Medically Reviewed By:
Last Updated on November 17, 2023 by Nazma
Diabetes is a major health issue affecting a large number of individuals in India. Diabetes has been known for a very long time, and it’s a big deal because it can cause a lot of health problems. Beyond simply causing high levels of sugar in the blood, diabetes can contribute to conditions like heart diseases, vision impairments, and kidney disorders. Additionally, managing diabetes can be costly in terms of healthcare.
The World Health Organization (WHO) website informs that India has over 77 million adults aged 18 and above who are diagnosed with type 2 diabetes. Moreover, an additional 25 million people are in the early stages known as prediabetes, putting them at a higher risk of developing full-blown diabetes. Unfortunately, more than half of these individuals are unaware of their diabetes status, which poses a significant health risk if left undetected and untreated. This lack of awareness can lead to the onset of health problems that could have been prevented with timely intervention.
The current research also shows that individuals who develop diabetes during their adult years face a much greater risk—two to three times higher—of experiencing heart attacks and strokes. These life-threatening events can have profound consequences on a person’s well-being. Therefore, it is crucial to raise awareness, promote early detection, and implement effective management strategies to mitigate the impact of diabetes-related complications.
In this review, we want to explain diabetes in simple terms. We’ll look at what causes it, how it affects the body, how doctors diagnose and treat it, and what new things are being tried to manage it better. We’ll also talk about how we can try to stop it from happening and what we need to study more in the future. Our goal is to help everyone understand diabetes better and find better ways to deal with it.
What are the types of diabetes?
There are several types of diabetes, each with distinct characteristics and causes. The main types of diabetes are:
Type 1 diabetes
This is a chronic medical condition in which the pancreas produces little to no insulin, a hormone that regulates blood sugar levels. This results in high blood sugar levels, requiring regular monitoring and insulin injections to manage the condition and prevent complications.
Type 2 diabetes
This is the most common type of diabetes and is often associated with lifestyle factors such as obesity and lack of physical activity. In type 2 diabetes, the body either doesn’t produce enough insulin or becomes resistant to its effects. It can often be managed through diet, exercise, oral medications, and sometimes insulin injections. (1)
Gestational diabetes
This type of diabetes occurs during pregnancy and usually resolves after childbirth. It develops when the body cannot produce enough insulin to meet the increased needs, leading to elevated blood sugar levels. Gestational diabetes requires careful monitoring and, in some cases, medication or insulin. (2)
Prediabetes
Prediabetes is a condition in which blood sugar levels are higher than normal but not high enough to be classified as type 2 diabetes. It’s considered a warning sign and an opportunity to make lifestyle changes to prevent or delay the onset of type 2 diabetes. (3)
Monogenic diabetes
This is a rare form of diabetes caused by a mutation in a single gene. It can sometimes be mistaken for type 1 or type 2 diabetes, but it has a distinct genetic cause. (4)
Secondary diabetes
This type of diabetes is caused by another underlying medical condition or medication. For example, certain hormonal disorders, pancreatic diseases, or medications can lead to secondary diabetes. (5)
Other forms of diabetes
There are various other rare and specific forms of diabetes, including neonatal diabetes (diagnosed in the first few months of life) (6) or mitochondrial diabetes (caused by mutations in mitochondrial DNA). (7 )
What are the mechanisms through which diabetes affects the body?
Diabetes arises from a complex interplay of physiological processes that impact the body’s ability to regulate blood sugar levels effectively.
Insulin resistance
Insulin resistance occurs when the body’s cells become less responsive to the effects of insulin. As a result, glucose uptake by cells is impaired, leading to elevated blood sugar levels. (8) This phenomenon is particularly prominent in type 2 diabetes and is often linked to factors like obesity and sedentary lifestyles.
Beta-Cell dysfunction
Beta cells in the pancreas play a vital role in producing insulin. In diabetes, these cells may not function properly, leading to reduced insulin secretion. This dysfunction is a key feature of both type 1 and type 2 diabetes, contributing to the disruption of blood sugar regulation.
Abnormal glucose metabolism
Diabetes disrupts the body’s ability to properly utilize glucose, the main source of energy. This can result in elevated blood sugar levels, which, over time, can lead to various complications affecting different organs and systems. (9)
Hormonal signalling pathways
Hormonal signalling pathways, including those involving insulin and other hormones like glucagon, play a crucial role in maintaining glucose balance. In diabetes, these pathways can become dysregulated, further contributing to abnormal blood sugar levels and metabolic imbalances. (10)
Family history
Genetics plays a role in diabetes susceptibility. Some people have a genetic predisposition that increases their risk of developing the condition. However, environmental factors such as poor diet, lack of exercise, obesity, and exposure to certain viruses also contribute significantly to the onset of diabetes.
