Diabetes mellitus (DM),
commonly referred to as diabetes, is a group of metabolic disorders in
which there are high blood sugar levels
over a prolonged period. Symptoms of high blood sugar include frequent
urination, increased thirst, and increased hunger. If left untreated,
diabetes can cause many complications. Acute complications can include diabetic ketoacidosis, hyperosmolar
hyperglycemic state, or death. Serious long-term complications
include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.
Diabetes is due to
either the pancreas not producing enough insulin or the cells of the body not responding properly
to the insulin produced. There are three main types of diabetes mellitus:
·
Type 1 DM results
from the pancreas's failure to produce enough insulin. This form was
previously referred to as "insulin-dependent diabetes mellitus"
(IDDM) or "juvenile diabetes". The cause is unknown.
· Type 2 DM begins
with insulin resistance, a
condition in which cells fail to respond to insulin properly. As the
disease progresses a lack of insulin may also develop. This form was
previously referred to as "non insulin-dependent diabetes mellitus"
(NIDDM) or "adult-onset diabetes". The most common cause is
excessive body weight and insufficient exercise.
·
Gestational diabetes is
the third main form, and occurs when pregnant women without a previous history
of diabetes develop high blood sugar levels.
Prevention and
treatment involve maintaining a healthy diet, regular physical exercise, a
normal body weight, and avoiding use of tobacco. Control of blood pressure
and maintaining proper foot care are important for people with the
disease. Type 1 DM must be managed with insulin injections. Type 2 DM
may be treated with medications with or without insulin. Insulin and some
oral medications can cause low blood sugar. Weight loss surgery in those with obesity is sometimes an effective measure in those with
type 2 DM. Gestational diabetes usually resolves after the birth of the
baby.
As of 2015, an
estimated 415 million people had diabetes worldwide, with type 2 DM making
up about 90% of the cases. This represents 8.3% of the adult
population, with equal rates in both women and men. As of 2014,
trends suggested the rate would continue to rise. Diabetes at least
doubles a person's risk of early death. From 2012 to 2015, approximately
1.5 to 5.0 million deaths each year resulted from diabetes. The global
economic cost of diabetes in 2014 was estimated to
be US$612 billion. In the United States, diabetes cost $245
billion in 2012.
Signs and
symptoms
The classic symptoms of untreated diabetes are weight
loss, polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Symptoms may
develop rapidly (weeks or months) in type 1 DM, while they usually develop
much more slowly and may be subtle or absent in type 2 DM.
Several other signs and symptoms can mark the onset of diabetes
although they are not specific to the disease. In addition to the known ones
above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy skin.
Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape,
resulting in vision changes. A number of skin rashes that can occur in diabetes
are collectively known as diabetic dermadromes.
Diabetic emergencies
Low blood sugar (hypoglycemia),
is common in persons with type 1 and type 2 DM. Most cases are mild and are not
considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild
cases to more serious issues such as confusion,
changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in
severe cases. Moderately low blood sugar may easily be mistaken for
drunkenness; rapid breathing and sweating, cold, pale skin are
characteristic of low blood sugar but not definitive. Mild to moderate
cases are self-treated by eating or drinking something high in sugar. Severe
cases can lead to unconsciousness and must be treated with intravenous glucose
or injections with glucagon.
People (usually with type 1 DM) may also experience
episodes of diabetic ketoacidosis,
a metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell of acetone on the breath, deep breathing known
as Kussmaul breathing,
and in severe cases a decreased level of consciousness.
A rare but equally severe possibility is hyperosmolar
hyperglycemic state, which is more common in type 2 DM and is
mainly the result of dehydration.
Complications
All forms of diabetes increase the risk of long-term
complications. These typically develop after many years (10–20) but may be the
first symptom in those who have otherwise not received a diagnosis before that
time.
The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease and
about 75% of deaths in diabetics are due to coronary artery disease. Other "macrovascular"
diseases are stroke, and peripheral artery disease.
The primary complications of diabetes due to damage in small
blood vessels include damage to the eyes, kidneys, and nerves. Damage to
the eyes, known as diabetic retinopathy,
is caused by damage to the blood vessels in the retina of the eye, and can result in gradual
vision loss and blindness. Diabetes
also increases the risk of having glaucoma, cataracts, and other eye problems. It is recommended
that diabetics visit an eye doctor once a year. Damage to the kidneys,
known as diabetic nephropathy,
can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease,
sometimes requiring dialysis or kidney transplantation. Damage
to the nerves of the body, known as diabetic neuropathy,
is the most common complication of diabetes. The symptoms can include
numbness, tingling, pain, and altered pain sensation, which can lead to damage
to the skin. Diabetes-related foot
problems (such as diabetic foot ulcers)
may occur, and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic
neuropathy causes painful muscle atrophy and weakness.
