Diabetes mellitus (DM) is a chronic metabolic disorder characterized by elevated blood glucose levels resulting from either insufficient insulin production by the pancreas or an impaired response to insulin by the body’s cells. The condition significantly impacts the metabolism of carbohydrates, fats, and proteins, leading to various long-term complications (Diabetes – WHO).
The prevalence of diabetes worldwide has exceeded 800 million adults, quadrupling since 1990, according to a study in The Lancet by the NCD Risk Factor Collaboration with WHO support. The global diabetes prevalence among adults rose from 7% to 14% between 1990 and 2022, with the largest increases and treatment gaps occurring in low- and middle-income countries (LMICs).
Nearly 450 million adults with diabetes remained untreated in 2022, 90% of whom live in LMICs. Regions like South-East Asia, Eastern Mediterranean, and Africa face the lowest treatment coverage, with fewer than 40% of adults receiving medication.
Urgent action needed as global diabetes cases increase four-fold over past decades – WHO
Table of contents
Types of Diabetes
There are three main types of diabetes:
- Type 1 Diabetes: An autoimmune condition where the immune system attacks insulin-producing beta cells in the pancreas. This results in little to no insulin production, necessitating lifelong insulin therapy.
- Type 2 Diabetes: A condition characterized by insulin resistance and relative insulin deficiency. It is often associated with obesity, sedentary lifestyles, and genetic predisposition.
- Gestational Diabetes: This occurs during pregnancy when hormonal changes lead to insulin resistance. While it typically resolves postpartum, it increases the risk of developing type 2 diabetes later in life.
- Type 1.5 Diabetes: Also known as latent autoimmune diabetes in adults (LADA), this condition occurs in adulthood and progresses gradually. It is an autoimmune disease and often misdiagnosed as type 2 diabetes but requires insulin therapy.
- Prediabetes: A condition where blood sugar levels are higher than normal but not high enough for a diabetes diagnosis. Prediabetes can lead to type 2 diabetes without lifestyle modifications.
A rare condition called diabetes insipidus, unrelated to diabetes mellitus, occurs when the kidneys remove excessive fluid from the body, leading to dehydration and other issues.
Risk Factors for Diabetes
A variety of factors contribute to an individual’s risk of developing diabetes, influencing the likelihood of complications and the management of the condition.
General Risk Factors
Gender: Men are generally more likely to have diabetes than women. However, socioeconomic factors, such as income, education level, and employment status, impact diabetes rates differently among men and women.
Socioeconomic Disadvantage: Populations with lower socioeconomic status are at higher risk due to contributing factors like:
- Obesity
- Cigarette smoking
- High blood pressure
Prediabetes
You’re at a higher risk of developing prediabetes if you have:
- Abdominal obesity
- A family history of type 2 diabetes
Taking steps to lower your risk and manage blood glucose levels can help prevent or delay the onset of type 2 diabetes.
Type 1 Diabetes
The risk factors for type 1 diabetes are not fully understood but may include:
- Age
- Genetics
- Environmental factors
Type 1 and 1.5 diabetes is not preventable.
Type 2 Diabetes
Several risk factors contribute to type 2 diabetes, including (Diabetes Risk Factors – CDC):
- Prediabetes
- Advanced age
- High cholesterol
- Physical inactivity
- High blood pressure
- Overweight or obesity
- A history of gestational diabetes
- A family history of type 2 diabetes
Prevalence in Certain Populations
Evidence suggests that type 2 and gestational diabetes are more common among (Diabetes Care 2016):
- Indigenous Peoples
- People of African, East Asian, and South Asian backgrounds
This increased prevalence often results from:
- Family history
- Cultural differences and inequities
- Limited opportunities and access to care
Associated Conditions
The risk of developing type 2 diabetes also increases if you have other conditions, such as:
Symptoms of Diabetes
Symptoms of diabetes are caused by elevated blood sugar levels and include:
- Polydipsia-Increased thirst
- Polyuria-Increased thirst
- Unexplained weight loss
- Fatigue
- Blurry vision
- Slow-healing wounds
- Frequent infections
Additional symptoms specific to:
- Men: Erectile dysfunction, decreased muscle strength.
- Women: Vaginal dryness, yeast infections, urinary tract infections.
- Gestational diabetes is often asymptomatic and is typically diagnosed through routine testing during pregnancy.
If these signs sound familiar, the next step is clinical testing for diagnosis.
Diabetes Diagnosis
Diabetes is diagnosed through blood tests, including (ADA Standards of Care in Diabetes — 2023):
- Fasting Blood Glucose Test: Measures blood sugar after fasting for 8 hours (≥126 mg/dL indicates diabetes).
- Oral Glucose Tolerance Test (OGTT): Checks blood sugar levels before and two hours after drinking a glucose solution (≥200 mg/dL confirms diabetes).
- HbA1c Test: Reflects average blood sugar levels over 2-3 months (≥6.5% indicates diabetes).
