Diabetes

Diabetes Mellitus is a chronic metabolic disturbance that has no cure. It is characterized by increased blood glucose concentrations and decreased insulin secretion and/or action.

All these clinical manifestations of diabetes are linked to a poor glycemic control, and the risk of developing several of these chronic complications of the disease can be greatly reduced by restoring normal or near-normal blood glucose levels. However, the intensive use of glucose lowering medications (especially insulin) aiming to optimal metabolic control leads to a significant increase in episodes of hypoglycemia.

When blood glucose falls too much or too quickly, acute neurological defects can appear such as cognitive dysfunction, de-coordination, memory loss, seizures, and sudden loss of consciousness (coma). In some patients, hypoglycemia occurs without preliminary symptoms and neurological defects can appear abruptly, further increasing the risk of car accidents or work-related injuries.

Diabetes — when it results in high blood sugar over a period of years — can affect almost every organ system of the body. We refer to these effects as the long-term complications of diabetes. These include effects on the heart, brain, kidneys, eyes, stomach, bowel, bladder, sexual organs, peripheral nerves, and others (more info) . The presence of these risks limits the possibility of pushing the treatment to an adequate level and therefore medical efforts to reduce diabetes-related complications through optimal metabolic control are partially frustrated by the problems encountered with the intensive use of medications.

Diabetes has become a worldwide epidemic, with increasing costs for health and welfare system and for the community. It affects approximately a 5% of population in developed countries (150 millions persons currently and 300 in 2025). High percentage of sick people remain still without diagnosis.

The International Diabetes Federation (IDF) estimates that the equivalent of an additional 23 million years of life are lost each year to the disability and to reduced quality of life caused by the preventable complications of diabetes. In Europe IDF estimates (IDF Diabetes Atlas 2007) that the yearly cost of diabetes is around 67 Million International Dollars.

The three major types of diabetes are:

TYPE 1 Insulin dependent:

The patients lack pancreatic secretion of insulin and depend on exogenous insulin injection
Risk Factors: autoimmune, genetic, environmental
It is usually diagnosed in children and young adults
It represents between 5 and 10 % of the total diabetic population (0.3–0.6% of the general population).

TYPE 2 non-insulin dependent

Patients are characterized by a variable degree of resistance to metabolic actions of insulin (insulin-resistance) and usually have an endogen secretion of insulin, which might be even increased compared to normal subjects, but insufficient to their increased needs
“new” tendency to appear in overweighed children and young people → It usually appears in overweighed people over 40
Associated to age, obesity, family records, gestational diabetes records, glycogen metabolism disorders, physical inactivity and race/ethnic origin
It is associated with a progressive loss of insulin secretion capability from the pancreas, and several patients require insulin treatment to maintain acceptable glucose levels
90–95 % of total diabetic population

GESTATIONAL DIABETES

Glucose intolerance diagnosed during pregnancy
20–25 % 5 years later → Increases the risk of suffering from Type 2 Diabetes after the end of the pregnancy (5–10%)

Diabetes Chronic Complications

Cardiac Disease

According to the American Diabetes Association, 65% (until 70% according to Toronto University) of diabetics die due to coronary diseases or Heart Failure
DM is associated to a considerable increase in the risk of developing a cardiovascular disease (CVD) in comparison to healthy persons: double for men and 5 times higher for women in ages between 47 – 65 years. The figures rise up to 4 – 8 in the elderly.
This susceptibility is seen in both T1DM and T2DM. The development of arterial diseases fastens in the case of T1DM is is often present in the diagnosis of T2DM.
77% of hospitalizations for diabetes in US are related to CVD. Glycemic control has proved to improve cardiac metabolism and myocardial function
Patients with cardiac disorders suffer a change in their drugs, nutrients and insulin patterns → absorption = blood flow function

Retinopathy

Diabetic rethinopathy is the 1st cause of non-reversable blindness in the western world. The appearance and progression of this complication is strictly dependent upon glycemic control and blood pressure level, although a genetic predisposition is also involved. A person with diabetes has 10– to 20-fold increased risk of blindness.

Nephropathy

Diabetes is the leading cause of end-stage renal disease. Although renal disease has several known risk factors (above all hyperglycemia and hypertension), the genetic component behind development and progression of nephropathy may play a significant role, especially in type 1 diabetics. Nephropathy increases cardiovascular morbidity and mortality.

Diabetic Neuropathy

It usually occurs in patients with long-standing and often poorly controlled diabetes. Diabetic neuropathy may affect the peripheral nervous system – leading to neuropathic pain, loss of limb sensitivity (a major risk factor for food ulceration) and loss of muscular strength – , but also the autonomic system leading to development of cardiovascular symptoms (orthostatic hypotension, syncope, arrhythmias, etc.), gastrointenstinal disturbances (including chronic abdominal pain, diarrhoea with loss of sphincterial competence, vomit, hypo-nutrition, etc.), urinary incompetence, or male impotence. Patients with CVD may not experiment angina symptoms as others → increase in morbidity for „silent“ myocardial ischemia → possible relation with the neuropathy.

Foot Ulceration

It is the first cause of lower limb amputation in the western world. Commonest Risk factor → Chronic sensorimotor neuropathy and/or impaired blood supply.

Others

Diabetes is also associated with an increased incidence of infections (especially dermatological, dental and urinary) and skin diseases. Chronic cerebrovascular disturbances and liver disease have also been associated with diabetes.