There is a link between cognitive deficit and diabetes. Compared to
those without diabetes, those with the disease have a 1.2 to 1.5-fold greater
rate of decline in cognitive function. Being diabetic, especially when on
insulin, increases the risk of falls in older people.
Causes
|
Comparison of type 1 and 2 diabetes
|
||
|
Feature
|
Type 1 diabetes
|
Type 2 diabetes
|
|
Onset
|
Sudden
|
Gradual
|
|
Age at onset
|
Mostly in children
|
Mostly in adults
|
|
Body size
|
Thin or normal
|
Often obese
|
|
Common
|
Rare
|
|
|
Usually present
|
Absent
|
|
|
Endogenous insulin
|
Low or absent
|
Normal, decreased
or increased |
|
50%
|
90%
|
|
|
Prevalence
|
~10%
|
~90%
|
Diabetes mellitus is classified into four broad
categories: type 1, type 2, gestational diabetes,
and "other specific types". The "other specific types"
are a collection of a few dozen individual causes. Diabetes is a more
variable disease than once thought and people may have combinations of forms. The
term "diabetes", without qualification, usually refers to diabetes
mellitus.
Type 1
Type 1 diabetes mellitus is characterized by loss of the
insulin-producing beta cells of
the pancreatic islets,
leading to insulin deficiency. This type can be further classified as
immune-mediated or idiopathic. The majority of type 1 diabetes is of the
immune-mediated nature, in which a T cell-mediated autoimmune attack leads to the loss of beta
cells and thus insulin. It causes approximately 10% of diabetes mellitus
cases in North America and Europe. Most affected people are otherwise healthy
and of a healthy weight when onset occurs. Sensitivity and responsiveness to
insulin are usually normal, especially in the early stages. Type 1
diabetes can affect children or adults, but was traditionally termed
"juvenile diabetes" because a majority of these diabetes cases were
in children.
"Brittle" diabetes, also known as unstable diabetes or
labile diabetes, is a term that was traditionally used to describe the dramatic
and recurrent swings in glucose levels,
often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has
no biologic basis and should not be used. Still, type 1 diabetes can
be accompanied by irregular and unpredictable high blood sugar levels, frequently with ketosis, and sometimes with serious low blood sugar levels. Other complications include
an impaired counterregulatory response to low blood sugar, infection, gastroparesis (which leads to erratic absorption
of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease). These
phenomena are believed to occur no more frequently than in 1% to 2% of persons
with type 1 diabetes.
Type 1 diabetes is partly inherited, with multiple genes,
including certain HLA genotypes,
known to influence the risk of diabetes. In genetically susceptible people, the
onset of diabetes can be triggered by one or more environmental factors, such
as a viral infection or diet. Several viruses have been implicated, but to date
there is no stringent evidence to support this hypothesis in humans. Among
dietary factors, data suggest that gliadin (a protein present in gluten) may play a role in the development of type 1
diabetes, but the mechanism is not fully understood.
Type 2
Type 2 DM is characterized by insulin resistance,
which may be combined with relatively reduced insulin secretion. The
defective responsiveness of body tissues to insulin is believed to involve
the insulin receptor.
However, the specific defects are not known. Diabetes mellitus cases due to a
known defect are classified separately. Type 2 DM is the most common type
of diabetes mellitus.
In the early stage of type 2, the predominant abnormality
is reduced insulin sensitivity. At this stage, high blood sugar can be reversed
by a variety of measures and medications that
improve insulin sensitivity or reduce the liver's
glucose production.
Type 2 DM is primarily due to lifestyle factors and
genetics. A number of lifestyle factors are known to be important to the
development of type 2 DM, including obesity (defined by a body mass index of greater than 30), lack
of physical activity,
poor diet, stress, and urbanization. Excess body fat is associated with
30% of cases in those of Chinese and Japanese descent, 60–80% of cases in those
of European and African descent, and 100% of Pima Indians and Pacific
Islanders. Even those who are not obese often have a high waist–hip ratio.
