DIABETES: AN EVER-GROWING HEALTH ISSUE

 One of the major public health challenges of the 21st century, diabetes has today reached pandemic levels. In 2006, the United Nation General Assembly unanimously passed a resolution declaring diabetes an international public health issue. The disease is associated with growing costs due to its numerous complications that lead to significant morbidity and mortality. It is also increasingly affecting younger patients who suffer from early and more severe complications than seen in the past. 

There are two main types: 

Type 1 diabetes, which accounts for less than 10 per cent of cases, occurs in children or young adults and is due to a complete lack of insulin, the hormone regulating glucose (the basic source of energy to the cells) level in the blood (glycaemia). 

Type 2 diabetes – or maturity onset diabetes – occurs in adults and is linked to insufficient insulin production associated, most of the time, with poorly efficient insulin (insulin resistance). The diabetes pandemic is due to type 2, which is the disease discussed here. 

The exact causes of insulin deficiency and insulin resistance are partly unknown although genetic and environmental factors play an important role. However, major changes in diet and lifestyle associated with Western behaviour have resulted in a dramatic increase in the prevalence of diabetes. 

In diabetes, the entry of glucose into the cells is impaired, which results in an excessive glucose concentration in the blood. Over the long term, the elevated glucose level becomes toxic to many cells and tissues – a process known as glucose toxicity. The resulting complications progressively affect many parts of the body, in particular the cardiovascular system, the nerves, the kidneys and eyes. 

Diabetics thus face a much higher risk of heart attack and stroke, renal insufficiency and poor vision. Cardiac complications are even more frequent if the patient also suffers from hypertension or high cholesterol, both frequently associated disorders. In addition, the patient is exposed to a much higher risk of renal insufficiency that could lead to kidney failure. Meanwhile, the retina, the thin layer at the back of the interior surface of the eye, is frequently the site of micro-vessel complications, which can induce blindness. Damage to the nerves can lead to pain, numbness, skin disorders, gastric upsets and uro-genital problems.

Diabetes is a severe chronic disease but early detection and modern treatment can prevent or limit most of these complications.

It is thus of paramount importance to identify the initial stage of the disease, called prediabetes. At this phase, the minor impairment in glycaemia can be totally or partially reversed though lifestyle modifications, namely getting back to a normal body weight and engaging in physical activity. 

For the treatment of established diabetes, some recently concluded long-term studies have contributed to significant improvement in the management of the disease. Among these, the ADVANCE trial, the largest study on the prevention of cardiovascular complications among diabetics, has helped identify some of the most appropriate drug regimens and also shed light on a global therapeutic approach to the disease. 

The normalisation of blood glucose remains a priority but the control of blood pressure appears equally important. The ADVANCE researchers have developed a predictive tool to accurately address any diabetic risk profile. 

With this practical assessment, general practitioners and endocrinologists are now better equipped to optimise the treatment of their patients and improve their quality of life over the long term.

 

Dr Gerard Lalande is the managing director of CEO-HEALTH, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at gerard.lalande@ceo-health.com.