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What is Diabetes (medically known as Diabetes Mellitus)?

In April 2000, the WHO revised its definition of diabetes mellitus as a metabolic disorder of multiple causes, characterized by chronic hyperglycaemia (high blood glucose) with disturbances of: carbohydrate metabolism, fat metabolism, and protein metabolism resulting from defects in: insulin secretion, insulin action, or both


The diagnostic criteria rely on fasting blood glucose levels and also the rise in blood glucose two hours following a 75g glucose drink. It became clear with time that there were several different types of diabetes mellitus, and the latest classification is from the American Diabetes Association 2004
(Diabetes Care 2004; 27 suppl 1: s5-s10). Although this classification describes many types of diabetes mellitus, the two main forms are types 1 and 2. Worldwide, at least 85-95% of patients with diabetes have type 2, and the main differences between type 1 and type 2 are listed below.

Main differences between type 1 and type 2 diabetes mellitus

 

TYPE 1 (insulin dependent)

TYPE 2 (insulin resistant)

Epidemiology

Usually younger & lean

Mostly older & overweight

Genetic

No general genetic predisposition

Genetic predisposition

Pathogenesis

Autoimmunity

No evidence of autoimmunity

Clinical

Insulin deficiency, always needs insulin

Insulin resistance AND not enough insulin (even though insulin level may be high)

 

Patients with any form of diabetes may require insulin treatment at some stage of their disease. Such use of insulin does not, by itself, classify the patient.

In the last few years, there has been a significant advance in our understanding of type 2 diabetes in particular, and it is no longer regarded as a condition where the blood sugar is high (hyperglycaemia), but more as a "metabolic syndrome" of:

Insulin resistance  

High blood pressure  

High total and LDL cholesterol 

High triglycerides 

Low HDL cholesterol 

Obesity

Premature heart disease associated with high blood sugar (hyperglycaemia).

The physician’s emphasis is therefore no longer tailored on just monitoring blood sugar levels, but should crucially address the other aspects of type 2 diabetes, with the aim of preventing or mitigating the high potential for heart disease, stroke, peripheral vascular disease and other complications of the metabolic syndrome. Blood pressure control is paramount for the reduction in these so-called "macrovascular" complications, as proven by the large UKPDS-38 trial (Brit Med J 1998; 317: 703-713). Our goal is to achieve meticulous blood pressure control, regular review and tight control of blood lipids (cholesterol, LDL, HDL, triglycerides), lifestyle changes, and all other means of cardiovascular risk management such as cessation of smoking, low-dose aspirin therapy and regular exercise.

In parallel with these measures, it is still important to control blood sugar levels. With the outcome of large multicentre trials (UKPDS-33 Lancet 1998; 352: 837-53), it is now clear that reducing blood sugar levels towards the normal range minimizes the other complications of diabetes (“microvascular”), namely eye problems (retinopathy), kidney disease (nephropathy) and nerve problems (neuropathy).

The optimal management of diabetes therefore has to be as part of a multi-disciplinary team including diabetes physicians, cardiologists, ophthalmologists, nephrologists, trained nurses, dieticians, podiatrists. Regularly-updated guidelines and protocols for management are critical, and the use of database systems/ registries are widely recommended.

 

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Last modified: 01/21/16