Dietary factors also influence the risk of developing
type 2 DM. Consumption of sugar-sweetened
drinks in excess is associated with an increased risk. The type of fats in
the diet is also important, with saturated fat and trans fats increasing the risk and polyunsaturated and monounsaturated fat decreasing
the risk. Eating lots of white rice also may increase the risk of
diabetes. A lack of physical activity is believed to cause 7% of cases.
Gestational diabetes
Gestational diabetes mellitus (GDM) resembles type 2 DM in
several respects, involving a combination of relatively inadequate insulin
secretion and responsiveness. It occurs in about 2–10% of all pregnancies and may improve or disappear after
delivery. However, after pregnancy approximately 5–10% of women with gestational
diabetes are found to have diabetes mellitus, most commonly type 2. Gestational
diabetes is fully treatable, but requires careful medical supervision throughout
the pregnancy. Management may include dietary changes, blood glucose
monitoring, and in some cases, insulin may be required.
Though it may be transient, untreated gestational diabetes can
damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital heart
and central nervous system abnormalities,
and skeletal muscle malformations.
Increased levels of insulin in a fetus's blood may inhibit fetal surfactant production and cause respiratory
distress syndrome. A high blood bilirubin level may
result from red blood cell destruction.
In severe cases, perinatal death may occur, most commonly as a result of poor
placental perfusion due to vascular impairment. Labor induction may be indicated with decreased
placental function. A Caesarean section may be performed if there is
marked fetal distress or an increased risk of injury associated with macrosomia, such
as shoulder dystocia.
Maturity onset diabetes of the young
Maturity
onset diabetes of the young (MODY) is an autosomal dominant inherited
form of diabetes, due to one of several single-gene mutations causing defects
in insulin production. It is significantly less common than the three main
types. The name of this disease refers to early hypotheses as to its nature.
Being due to a defective gene, this disease varies in age at presentation and
in severity according to the specific gene defect; thus there are at least 13
subtypes of MODY. People with MODY often can control it without using insulin.
Other types
Prediabetes indicates
a condition that occurs when a person's blood glucose levels are higher than
normal but not high enough for a diagnosis of type 2 DM. Many people who
later develop type 2 DM spend many years in a state of prediabetes.
Latent
autoimmune diabetes of adults (LADA) is a condition in which
type 1 DM develops in adults. Adults with LADA are frequently initially
misdiagnosed as having type 2 DM, based on age rather than cause.
Some cases of diabetes are caused by the body's tissue receptors
not responding to insulin (even when insulin levels are normal, which is what
separates it from type 2 diabetes); this form is very uncommon. Genetic
mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may
also have been genetically determined in some cases. Any disease that causes
extensive damage to the pancreas may
lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive
secretion of insulin-antagonistic hormones can cause diabetes (which is typically
resolved once the hormone excess is removed). Many drugs impair insulin
secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related
diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by
the World Health Organization when
the current taxonomy was introduced in 1999.
Other forms of diabetes mellitus include congenital diabetes,
which is due to genetic defects
of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes
induced by high doses of glucocorticoids, and several forms of monogenic
diabetes.
"Type 3 diabetes" has been suggested as a term
for Alzheimer's disease as
the underlying processes may involve insulin resistance by the brain.
The following is a comprehensive list of other causes of
diabetes:
|
·
Genetic defects
of β-cell function
·
Mitochondrial
DNA mutations
·
Genetic defects
in insulin processing or insulin action
·
Defects
in proinsulin conversion
·
Insulin gene
mutations
·
Insulin
receptor mutations
·
Exocrine
pancreatic defects
|
·
Growth hormone
excess (acromegaly)
·
Infections
·
Drugs
|
A 2018 study suggested that three types should be abandoned as
too simplistic. It classified diabetes into five subgroups, with what is
typically described as type 1 and autoimmune late-onset diabetes categorized as
one group, whereas type 2 encompasses four categories. This is hoped to improve
diabetes treatment by tailoring it more specifically to the subgroups.
Pathophysiology
The body obtains glucose from three main sources: the intestinal absorption of food; the breakdown of glycogen, the storage form of glucose found in the liver; and gluconeogenesis, the generation of glucose from non-carbohydrate substrates in the body. Insulin plays a critical role in balancing glucose levels in the body. Insulin can inhibit the breakdown of glycogen or the process of gluconeogenesis, it can stimulate the transport of glucose into fat and muscle cells, and it can stimulate the storage of glucose in the form of glycogen.
