considered. A patient-centered approach involves discussing the benefits, risks, and potential side effects of various treatment options with the patient, allowing them to make informed decisions about their diabetes management.

How to prevent type 2 diabetes?

While you might not be able to change your genetics, you can certainly make lifestyle changes that may reduce your risk of developing type 2 diabetes. Preventing type 2 diabetes is a critical public health goal that requires a multifaceted approach encompassing both individual and community-based interventions. 

Primary prevention approaches: Prevention of type 2 diabetes begins with addressing the underlying risk factors that contribute to its development. Primordial prevention focuses on avoiding the emergence of risk factors in the first place. This involves promoting healthy lifestyles from childhood, discouraging tobacco use, promoting a balanced diet, and encouraging physical activity. Primary prevention targets individuals with prediabetes or at high risk for developing diabetes. Lifestyle interventions, such as adopting a healthier diet and increasing physical activity, play a pivotal role in reducing the progression to full-blown diabetes.

Community interventions and health promotion: Community-wide interventions have a profound impact on preventing type 2 diabetes. Collaborative efforts involving schools, workplaces, local governments, and healthcare providers are essential. Health promotion campaigns that raise awareness about the importance of healthy lifestyles, access to nutritious foods, and opportunities for physical activity can influence behaviour change on a larger scale. Creating environments that encourage healthy choices, such as establishing walking paths and promoting farmers’ markets, can have a positive impact on the overall health of communities.

Screening and early intervention for high-risk individuals: Screening high-risk individuals is a key strategy for early detection and intervention. Identifying individuals with prediabetes or other risk factors allows for timely interventions that can prevent or delay the onset of diabetes. Healthcare providers play a critical role in assessing risk factors, conducting screening tests, and implementing appropriate interventions. Lifestyle interventions, such as structured education programs, can effectively promote healthy behaviours, encourage weight loss, and improve glucose control in high-risk individuals.

FAQ on Type 2 Diabetes

Can type 2 diabetes affect existing kidney diseases?

It may. Type 2 diabetes can lead to diabetic kidney disease, damaging the kidneys’ blood vessels and function due to high blood sugar and associated factors like high blood pressure and inflammation. Regular monitoring and managing blood sugar and related factors are essential to prevent or slow this complication.

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Can type 2 diabetes affect liver diseases?

It may. Type 2 diabetes can lead to a condition called nonalcoholic fatty liver disease (NAFLD), characterised by excess fat in the liver cells due to insulin resistance and metabolic factors. NAFLD can range from a mild accumulation of fat (NAFL) to inflammation and liver cell damage (NASH), which may progress to severe liver conditions. Managing diabetes and adopting a healthy lifestyle can help prevent and manage NAFLD.

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

Can type 2 diabetes be a sign of weak bones?

Not exactly. Type 2 diabetes is linked to a higher risk of bone health problems, but it doesn’t directly indicate weak bones. Factors like insulin resistance, inflammation, certain medications, obesity, vitamin D deficiency, hormonal changes, and elevated blood sugar levels can contribute to bone health issues in people with type 2 diabetes. Taking steps to manage these factors can help support bone health.

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

Can type 2 diabetes cause heart problems?

It can. Type 2 diabetes can increase the risk of heart problems by promoting artery plaque buildup (atherosclerosis). This can result in high blood pressure, disrupting lipid levels, triggering inflammation, damaging small blood vessels, affecting nerve control of the heart, increasing blood clotting, and contributing to heart failure. Managing diabetes through lifestyle changes and medical care can help mitigate these risks.

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

Does high cholesterol cause type 2 diabetes?

Not exactly. High cholesterol doesn’t directly cause type 2 diabetes, but it can increase the risk due to its connection with insulin resistance and related factors like obesity and metabolic syndrome.

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

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Last Updated on September 4, 2023 by Team THIP

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

Last Updated on September 4, 2023 by Team THIP

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

Last Updated on September 4, 2023 by Team THIP

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

Last Updated on September 4, 2023 by Team THIP

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

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Last Updated on September 4, 2023 by Team THIP

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

Last Updated on September 4, 2023 by Team THIP

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

Last Updated on September 4, 2023 by Team THIP

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

Last Updated on September 4, 2023 by Team THIP

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.

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