Facts about diabetes
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Understanding Diabetes: Key Facts and Insights
Definition and Description of Diabetes Mellitus
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia (high blood sugar) due to defects in insulin secretion, insulin action, or both . Chronic hyperglycemia is linked to long-term damage and failure of various organs, particularly the eyes, kidneys, nerves, heart, and blood vessels .
Pathogenesis and Types of Diabetes
Type 1 Diabetes
Type 1 diabetes (T1D) is caused by an absolute deficiency of insulin secretion. This is often due to autoimmune destruction of the beta-cells in the pancreas . Individuals at risk can often be identified by serological evidence of an autoimmune process and genetic markers .
Type 2 Diabetes
Type 2 diabetes (T2D), the more prevalent form, results from a combination of resistance to insulin action and an inadequate compensatory insulin secretory response . T2D is often associated with obesity and lack of exercise, and it represents a significant and growing health challenge globally .
Symptoms and Complications
Acute Symptoms
Symptoms of marked hyperglycemia include polyuria (frequent urination), polydipsia (excessive thirst), weight loss, polyphagia (excessive hunger), and blurred vision . Acute, life-threatening consequences of uncontrolled diabetes include ketoacidosis and the nonketotic hyperosmolar syndrome .
Long-term Complications
Long-term complications of diabetes include:
- Retinopathy: Potential loss of vision .
- Nephropathy: Leading to renal failure .
- Peripheral Neuropathy: Risk of foot ulcers, amputations, and Charcot joints .
- Autonomic Neuropathy: Causing gastrointestinal, genitourinary, cardiovascular symptoms, and sexual dysfunction .
- Cardiovascular Diseases: Increased incidence of atherosclerotic cardiovascular, peripheral arterial, and cerebrovascular disease .
Diagnosis and Classification
Diagnostic Criteria
Diabetes can be diagnosed by measuring plasma glucose levels in the fasting state or after an oral glucose load . The degree of hyperglycemia may change over time, reflecting the severity of the underlying metabolic process and its treatment .
Intermediate States
Intermediate states of hyperglycemia, such as impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), can be present without fulfilling the criteria for diabetes diagnosis .
Management and Treatment
Lifestyle Modifications
For some individuals, adequate glycemic control can be achieved through weight reduction, exercise, and/or oral glucose-lowering agents .
Insulin Therapy
Individuals with extensive beta-cell destruction and no residual insulin secretion require insulin for survival . Others with some residual insulin secretion may still need exogenous insulin for adequate glycemic control .
Global and Genetic Perspectives
Prevalence and Mortality
Diabetes is a significant public health challenge, with an estimated 280 million diabetic patients in 2011, projected to exceed 500 million by 2030. The prevalence of T2D is particularly high, accounting for about 90% of diabetes cases .
Genetic Factors
The genetic basis of diabetes is complex. While the genetic contribution to T1D is better understood, the genetic causes of T2D remain less clear, often referred to as "missing heritability". Environmental factors such as obesity and lack of exercise play a significant role in T2D.
Conclusion
Diabetes mellitus is a complex and multifaceted disease with significant health implications. Understanding its pathogenesis, symptoms, complications, and management strategies is crucial for effective treatment and prevention. Ongoing research and global health initiatives are essential to address the growing diabetes epidemic.
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