Insulin is released into the blood by beta cells (β-cells), found in the islets of Langerhans in
the pancreas, in response to rising levels of blood glucose, typically after
eating. Insulin is used by about two-thirds of the body's cells to absorb
glucose from the blood for use as fuel, for conversion to other needed
molecules, or for storage. Lower glucose levels result in decreased insulin
release from the beta cells and in the breakdown of glycogen to glucose. This
process is mainly controlled by the hormone glucagon, which acts in the opposite manner to
insulin.
If the amount of insulin available is insufficient, or if cells
respond poorly to the effects of insulin (insulin insensitivity or insulin resistance),
or if the insulin itself is defective, then glucose will not be absorbed
properly by the body cells that require it, and it will not be stored
appropriately in the liver and muscles. The net effect is persistently high
levels of blood glucose, poor protein synthesis, and other metabolic
derangements, such as acidosis.
When the glucose concentration in the blood remains high over
time, the kidneys will reach a threshold of reabsorption, and glucose will be excreted in
the urine (glycosuria). This increases the osmotic pressure of the urine and inhibits
reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume
will be replaced osmotically from water held in body cells and other body
compartments, causing dehydration and
increased thirst (polydipsia).
Diagnosis
See
also: Glycated hemoglobin and Glucose tolerance
test
|
WHO diabetes diagnostic criteria
|
||||
|
Condition
|
2 hour glucose
|
Fasting glucose
|
HbA1c
|
|
|
Unit
|
mmol/l(mg/dl)
|
mmol/l(mg/dl)
|
mmol/mol
|
DCCT %
|
|
Normal
|
<7.8 (<140)
|
<6.1 (<110)
|
<42
|
<6.0
|
|
<7.8 (<140)
|
≥6.1(≥110) & <7.0(<126)
|
42-46
|
6.0–6.4
|
|
|
≥7.8 (≥140)
|
<7.0 (<126)
|
42-46
|
6.0–6.4
|
|
|
Diabetes mellitus
|
≥11.1 (≥200)
|
≥7.0 (≥126)
|
≥48
|
≥6.5
|
Diabetes mellitus is characterized by recurrent or persistent
high blood sugar, and is diagnosed by demonstrating any one of the following:
·
Fasting plasma glucose level ≥ 7.0 mmol/l
(126 mg/dl)
·
Plasma glucose ≥ 11.1 mmol/l
(200 mg/dl) two hours after a 75 g oral glucose load as in a glucose tolerance
test
·
Symptoms of high blood sugar and casual plasma glucose
≥ 11.1 mmol/l (200 mg/dl)
A positive result, in the absence of unequivocal high blood
sugar, should be confirmed by a repeat of any of the above methods on a
different day. It is preferable to measure a fasting glucose level because of
the ease of measurement and the considerable time commitment of formal glucose
tolerance testing, which takes two hours to complete and offers no prognostic
advantage over the fasting test. According to the current definition, two
fasting glucose measurements above 126 mg/dl (7.0 mmol/l) is
considered diagnostic for diabetes mellitus.
Per the World Health Organization people
with fasting glucose levels from 6.1 to 6.9 mmol/l (110 to 125 mg/dl)
are considered to have impaired fasting glucose. people
with plasma glucose at or above 7.8 mmol/l (140 mg/dl), but not over
11.1 mmol/l (200 mg/dl), two hours after a 75 g oral glucose
load are considered to have impaired glucose tolerance.
Of these two prediabetic states, the latter in particular is a major risk
factor for progression to full-blown diabetes mellitus, as well as
cardiovascular disease. The American
Diabetes Association since 2003 uses a slightly different range
for impaired fasting glucose of 5.6 to 6.9 mmol/l (100 to 125 mg/dl).
Glycated hemoglobin is
better than fasting glucose for
determining risks of cardiovascular disease and death from any cause.
Prevention
See
also: Prevention
of diabetes mellitus type 2
There is no known preventive measure for type 1 diabetes. Type 2
diabetes – which accounts for 85–90% of all cases – can often be
prevented or delayed by maintaining a normal body weight,
engaging in physical activity, and consuming a healthy diet. Higher levels
of physical activity (more than 90 minutes per day) reduce the risk of diabetes
by 28%.Dietary changes known to be effective in helping to prevent diabetes
include maintaining a diet rich in whole grains and fiber, and choosing good fats, such as the polyunsaturated fats found
in nuts, vegetable oils, and fish. Limiting sugary beverages and eating
less red meat and other sources of saturated fat can also help prevent diabetes. Tobacco
smoking is also associated with an increased risk of diabetes and its
complications, so smoking cessation can
be an important preventive measure as well.
