Diabetes

Diabetes

What is Diabetes?

Diabetes Mellitus is a chronic metabolic disorder characterized by elevated blood glucose levels (hyperglycemia) due to impaired insulin secretion, insulin action, or both.

Types of Diabetes

  • Type 1 Diabetes (T1D): Autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency.
  • Type 2 Diabetes (T2D): A combination of insulin resistance and relative insulin deficiency, often associated with obesity and lifestyle factors.
  • Gestational Diabetes Mellitus (GDM): Hyperglycemia first detected during pregnancy.
  • Other Types: Includes monogenic diabetes, secondary diabetes due to other diseases or medications, and more.

Pathophysiology

  • Type 1 Diabetes: Caused by autoimmune destruction of insulin-producing beta cells in the pancreas. Triggering factors may include genetic predisposition and environmental factors (e.g., viral infections).
  • Type 2 Diabetes: Involves a progressive loss of beta-cell function in the context of insulin resistance in tissues like the liver, muscle, and adipose tissue. Chronic inflammation and ectopic fat deposition also play a role.
  • Gestational Diabetes Mellitus: Insulin resistance increases naturally during pregnancy, but in GDM, the pancreas fails to compensate with adequate insulin production.

Symptoms of Diabetes

  • Polyuria (excessive urination)
  • Polydipsia (excessive thirst)
  • Polyphagia (excessive hunger)
  • Unexplained weight loss (especially in T1D)
  • Fatigue
  • Blurred vision

Complications

Acute:

  • Diabetic ketoacidosis (DKA) in T1D
  • Hyperosmolar hyperglycemic state (HHS) in T2D

Chronic:

  • Microvascular: Retinopathy, nephropathy, neuropathy
  • Macrovascular: Cardiovascular disease, stroke, peripheral arterial disease
  • Other: Increased risk of infections, poor wound healing

Diagnosis

Criteria for Diagnosis:

  • Fasting Plasma Glucose (FPG) ≥126 mg/dL (7.0 mmol/L)
  • 2-Hour Plasma Glucose ≥200 mg/dL (11.1 mmol/L) during an Oral Glucose Tolerance Test (OGTT)
  • HbA1c ≥6.5%
  • Random Plasma Glucose ≥200 mg/dL in the presence of symptoms

Screening:

Recommended for individuals at high risk (e.g., obesity, family history, sedentary lifestyle) or those over 45 years old.

Management

1. Lifestyle Modifications:

  • Diet: Emphasis on whole grains, vegetables, lean protein, and limited refined carbohydrates.
  • Physical Activity: At least 150 minutes of moderate aerobic exercise per week.
  • Weight Management: Target 5-10% weight loss in T2D for improved glycemic control.

2. Pharmacological Therapy:

  • Type 1 Diabetes: Insulin therapy (basal-bolus or continuous insulin infusion).
  • Type 2 Diabetes:
    • First-line: Metformin
    • Additional options: GLP-1 receptor agonists, SGLT2 inhibitors, DPP-4 inhibitors, sulfonylureas, insulin.
  • Gestational Diabetes: Insulin is preferred; metformin and glyburide may be used.

3. Monitoring:

  • Self-monitoring of blood glucose (SMBG)
  • Continuous glucose monitoring (CGM) for advanced management
  • Routine HbA1c testing every 3-6 months

Prevention

1. Type 2 Diabetes:

  • Regular physical activity
  • Healthy diet
  • Weight management
  • Early screening for individuals with prediabetes (FPG 100–125 mg/dL or HbA1c 5.7–6.4%)

2. Gestational Diabetes:

  • Preconception counselling and optimizing maternal weight
  • Regular screening in high-risk pregnancies

Research and Innovations

  • Artificial Pancreas: Advances in closed-loop insulin delivery systems.
  • Regenerative Medicine: Beta-cell replacement and stem cell therapies.
  • Precision Medicine: Genetic profiling to tailor treatments.
  • New Drug Classes: Agents targeting novel pathways (e.g., dual GLP-1/GIP agonists).