Diabetes

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Introduction

Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia due to defects in insulin secretion, insulin action, or both. It is associated with long-term damage to various organs and is a major global health concern. The two primary types of diabetes are type 1, which involves an absolute deficiency of insulin, and type 2, which involves insulin resistance and inadequate insulin secretion.

Key Insights

Pathophysiology and Classification:
- Diabetes is characterized by hyperglycemia due to defects in insulin secretion, insulin action, or both. It leads to long-term damage to organs such as the eyes, kidneys, nerves, heart, and blood vessels .
- Type 1 diabetes is caused by autoimmune destruction of pancreatic beta cells, leading to an absolute deficiency of insulin .
- Type 2 diabetes is caused by a combination of insulin resistance and inadequate compensatory insulin secretion .
Global and Societal Impact:
- The incidence of diabetes, particularly type 2, has dramatically increased due to changes in human behavior and lifestyle, such as sedentary habits and poor nutrition.
- Diabetes is associated with significant premature morbidity and mortality, necessitating an integrated, international approach for prevention and control.
Complications and Associated Conditions:
- Long-term complications of diabetes include retinopathy, nephropathy, peripheral neuropathy, autonomic neuropathy, and increased risk of cardiovascular diseases .
- Diabetes is strongly associated with an increased risk of various cancers, including pancreatic, hepatocellular, breast, endometrial, and colorectal cancers.
Mechanisms Linking Obesity and Diabetes:
- Obesity is a major risk factor for type 2 diabetes, with adipose tissue releasing factors that contribute to insulin resistance .
- The hormone resistin, secreted by adipocytes, links obesity to insulin resistance by impairing glucose tolerance and insulin action.
- Increased non-esterified fatty acids, glycerol, hormones, and pro-inflammatory cytokines from adipose tissue in obese individuals contribute to insulin resistance.
Insulin Resistance and Metabolic Pathways:
- Insulin resistance involves a complex network of signaling pathways that regulate glucose and lipid metabolism. This resistance is linked to other health issues such as obesity, polycystic ovarian disease, hyperlipidemia, hypertension, and atherosclerosis.

Conclusion

Diabetes mellitus, particularly type 2, is a growing global health issue driven by lifestyle changes and obesity. It is characterized by chronic hyperglycemia due to defects in insulin secretion and action, leading to severe long-term complications. Effective management and prevention require a comprehensive understanding of its pathophysiology, the role of obesity, and the complex metabolic pathways involved. An integrated, international approach is essential to mitigate the significant morbidity and mortality associated with diabetes.