Diabetes mellitus is a serious medical condition where a person is unable to control their blood sugar levels. It’s one of the world’s largest health challenges;it kills over 3 million people per yearand the number of people diagnosed is rising dramatically.
There aretwo main types of diabetes, type 1 and type 2. Insulin, a hormone produced by specialised cells in the pancreas called β-cells, works to control glucose levels in the blood. In type 1, the pancreas is not able to produce this hormone. In type 2, the pancreas does not produce enough of it or the body cells don’t react to it as they should.
The causes of these diseases are different, but the potentially devastating effects are similar. High blood glucose levels (hyperglycaemia) can, over time, result in some serious long-term health problems, for examplediabetic retinopathy, nerve damage (peripheral neuropathy),cardiovascular diseaseandkidney disease.
Shockingly, on a global scale,50% of all people with diabetes are not diagnosed. That’s approximately 193 million adults with diabetes. Someone with type 2 diabetes can live with it for several years without any symptoms, allowing the disease to ravage the body unhindered.
50% of all people with diabetes are not diagnosed.
This year,World Diabetes Dayis concentrating on the importance of screening for diabetes, early diagnosis and treatment to help prevent serious complications. To mark the occasion,ISRCTNis doing something similar, focusing on recent research to help prevent the development of diabetes and the complications of diabetes.
Prevention of diabetes
Type 1 diabetes is an autoimmune disease which attacks the pancreas. There isn’t anything that people can do prevent this condition.
However, type 2 diabetes is a different matter. And that’s important as approximately90% of peoplediagnosed with the condition have type 2 diabetes. It can be related to lifestyle, and so is preventable. Being overweight puts people at much greater risk of developing the disease than people who are not. A higher body fat to muscle ratio means that insulin may not be effectively used by the body. More insulin is produced to compensate. Over time, increasing amounts of insulin is needed as the body gradually becomesinsulin resistant.All this extra production eventually causes β-cells in the pancreas to fail. This inevitably results in an increase in blood glucose levels. Maintaining a healthy weight therefore reduces the risk of type 2 diabetes, along with eating a healthy diet and exercising regularly. There are many studies registered in the ISRCTN registry that look at doing just this.
TheD-PLAN project, for example, tested a ten-month diabetes prevention course taking place in health centres in Poland. It involved group sessions focusing on changing diet and exercise habits, a two day a week exercise class as well as providing support and motivation.
Similarly, the ongoingNorfolk Diabetes Prevention Studyis looking at an education and exercise course for people at risk of type 2 diabetes, combined with help and support from people who have already been diagnosed with the condition.
Prevention of the complications of diabetes
Of course, not everyone is lucky enough to avoid developing diabetes and being diagnosed with the disease can feeldevastating. The good news, however, is that there is a lot that can be done to manage it. It is a very active area of research (the ISRCTN registry alone lists over600 studies) with researchers testing out new ways to help people manage their condition and prevent complications. We are going to look at just a few of them here.
Preventing heart disease and stroke
患有1型和2型糖尿病re at a higher than usual risk of developing cardiovascular disease, including heart disease, high blood pressure and stroke.
Diabetics are at greater risk of cardiovascular disease, such as heart disease and stroke.
One reason for this is that hyperglycaemia causesdamage to blood vessels,使他们more susceptible toatherosclerosis.People with diabetes develop atherosclerosis younger and to a greater degree than people without diabetes.
Themultidisciplinary diabetic care programlooked at whether a treatment package providing education, dietary advice and support from a social worker reduces hyperglycaemia and leads to a decrease in, for example, high cholesterol levels and high blood pressure – both risk factors for cardiovascular disease.
Preventing blindness
糖尿病性视网膜病变is a complication of diabetes that, if left untreated, can lead to loss of vision. It is caused by damage to the tiny blood vessels supplying the retina and, eventually, the development of scar
tissue andproliferative retinopathy. Early detection and treatment of diabetic retinopathy is vital in helping prevent visual impairment and even blindness.
Thisrecent UK studylooked into the effect of financial incentives to encourage reluctant diabetes patients to attend diabetic retinopathy screening appointments.
Once diabetic retinopathy has been diagnosed, there are varioustreatments available有一个considerable amount of researchin this area. Arecently registered studyfrom the Czech Republic, for example, explored the use of a light-emitting sleep mask to help prevent proliferative retinopathy.
Preventing diabetic foot ulcers
Up to 10% of diabetic patients have problems with their feet. Damage to the nerves in the leg (caused byperipheral neuropathy), combined with poor circulation can lead to foot ulcers and, ultimately, amputation of the affected limb. There area number of waysin this can be prevented including wearing especially designed footwear or orthoses.
For example,in this studyparticipants are being provided with insoles tailor made for their needs to test if it eases pressure on their foot compared to more traditional foot orthoses. Similarly, researchers at theUniversity Hospital Ayrhave been looking atimproving the design of insolesfor patients with diabetic peripheral neuropathy of the foot.
The take home message
Diabetes is a serious disease, potentially seriously affecting quality of life and causingpremature death.However, with screening, good treatment, good diet and exercise and taking preventive measures against complications, the road to a longer and healthier life for diabetics is well within reach.
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