What are the causes of diabetes?
Type 1 diabetes
This is an autoimmune condition where the body’s immune system attacks and destroys insulin-producing beta cells in the pancreas. (11) In this case, the immune system mistakenly targets and destroys insulin-producing beta cells in the pancreas. This autoimmune process reduces insulin production, leading to high blood sugar levels. The exact trigger for this immune response is not fully understood but likely involves a combination of genetic and environmental factors. People with type 1 diabetes require insulin injections or an insulin pump to regulate their blood sugar levels.
Type 2 diabetes
This condition is largely associated with insulin resistance, where the body’s cells do not respond effectively to insulin. (12) Over time, the pancreas may struggle to produce enough insulin to overcome this resistance, leading to elevated blood sugar levels. Genetic factors and lifestyle choices, such as poor diet and lack of physical activity, contribute to the development of type 2 diabetes.
Gestational diabetes
This condition is a pregnancy complication that occurs when the body cannot produce enough insulin to meet the increased demands, leading to elevated blood sugar levels. (13) This condition usually resolves after childbirth, but it increases the risk of developing type 2 diabetes in both the mother and child later in life.
There are various other specific types of diabetes caused by distinct factors. For instance, monogenic diabetes results from mutations in a single gene, while secondary diabetes is caused by certain medical conditions or medications. (14)
How is diabetes diagnosed?
Diagnosing diabetes involves carefully assessing specific criteria and indicators related to blood sugar levels and associated risks. This process helps healthcare professionals accurately identify and manage the condition.
Diagnostic criteria
Diagnostic criteria are the established guidelines used to determine if an individual has diabetes. These criteria often include specific blood sugar levels that, when exceeded, indicate the presence of the condition. The diagnostic criteria may vary depending on the type of diabetes and are an essential tool for early detection and intervention.
Glycemic indicators
Glycemic indicators are measurements that provide insights into a person’s blood sugar levels over time. One commonly used glycemic indicator is HbA1c, which reflects average blood sugar levels over several months. (15) Fasting plasma glucose and the oral glucose tolerance test are other indicators that help assess how well the body manages glucose after periods of fasting or consuming sugars.
Risk assessment tools
Healthcare professionals use risk assessment tools to evaluate an individual’s likelihood of developing diabetes or related complications. (16) These tools take into account various factors such as age, weight, family history, and lifestyle habits. By identifying individuals at higher risk, healthcare providers can offer targeted guidance and preventive measures to minimize the chances of developing diabetes.
Through careful consideration of diagnostic criteria, glycemic indicators, and risk assessment tools, healthcare professionals can effectively diagnose diabetes and tailor treatment plans to address each person’s unique needs. This comprehensive approach ensures timely intervention and better management of the condition to prevent complications and promote overall well-being.
What are the risk factors of diabetes?
Diabetes is influenced by a combination of factors that contribute to its development. These causes and risk factors provide insights into why some individuals are more susceptible to the condition than others.
Genetic predisposition
Genetic predisposition refers to the likelihood of developing diabetes due to inherited traits from family members. (17) Certain genes can increase the risk of diabetes, although genetics alone are not always the sole cause. Individuals with a family history of diabetes may have a higher likelihood of developing the condition.
Obesity and sedentary lifestyle
Being overweight or obese and leading a sedentary lifestyle significantly increase the risk of diabetes. (18) Excess body weight and lack of physical activity contribute to insulin resistance, a key factor in diabetes development.
Diet and Nutrition: Unhealthy eating habits, particularly a diet high in sugary and processed foods, can contribute to diabetes. (19) Consuming excess sugar and refined carbohydrates can lead to weight gain and negatively affect insulin sensitivity.
Age and ethnicity
Advancing age is a risk factor for diabetes. Older adults are more prone to developing the condition due to factors like decreased physical activity and changes in metabolism. Additionally, certain ethnic groups have a higher risk of developing diabetes. (20)
Gestational factors
During pregnancy, some women may develop gestational diabetes, a temporary form of diabetes. Hormonal changes during pregnancy can affect insulin function, leading to elevated blood sugar levels. While gestational diabetes typically resolves after childbirth, it increases the risk of developing type 2 diabetes later in life.
