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Diabetes Mellitus

The sugar menace

The Background

According to the International Diabetes Federation (IDF), 415 million people were living with diabetes mellitus (DM) worldwide in 2015 and is expected to rise to 552 million by 2030. Diabetes mellitus accounted for approximately 5 million deaths (aged 20-79 years) worldwide in 2015, of which 46.6% were under the age of sixty years. The World Health Organization (WHO) predicts that diabetes will be the seventh leading cause of death worldwide by 2035. Fifty percent of adults with diabetes in 2014 lived in five countries: China, India, the United States of America (USA), Brazil and Indonesia. These countries also accounted for one half of the world’s adult population in 2014. It is predicted that by 2030, DM may affect up to 79.4 million individuals in India, 42.3 million in China, 30.3 million in the USA and 5.25 million in South Africa.

Definition

Diabetes is a group of metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels. [American Diabetes Association]

Types & Causes of Diabetes

  • Type 1 diabetes mellitus or insulin dependent diabetes mellitus (IDDM). Type 1 diabetes mellitus is caused by an autoimmune reaction, in which the body’s defence system attacks the insulin-producing beta cells in the pancreas. As a result, the body can no longer produce the insulin it needs. The reason for this is not fully understood and the disease can affect people of any age. However, onset usually occurs in children or young adults. People with this form of diabetes require insulin daily in order to control blood glucose levels. Without insulin, a person with type 1 diabetes mellitus will die.

  • Type 2 diabetes mellitus or non-insulin dependent diabetes mellitus (NIDDM) (other specific types include damage to the pancreas by specific causes such as toxins and infections). Type 2 diabetes is the most common type of diabetes. It usually occurs in adults, but is increasingly seen in children and adolescents. In T2DM, the body is able to produce insulin but becomes resistant so that the insulin is ineffective. Over time, insulin levels may subsequently become insufficient. Both insulin resistance and deficiency lead to high blood glucose levels. In the case of individuals with raised blood glucose levels that are not high enough for a diagnosis, a diagnosis of IGT or IFG may be made.

  • Impaired glucose tolerance (blood glucose ≥ 11.1mmol/l after 2 hr of 75g of glucose intake) and impaired fasting glucose (blood glucose >7 mmol/l).

  • Gestational diabetes mellitus (GDM) occurs only during pregnancy. It can lead to serious health risks for both the mother and child. Gestational diabetes mellitus is associated with an increased risk of both mother and child developing T2DM later in life.

Diagnosis and Treatment

Diabetes symptoms (e.g. polyuria, polydipsia and unexplained weight loss for Type 1) plus:

  • a random venous plasma glucose concentration ≥ 11.1 mmol/l or

  • a fasting plasma glucose concentration ≥ 7.0 mmol/l (whole blood ≥ 6.1 mmol/l) or

  • two hour plasma glucose concentration ≥ 11.1 mmol/l two hours after 75g anhydrous glucose in an oral glucose tolerance test (OGTT).

Treatment:

  • Type 2 diabetes: Treatments include diet, exercise, medication and insulin therapy & meditation.

  • Type 1 diabetes: Treatment aims at maintaining normal blood sugar levels through regular monitoring, insulin therapy, diet, exercise and meditation.

  • Prediabetes: Progression from prediabetes to type 2 diabetes isn't inevitable. With lifestyle changes, weight loss and medication, it's possible to bring a blood sugar level back to normal.

  • Gestational diabetes: Treatment strategies include daily blood sugar monitoring, a healthy diet, exercise and monitoring the baby. If blood sugar is too high, medication is required.