The relationship between type 2 diabetes and the main modifiable
risk factors (excess weight, unhealthy diet, physical inactivity and tobacco
use) is similar in all regions of the world. There is growing evidence that the
underlying determinants of diabetes are a reflection of the major forces
driving social, economic and cultural change: globalization, urbanization,
population aging, and the general health policy environment.
Management
Diabetes mellitus is a chronic disease, for which there is no known cure
except in very specific situations. Management concentrates on keeping
blood sugar levels as close to normal, without causing low blood sugar. This
can usually be accomplished with a healthy diet, exercise, weight loss, and use
of appropriate medications (insulin in the case of type 1 diabetes; oral
medications, as well as possibly insulin, in type 2 diabetes).
Learning about the disease and actively participating in the
treatment is important, since complications are far less common and less severe
in people who have well-managed blood sugar levels. The goal of treatment
is an HbA1C level of 6.5%, but should not be lower than that, and may
be set higher. Attention is also paid to other health problems that may
accelerate the negative effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. Specialized footwear is widely used to reduce
the risk of ulceration, or re-ulceration, in at-risk diabetic feet. Evidence
for the efficacy of this remains equivocal, however.
Lifestyle
People with diabetes can benefit from education about the
disease and treatment, good nutrition to achieve a normal body weight, and
exercise, with the goal of keeping both short-term and long-term blood glucose
levels within acceptable bounds.
In addition, given the associated higher risks of cardiovascular disease,
lifestyle modifications are recommended to control blood pressure.
There is no single dietary pattern that is best for all people
with diabetes. For overweight people with type 2 diabetes, any diet that the
person will adhere to and achieve weight loss on is effective.
Medications
Glucose
control
Medications used to treat diabetes do so by lowering blood sugar levels. There is broad consensus that
when people with diabetes maintain tight glucose control (also called
"tight glycemic control") -- keeping the glucose levels in their
blood within normal ranges - that they fewer complications like kidney problems and
[diabetic retinopathy|eye problems]]. There is however debate as to
whether this is cost effective for
people later in life.
There are a number of different classes of anti-diabetic
medications. Some are available by mouth, such as metformin, while others are only available by
injection such as GLP-1 agonists.
Type 1 diabetes can only be treated with insulin, typically with a
combination of regular and NPH insulin, or synthetic insulin analogs.
Metformin is
generally recommended as a first line treatment for type 2 diabetes, as
there is good evidence that it decreases mortality. It works by decreasing
the liver's production of glucose. Several other groups of drugs, mostly
given by mouth, may also decrease blood sugar in type II DM. These include
agents that increase insulin release, agents that decrease absorption of sugar
from the intestines, and agents that make the body more sensitive to insulin. When
insulin is used in type 2 diabetes, a long-acting formulation is usually
added initially, while continuing oral medications. Doses of insulin are then
increased to effect.
Blood
presssure
Since cardiovascular disease is
a serious complication associated with diabetes, some have recommended blood
pressure levels below 130/80 mmHg. However, evidence supports less
than or equal to somewhere between 140/90 mmHg to 160/100 mmHg; the
only additional benefit found for blood pressure targets beneath this range was
an isolated decrease in stroke risk, and this was accompanied by an increased
risk of other serious adverse events. A 2016 review found potential harm
to treating lower than 140 mmHg. Among medications that lower blood pressure, angiotensin
converting enzyme inhibitors (ACEIs) improve outcomes in those
with DM while the similar medications angiotensin
receptor blockers (ARBs) do not. Aspirin is also recommended for people with
cardiovascular problems, however routine use of aspirin has not been found to
improve outcomes in uncomplicated diabetes.
Surgery
Weight loss surgery in
those with obesity and type two diabetes is often an
effective measure. Many are able to maintain normal blood sugar levels with
little or no medications following surgery and long-term mortality is
decreased. There is, however, a short-term mortality risk of less than 1%
from the surgery. The body mass index cutoffs for when surgery is
appropriate are not yet clear. It is recommended that this option be
considered in those who are unable to get both their weight and blood sugar
under control.
A pancreas transplant is
occasionally considered for people with type 1 diabetes who have severe
complications of their disease, including end stage kidney disease requiring kidney transplantation.