- Gestational diabetes is diagnosed through glucose challenge and glucose tolerance tests performed during the second trimester.
With diagnosis established, the next priority is understanding and preventing complications.
Diabetes Complications
Poorly managed diabetes can lead to complications such as:
- Cardiovascular Disease: Increased risk of heart attacks and strokes.
- Kidney Damage (Nephropathy): Progressing to chronic kidney disease.
- Nerve Damage (Neuropathy): Pain, tingling, or numbness in extremities.
- Eye Damage (Retinopathy): Potential blindness.
- Foot Complications: Ulcers and infections, sometimes requiring amputation.
- Pregnancy Complications: High birth weight, premature birth, or increased risk of type 2 diabetes in offspring.
With risks identified, evidence-based treatment becomes the priority.
Treatment of Diabetes
Insulin, Medicines, & Other Diabetes Treatments
Taking insulin or other diabetes medicines is often part of treating diabetes. In addition to making healthy food and beverage choices, getting physical activity, getting enough sleep, and managing stress, medicines can help you manage the disease. Some other treatment options are also available.
Read more about Insulin and how to use it here
What Medicines Might I Take for Diabetes?
The medicine you take depends on the type of diabetes you have and how well the medicine controls your blood glucose levels. Other factors, such as your other health conditions, medication costs, and lifestyle, may influence your treatment plan.
What Type of Diabetes Do I Have?
- Type 1 Diabetes: Requires insulin therapy because the pancreas does not produce insulin. Insulin delivery options include syringes, pens, pumps, and artificial pancreas systems.
- Type 2 Diabetes: Managed with lifestyle changes, oral medications, and sometimes insulin. Insulin may be necessary during specific situations like pregnancy or hospital stays.
-
Gestational Diabetes: Treated through diet, exercise, and possibly insulin to keep blood glucose levels within a healthy range during pregnancy.
Oral Medicines for Type 2 Diabetes
Oral medications like metformin help reduce blood glucose levels and improve insulin sensitivity.
|
Drug Class | Example of Drugs | Adverse Effects | |
|---|---|---|---|---|
| 1 | Insulin and analogues | Regular Insulin | Hypoglycemia, Weight gain, Insulin allergy, Lipodystrophy at injection sites | |
| 2 | Sulphonylureas | Glibenclamide | Hypoglycemia, Weight gain, Cardiovascular risk, Rash, Cholestatic jaundice, Bone marrow damage, Photosensitivity | |
| 3 | Meglitinides | Repaglinide | Hypoglycemia, Sensitivity reactions | |
| 4 | Biguanides | Metformin |
Gastrointestinal effects, Lactic acidosis |
|
| 5 | GLP-1 agonists | Exenatide | Gastrointestinal effects, Pancreatitis, Risks for cancer and cardiovascular events | |
| 6 | DPP-4 inhibitors | Saxagliptin | Pancreatitis, Risk for cancer, Acute hepatitis, Kidney impairment | |
| 7 | Thiazolidinedions | Pioglitazone | Hepatitis, Cardiovascular risk, Bladder cancer, Water retention, Weight gain | |
| 8 | Dual PPAR agonists | Saroglitazar | Gastritis, Asthenia, Pyrexia | |
| 9 | Alpha-glucosidase inhibitors | Acarbose | Gastrointestinal effects, Hepatitis | |
| 10 | Amylin analogues | Pramlintide | Hypoglycemia, Allergy | |
| 11 | SGLT 2 inhibitors | Canagliflozin | Glycosuria, Cardiovascular concern |
Antidiabetic Drugs – British Journal of Pharmaceutical Research 4
Additional Treatment Options
- Weight-loss Surgery: Effective for certain people with type 2 diabetes and obesity.
- Pancreatic Islet Transplantation: An option for people with type 1 diabetes who struggle with blood glucose management.
Alongside prescriptions, prevention is crucial to slow or avert disease progression.
Diabetes Prevention
Prevention focuses on lifestyle changes (Diabetes Prevention – ADA):
- Maintaining a healthy weight
- Engaging in regular physical activity (150 minutes/week – 30 minutes x 5 days/week)
- Eating a balanced diet rich in whole grains, vegetables, and lean protein
- Avoiding sugary drinks and processed foods
The next step in prevention is crafting the right Diabetes Diet.
Diabetes and Diet
A diabetes-friendly diet includes:
- Low Glycemic Index Foods: Such as whole grains and legumes.
- Healthy Fats: Avocados, nuts, olive oil.
- High Fiber: Fruits, vegetables, whole grains.
- Controlled Portions: To manage calorie and carb intake.
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After dialing in your diet, exercise amplifies glucose control.
Diabetes and Exercise
Regular exercise helps:
- Improve insulin sensitivity
- Lower blood glucose levels
- Manage weight
- Reduce cardiovascular risks
Activities like walking, swimming, and cycling are recommended, along with monitoring blood sugar levels before and after workouts.
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