Diabetes-A global disease burden

November 14 was World Diabetes Day. A day set aside by the global health community to raise awareness about diabetes as a critical global public health issue and empha­sise the collective and individual actions needed to improve the prevention, diagnosis, and man­agement of the condition. This year’s theme, “Breaking Barriers, Bridging Gaps.” I will be using materials from the World Health Organisation (WHO) website for this piece.

Diabetes is a chronic disease that occurs either when the pan­creas does not produce enough insulin or when the body can­not effectively use the insulin it produces. Insulin is a hormone that regulates blood glucose. Hyperglycaemia (raised blood glucose or raised blood sugar), is a common effect of uncontrolled diabetes and over time leads to considerable damage to many of the body’s systems, especially the nerves and blood vessels.

In 2022, 14 per cent of adults aged 18 years and older were living with diabetes, an increase from seven per cent in 1990. More than half (59%) of adults aged 30 years and over living with diabetes were not taking medi­cation for their diabetes in 2022. Diabetes treatment coverage was lowest in low- and middle-income countries.

In 2021, diabetes was the direct cause of 1.6 million deaths and 47per cent of all deaths due to diabetes occurred before the age of 70 years. Another 530,000 kid­ney disease deaths were caused by diabetes, and high blood glucose causes around 11 per cent of cardiovascular deaths.

SYMPTOMS

Symptoms of diabetes may occur suddenly. In type 2 diabe­tes, the symptoms can be mild and may take many years to be noticed. Symptoms of diabetes include feeling very thirsty, need­ing to urinate more often than usual, blurred vision, feeling tired and losing weight unintentionally.

COMPLICATIONS

Over time, diabetes can damage blood vessels in the heart, eyes, kidneys, and nerves. People with diabetes have a higher risk of health problems including heart attack, stroke, and kidney failure. Diabetes can cause permanent vision loss by damaging blood vessels in the eyes. Many people with diabetes develop problems with their feet from nerve dam­age and poor blood flow. This can cause foot ulcers and may lead to amputation.

TYPES

Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterised by deficient insulin production and requires daily administration of insulin.

Type 2 diabetes affects how the body uses sugar (glucose) for energy. It stops the body from using insulin properly, which can lead to high levels of blood sugar if not treated.

Type 2 diabetes is often pre­ventable. Factors that contribute to developing type 2 diabetes include being overweight, not getting enough exercise, and genetics.

Symptoms of type 2 diabetes can be mild. They may take sev­eral years to be noticed. Symp­toms may be similar to those of type 1 diabetes but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen.

More than 95 per cent of people with diabetes have type 2 diabetes. Type 2 diabetes was formerly called non-insulin dependent, or adult-onset. Until recently, this type of diabetes was seen only in adults, but it is now also occurring increasingly frequently in children.

Early diagnosis is important to prevent the worst effects of type 2 diabetes. The best way to detect diabetes early is to get regular check-ups and blood tests with a healthcare provider.

Gestational diabetes is hyper­glycaemia with blood glucose values above normal but below those diagnostics of diabetes in pregnant women. Women with gestational diabetes are at an increased risk of complications during pregnancy and delivery. These women and their children are also at increased risk of type 2 diabetes in the future.

Gestational diabetes is diag­nosed through prenatal screen­ing, rather than through reported symptoms.

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermedi­ate conditions in the transition between normality and dia­betes. People with IGT (7.8-11.0 mmol/L) or IFG (6.1-6.9 mmol/L) are at high risk of progressing to type 2 diabetes.

Lifestyle changes are the best way to prevent or delay the onset of type 2 diabetes.

To help prevent type 2 diabe­tes and its complications, people should: reach and keep a healthy body weight; stay physically active with at least 150 minutes of moderate exercise each week; eat a healthy diet and avoid sugar and saturated fat; and not smoke tobacco.

Along with medicines to lower blood sugar, people with diabetes often need medications to lower their blood pressure and statins to reduce the risk of complica­tions.

Additional medical care may be needed to treat the effects of diabetes: foot care to treat ulcers; screening and treatment for kid­ney disease; eye exams to screen for retinopathy (which causes blindness).

WHO RESPONSE

WHO aims to stimulate and support the adoption of effective measures for the surveillance, prevention and control of diabe­tes and its complications, partic­ularly in low- and middle-income countries. To this end, WHO: provides scientific guidelines for the prevention of major non­communicable diseases including diabetes; develops norms and standards for diabetes diagnosis and care; builds awareness on the global epidemic of diabetes, marking World Diabetes Day (14 November); and conducts surveillance of diabetes and its risk factors.

In April 2021 WHO launched the Global Diabetes Compact, a global initiative aiming for sus­tained improvements in diabetes prevention and care, with a par­ticular focus on supporting low- and middle-income countries.

In May 2021, the World Health Assembly agreed to a Resolution on strengthening prevention and control of diabetes. In May 2022, the World Health Assem­bly endorsed five global diabetes coverage targets to be achieved by 2030. The 5 new targets set the standard that, by 2030: 80 per cent of people with diabetes be diagnosed; 80 per cent of people with diagnosed diabetes have good control of glycaemia; 80 per cent of people with diag­nosed diabetes have good control of blood pressure; 60 per cent of people with diabetes of 40 years or older receive statins; and 100 per cent of people with type 1 diabetes have access to afford­able insulin and blood glucose self-monitoring.

POLYPHENOL-RICH FOODS REDUCE DIABE­TES RISK

More than 95 per cent of people with diabetes have type 2 diabetes. Type 2 diabetes mel­litus (T2DM) is recognized as a serious public health concern with a considerable impact on human life, long-term health expenditures, and substantial health losses. The use of dietary polyphenols to prevent and man­age T2DM is widely documented. These dietary compounds exert their beneficial effects through several actions, including the protection of pancreatic islet β-cell, the antioxidant capacities of these molecules, their effects on insulin secretion and actions, the regulation of intestinal micro­biota, and their contribution to ameliorate diabetic complications, particularly those of vascular origin (Gonzales et al. Emerg­ing and multifaceted potential contributions of polyphenols in the management of type 2 dia­betes mellitus. World J Diabetes. 2024 Feb 15;15(2):154–169. doi: 10.4239/wjd.v15.i2.154). Cocoa is an excellent source of polyphe­nols.