Support
In countries using a general practitioner system,
such as the United Kingdom, care may take place mainly outside hospitals, with
hospital-based specialist care used only in case of complications, difficult
blood sugar control, or research projects. In other circumstances, general
practitioners and specialists share care in a team approach. Home telehealth support can be an effective
management technique.
Epidemiology
As of 2016, 422 million people have diabetes worldwide, up
from an estimated 382 million people in 2013 and from 108 million in 1980. Accounting
for the shifting age structure of the global population, the prevalence of
diabetes is 8.5% among adults, nearly double the rate of 4.7% in 1980. Type 2
makes up about 90% of the cases. Some data indicate rates are roughly
equal in women and men, but male excess in diabetes has been found in many
populations with higher type 2 incidence, possibly due to sex-related
differences in insulin sensitivity, consequences of obesity and regional body
fat deposition, and other contributing factors such as high blood pressure,
tobacco smoking, and alcohol intake.
The World Health Organization (WHO)
estimates that diabetes mellitus resulted in 1.5 million deaths in 2012, making
it the 8th leading cause of death. However another 2.2 million deaths
worldwide were attributable to high blood glucose and the increased risks of
cardiovascular disease and other associated complications (e.g. kidney
failure), which often lead to premature death and are often listed as the
underlying cause on death certificates rather than diabetes. For example,
in 2014, the International
Diabetes Federation (IDF) estimated that diabetes resulted in
4.9 million deaths worldwide, using modeling to estimate the total number
of deaths that could be directly or indirectly attributed to diabetes.
Diabetes mellitus occurs throughout the world but is more common
(especially type 2) in more developed countries. The greatest increase in rates
has however been seen in low- and middle-income countries, where
more than 80% of diabetic deaths occur. The fastest prevalence increase is
expected to occur in Asia and Africa, where most people with diabetes will
probably live in 2030. The increase in rates in developing countries
follows the trend of urbanization and lifestyle changes, including increasingly
sedentary lifestyles, less physically demanding work and the global nutrition
transition, marked by increased intake of foods that are high energy-dense but
nutrient-poor (often high in sugar and saturated fats, sometimes referred to as
the "Western-style" diet).
History
Diabetes was one of the first diseases described, with an
Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the
urine". The Ebers papyrus includes
a recommendation for a drink to be taken in such cases. The first
described cases are believed to be of type 1 diabetes. Indian
physicians around the same time identified the disease and classified it
as madhumeha or "honey urine", noting the urine
would attract ants.
The term "diabetes" or "to pass through" was
first used in 230 BCE by the Greek Apollonius of Memphis. The
disease was considered rare during the time of the Roman empire, with Galen commenting
he had only seen two cases during his career. This is possibly due to the
diet and lifestyle of the ancients, or because the clinical symptoms were
observed during the advanced stage of the disease. Galen named the disease
"diarrhea of the urine" (diarrhea urinosa).
The earliest surviving work with a detailed reference to
diabetes is that of Aretaeus of Cappadocia (2nd
or early 3rd century CE). He described the
symptoms and the course of the disease, which he attributed to the moisture and
coldness, reflecting the beliefs of the "Pneumatic School". He
hypothesized a correlation of diabetes with other diseases, and he discussed
differential diagnosis from the snakebite which also provokes excessive thirst.
His work remained unknown in the West until 1552, when the first Latin edition
was published in Venice.
Type 1 and type 2 diabetes were identified as separate
conditions for the first time by the Indian physicians Sushruta and Charaka in 400–500 CE with type 1
associated with youth and type 2 with being overweight. The term
"mellitus" or "from honey" was added by the Briton John
Rolle in the late 1700s to separate the condition from diabetes insipidus,
which is also associated with frequent urination. Effective treatment was
not developed until the early part of the 20th century, when Canadians Frederick Banting and Charles Herbert Best isolated
and purified insulin in 1921 and 1922. This was followed by the
development of the long-acting insulin NPH in the 1940s.
Etymology
The word diabetes (/ˌdaɪ.əˈbiːtiːz/ or /ˌdaɪ.əˈbiːtɪs/) comes
from Latin diabētēs, which in turn comes
from Ancient Greek διαβήτης
(diabētēs), which literally means "a passer through; a siphon". Ancient Greek physician Aretaeus of Cappadocia (fl. 1st century CE) used that word, with the intended meaning
"excessive discharge of urine", as the name for the disease. Ultimately,
the word comes from Greek διαβαίνειν (diabainein), meaning "to pass
through," which is composed of δια- (dia-), meaning
"through" and βαίνειν (bainein), meaning "to go". The
word "diabetes" is first recorded in English, in the form diabete,
in a medical text written around 1425.
