A 61-year-old man who has achieved great success in the areas of business and community influence is frustrated that he has received a diagnosis of type 2 diabetes. The man tells the nurse, "I'm not at all obese, so I don't see how this could have developed.”. When discussing the risk factors for diabetes, which of the following factors should the nurse identify? Select all that apply.

Choice A rationale Asthma is a chronic inflammatory airway disease and is not recognized as a direct independent risk factor for the development of type 2 diabetes. While some medications used to treat asthma, such as long-term systemic corticosteroids, can lead to secondary hyperglycemia or steroid-induced diabetes, the condition itself does not involve the metabolic pathways of insulin resistance. Therefore, a history of asthma would not be identified as a primary risk factor when discussing the etiology of diabetes with this client. Choice B rationale Advancing age is a significant non-modifiable risk factor for type 2 diabetes, with the risk increasing substantially after age 45. As individuals age, there is a natural decline in beta-cell function and a progressive increase in insulin resistance, often exacerbated by changes in body composition and decreased physical activity. Even in the absence of obesity, the physiological changes associated with aging make it difficult for the body to maintain glucose homeostasis, making this a relevant factor for the 61-year-old client. Choice C rationale Hypertension is frequently comorbid with type 2 diabetes and is a component of metabolic syndrome. Blood pressure readings ≥ 140/90 mm Hg are associated with a higher risk of developing insulin resistance. The relationship is bidirectional, as hyperinsulinemia can lead to sodium retention and sympathetic nervous system activation, further elevating blood pressure. Identifying hypertension as a risk factor helps the client understand that diabetes is often part of a broader spectrum of cardiovascular and metabolic dysfunction. Choice D rationale Family history remains one of the strongest predictors for the development of type 2 diabetes due to genetic predisposition. Genetic variations can affect insulin production, glucose sensing in the pancreas, and the sensitivity of peripheral tissues to insulin. Having a first-degree relative with the condition significantly increases an individual's lifetime risk. Discussing family history helps the client move past the misconception that obesity is the sole cause, highlighting the complex interplay between genetics and metabolic health. Choice E rationale A history of macrovascular disease, including angina or myocardial infarction, is strongly linked to the presence of underlying insulin resistance and metabolic dysfunction. Cardiovascular disease is often considered a "diabetes equivalent" because the atherosclerotic processes and endothelial dysfunction seen in these conditions are the same mechanisms that drive diabetic complications. The presence of existing heart disease indicates that the client's metabolic environment has been compromised for some time, eventually culminating in a formal diabetes diagnosis.