Other contributing factors
Other factors that may contribute to diabetes risk include hormonal imbalances, medical conditions like polycystic ovary syndrome (PCOS), and certain medications. Chronic stress, sleep disturbances, and exposure to environmental factors may also play a role in diabetes development.
Understanding these causes and risk factors helps individuals and healthcare professionals identify potential vulnerabilities and take proactive measures to prevent or manage diabetes. By addressing modifiable risk factors such as lifestyle choices and adopting healthy habits, the risk of developing diabetes can be minimized, promoting better overall health and well-being.
What are the symptoms of diabetes?
The symptoms and clinical signs of diabetes can vary, but they often provide important clues for diagnosing and managing the condition. Recognizing these indicators is crucial for timely intervention and effective treatment.
Polyuria, polydipsia, polyphagia
These three ‘poly symptoms are commonly associated with diabetes. Polyuria refers to frequent urination, caused by the body’s attempt to eliminate excess glucose through urine. Polydipsia is excessive thirst resulting from fluid loss due to frequent urination. Polyphagia is increased hunger as the body’s cells struggle to access glucose, leading to a feeling of constant hunger. (21)
Unexplained weight loss
Unintentional weight loss is a common symptom of diabetes. It occurs when the body starts breaking down muscle and fat for energy because it cannot effectively use glucose.
Fatigue and weakness
People with diabetes often experience persistent fatigue and weakness. This is because the body’s cells are not getting enough glucose for energy due to insulin-related issues.
Blurred vision
Elevated blood sugar levels can affect the lens of the eye, leading to blurred vision. While this symptom is usually temporary, it can be a sign of poorly controlled diabetes.
Slow wound healing
Diabetes can impair the body’s ability to heal wounds and injuries. High blood sugar levels can damage blood vessels and reduce blood flow, slowing down the healing process.
Neuropathic symptoms
Diabetes can lead to nerve damage, causing symptoms like tingling, numbness, and pain in the extremities, known as neuropathy. (22) This can impact the quality of life and require specialized management.
Cardiovascular symptoms
Diabetes is a significant risk factor for cardiovascular problems. People with diabetes may experience symptoms like chest pain, shortness of breath, and palpitations, indicating potential heart issues.
What is the treatment for diabetes?
Managing diabetes involves a combination of strategies aimed at controlling blood sugar levels, reducing complications, and improving overall health. These treatment approaches encompass various aspects of lifestyle adjustments and medical interventions.
Lifestyle modifications
Lifestyle changes play a crucial role in diabetes management. They include adopting healthier habits to better control blood sugar levels and improve overall well-being.
Diet
A balanced and nutritious diet is key to managing diabetes. Monitoring carbohydrate intake, focusing on whole foods, and controlling portion sizes help regulate blood sugar levels.
Physical activities
Regular exercise improves insulin sensitivity, helps manage weight, and contributes to better blood sugar control. (23) Engaging in activities like walking, swimming, or dancing can make a significant difference.
Weight management
Maintaining a healthy weight is important for diabetes management. Achieving and maintaining an appropriate weight can enhance insulin function and overall metabolic health.
Pharmacotherapy
Pharmacotherapy involves the use of medications to help control blood sugar levels. Various medications are available, and their selection depends on the type of diabetes and individual needs.
Oral antidiabetic agents
These are medications taken by mouth to help lower blood sugar levels. They work in different ways, such as improving insulin sensitivity or reducing glucose production in the liver.
Injectable insulin therapies
For individuals with type 1 diabetes or advanced type 2 diabetes, insulin injections are often necessary. Injectable insulin helps regulate blood sugar levels by replacing or supplementing the body’s insulin production. (24)
Surgical interventions
In specific cases, surgical procedures can be considered to manage diabetes and its associated risks. Bariatric surgery, such as gastric bypass or gastric sleeve surgery, may be recommended for individuals with severe obesity and diabetes. (25) These surgeries can lead to weight loss and improved blood sugar control.
How to manage diabetes?
Advancements in technology have introduced innovative approaches to diabetes management that offer improved monitoring, precision, and convenience. These contemporary strategies empower individuals to better control their blood sugar levels and enhance their overall quality of life.
Continuous glucose monitoring (CGM)
CGM involves wearing a small sensor under the skin to measure glucose levels continuously throughout the day and night. (26) This real-time data provides valuable insights into how various factors, such as meals and physical activity, affect blood sugar levels. CGM helps individuals make informed decisions about insulin doses, diet adjustments, and overall lifestyle choices.