The word mellitus (/məˈlaɪtəs/ or /ˈmɛlɪtəs/) comes
from the classical Latin word mellītus, meaning "mellite" (i.e.
sweetened with honey; honey-sweet). The Latin word comes from mell-,
which comes from mel, meaning "honey"; sweetness; pleasant
thing, and the suffix -ītus, whose meaning is the same as that
of the English suffix "-ite". It was Thomas Willis who in 1675 added
"mellitus" to the word "diabetes" as a designation for the
disease, when he noticed the urine of a diabetic had a sweet taste (glycosuria). This sweet taste had been noticed in
urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians.
Society
and culture
The 1989 "St. Vincent Declaration" was
the result of international efforts to improve the care accorded to those with
diabetes. Doing so is important not only in terms of quality of life and life
expectancy but also economically – expenses due to diabetes have been
shown to be a major drain on health – and productivity-related resources
for healthcare systems and governments.
Several countries established more and less successful national
diabetes programmes to improve treatment of the disease.
People with diabetes who have neuropathic symptoms such as numbness or tingling in feet or hands are twice
as likely to be unemployed as
those without the symptoms.
In 2010, diabetes-related emergency room (ER) visit rates in the
United States were higher among people from the lowest income communities (526
per 10,000 population) than from the highest income communities (236 per 10,000
population). Approximately 9.4% of diabetes-related ER visits were for the
uninsured.
Naming
The term "type 1 diabetes" has replaced several
former terms, including childhood-onset diabetes, juvenile diabetes, and
insulin-dependent diabetes mellitus (IDDM). Likewise, the term
"type 2 diabetes" has replaced several former terms, including
adult-onset diabetes, obesity-related diabetes, and noninsulin-dependent
diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon
standard nomenclature.
Diabetes mellitus is also occasionally known as "sugar
diabetes" to differentiate it from diabetes insipidus.
Other
animals
In animals, diabetes is most commonly encountered in dogs and
cats. Middle-aged animals are most commonly affected. Female dogs are twice as
likely to be affected as males, while according to some sources, male cats are
also more prone than females. In both species, all breeds may be affected, but
some small dog breeds are particularly likely to develop diabetes, such
as Miniature Poodles.
Feline diabetes mellitus is strikingly similar to human type 2
diabetes. The Burmese breed, along with the Russian Blue, Abyssinian, and
Norwegian Forest cat breeds, showed an increased risk of DM, while several
breeds showed a lower risk. There is an association between overweight and an
increased risk of feline diabetes.
The symptoms may relate to fluid loss and polyuria, but the
course may also be insidious. Diabetic animals are more prone to infections.
The long-term complications recognized in humans are much rarer in animals. The
principles of treatment (weight loss, oral antidiabetics, subcutaneous insulin)
and management of emergencies (e.g. ketoacidosis) are similar to those in
humans.
Research
Inhalable insulin has
been developed. The original products were withdrawn due to side effects. Afrezza,
under development by the pharmaceuticals company MannKind Corporation,
was approved by the FDA for general sale in June 2014. An advantage to
inhaled insulin is that it may be more convenient and easy to use.
Transdermal insulin in the form of a cream has been developed
and trials are being conducted on people with type 2
diabetes.
Major clinical trials
The Diabetes Control and Complications Trial (DCCT) was a
clinical study conducted by the United States National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
that was published in the New England Journal of Medicine in
1993. Test subjects all had diabetes mellitus type 1 and were randomized to a
tight glycemic arm and a control arm with the standard of care at the time;
people were followed for an average of seven years, and people in the treatment
had dramatically lower rates of diabetic complications. It was as a landmark
study at the time, and significantly changed the management of all forms of
diabetes.
The United Kingdom Prospective Diabetes Study (UKPDS) was a
clinical study conducted by Z that was published in The Lancet in
1998. Around 3,800 people with type II diabetes were followed for an average of
ten years, and were treated with tight glucose control or the standard of care,
and again the treatment arm had far better outcomes. This confirmed the
importance of tight glucose control, as well as blood pressure control, for
people with this condition.
Source :
https://en.wikipedia.org/wiki/Diabetes_mellitus
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