Insulin pumps
Insulin pumps are small devices that deliver a continuous supply of insulin directly into the body through a small tube placed under the skin. (27) This method closely mimics the body’s natural insulin release and allows for precise insulin dosing adjustments based on individual needs. Insulin pumps offer flexibility in managing insulin delivery and can lead to better blood sugar control.
Artificial pancreas systems
Artificial pancreas systems, also known as closed-loop systems, combine CGM technology with insulin pumps to automate insulin delivery. (28) These systems continuously monitor blood sugar levels and adjust insulin doses in real time, reducing the need for manual intervention. Artificial pancreas systems aim to maintain blood sugar levels within a target range, minimizing the risk of highs and lows.
Telemedicine and digital health platforms
Telemedicine leverages digital communication tools to connect individuals with healthcare professionals remotely. Digital health platforms include mobile apps and online resources that offer personalized guidance, education, and monitoring. (29) These tools enable individuals to track their blood sugar levels, share data with healthcare providers, and receive real-time support, enhancing self-management and reducing the need for frequent in-person visits.
What are complications related to diabetes?
Diabetes can give rise to a range of health problems that affect different parts of the body. These complications can impact both small blood vessels (microvascular) and larger blood vessels (macrovascular).
Microvascular complications: Microvascular complications are problems that arise in small blood vessels due to diabetes. (30)
Retinopathy: Diabetes can cause damage to the blood vessels in the retina, leading to vision problems and potential blindness if not managed. (31)
Neuropathy: Nerve damage caused by diabetes can result in neuropathy, leading to tingling, numbness, and pain in the extremities. (32)
Nephropathy: Diabetes-related kidney damage, known as nephropathy, can impair kidney function over time and may lead to kidney failure. (33)
Macrovascular Complications: Macrovascular complications involve issues with larger blood vessels, particularly those related to the heart and circulatory system. (34)
Cardiovascular Disease: Diabetes increases the risk of heart diseases, including heart attacks and strokes, due to its impact on blood vessels and the heart. (35)
Atherosclerosis: The buildup of plaque in arteries, a condition known as atherosclerosis, is accelerated in individuals with diabetes, increasing the risk of heart problems. (36)
Foot Complications: Diabetes can lead to poor circulation and nerve damage in the feet, making them vulnerable to infections, ulcers, and in severe cases, amputation. (37)
How to prevent diabetes?
Preventing diabetes and promoting public health awareness involves various strategies aimed at reducing the occurrence of the condition and its associated complications on a larger scale.
Healthy lifestyle promotion
Promoting a healthy lifestyle is a fundamental approach to diabetes prevention. Encouraging individuals to adopt balanced diets, engage in regular physical activity, maintain a healthy weight, and manage stress can significantly reduce the risk of developing diabetes.
Awareness campaigns
Public awareness campaigns play a crucial role in educating individuals about diabetes risk factors, symptoms, and the importance of early detection. These campaigns raise consciousness about the condition and empower people to take proactive steps toward prevention and management.
Population-based solutions
Implementing solutions at the community or population level can have a broad impact on diabetes prevention. These interventions might include creating accessible spaces for physical activity, promoting healthy food environments, and offering educational programs in schools and workplaces.
Policy initiatives
Government policies and regulations can shape environments that either promote or hinder healthy behaviours. Policies related to food labelling, marketing of unhealthy products, urban planning, and healthcare access can influence diabetes prevention efforts.
What is the future research in diabetes?
Advancements in diabetes research continue to shape the way we understand, prevent, and treat the condition. Future research directions are aimed at harnessing innovative approaches to improve outcomes and quality of life for individuals with diabetes.
Precision medicine
Precision medicine involves tailoring treatments to an individual’s unique characteristics, including genetics, lifestyle, and environmental factors. In diabetes, precision medicine aims to develop targeted therapies that address specific aspects of the condition for each person, optimizing effectiveness and minimizing side effects. (38)
Genetics and personalised treatment
Research is delving deeper into the genetic factors that contribute to diabetes susceptibility and progression. (39) By identifying genetic markers and variations, scientists aim to predict who is at higher risk of developing diabetes and personalize treatment plans based on genetic predisposition.
Novel therapeutic targets
Scientists are exploring new therapeutic targets to develop more effective medications and interventions. This includes investigating molecules, pathways, and cellular mechanisms that play critical roles in diabetes development and progression. (40)
By embracing these future directions in diabetes research, we can expect to witness the development of more precise and effective treatments that address the underlying causes of the condition. This progress holds the potential to revolutionize diabetes management and significantly improve the lives of individuals affected by diabetes.
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