Diabetes mellitus, WHO,

http://www.who.int/mediacentre/factsheets/fs138/en/
Fact sheet N138

Diabetes mellitus is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas or by the ineffecti!eness of the insulin produced. "uch a deficiency results in increased concentrations of #lucose in the blood which in turn dama#e many of the body$s systems in particular the blood !essels and ner!es. %here are two principle forms of diabetes: Type 1 diabetes &formerly 'nown as insulin(dependent) in which the pancreas fails to produce the insulin which is essential for sur!i!al. %his form de!elops most frequently in children and adolescents but is bein# increasin#ly noted later in life. Type 2 diabetes &formerly named non(insulin(dependent) which results from the body$s inability to respond properly to the action of insulin produced by the pancreas. %ype * diabetes is much more common and accounts for around +,- of all diabetes cases worldwide. .t occurs most frequently in adults but is bein# noted increasin#ly in adolescents as well. /ertain #enetic mar'ers ha!e been shown to increase the ris' of de!elopin# %ype 1 diabetes. %ype * diabetes is stron#ly familial but it is only recently that some #enes ha!e been consistently associated with increased ris' for %ype * diabetes in certain populations. 0oth types of diabetes are comple1 diseases caused by mutations in more than one #ene as well as by en!ironmental factors. Diabetes in pre#nancy may #i!e rise to se!eral ad!erse outcomes includin# con#enital malformations increased birth wei#ht and an ele!ated ris' of perinatal mortality. "trict metabolic control may reduce these ris's to the le!el of those of non(diabetic e1pectant mothers. .mpaired #lucose tolerance &.2%) and impaired fastin# #lycaemia &.F2) refer to le!els of blood #lucose concentration abo!e the normal ran#e but below those which are dia#nostic for diabetes. "ub3ects with .2% and/or .F2 are at substantially hi#her ris' of de!elopin# diabetes and cardio!ascular disease than those with normal #lucose tolerance. %he benefits of clinical inter!ention in sub3ects with moderate #lucose intolerance is a topic of much current interest.

Symptoms
%he symptoms of diabetes may be pronounced subdued or e!en absent. .n %ype 1 diabetes the classic symptoms are e1cessi!e secretion of urine &polyuria) thirst &polydipsia) wei#ht loss and tiredness. %hese symptoms may be less mar'ed in %ype * diabetes. .n this form it can also happen that no early symptoms appear and the disease is only dia#nosed se!eral years after its onset when complications are already present.

Prevalence
4ecently compiled data show that appro1imately 15, million people ha!e diabetes mellitus worldwide and that this number may well double by the year *,*5. 6uch of this increase will occur in de!elopin# countries and will be due to population #rowth a#ein# unhealthy diets obesity and sedentary lifestyles. 0y *,*5 while most people with diabetes in de!eloped countries will be a#ed 75 years or more in de!elopin# countries most will be in the 85(78 year a#e brac'et and affected in their most producti!e years.

Diagnosis

9:; has published recommendations on dia#nostic !alues for blood #lucose concentration. %he dia#nostic le!el of fastin# blood #lucose concentration was last modified in 1+++.

Treatment
%he mainstay of non(pharmacolo#ical diabetes treatment is diet and physical acti!ity. <bout 8,- of diabetes sufferers require oral a#ents for satisfactory blood #lucose control and some 8,- need insulin in3ections. %his hormone was isolated by Frederic 0antin# and /harles 0est in 1+*1 in /anada. .t re!olutioni=ed the treatment of diabetes and pre!ention of its complications transformin# %ype 1 diabetes from a fatal disease to one in which lon#(term sur!i!al became achie!able. >eople with %ype 1 diabetes are usually totally dependent on insulin in3ections for sur!i!al. "uch people require daily administration of insulin. %he ma3ority of people sufferin# from diabetes ha!e the %ype * form. <lthou#h they do not depend on insulin for sur!i!al about one third of sufferers needs insulin for reducin# their blood #lucose le!els. .nsulin is una!ailable and unaffordable in many poor countries despite bein# listed by 9:; as an essential dru#. <ccess to insulin by those who require it is a sub3ect of special concern to international health a#encies and national health authorities.

Complications associated wit

diabetes mellitus

Diabetic retinopathy is a leadin# cause of blindness and !isual disability. Diabetes mellitus is associated with dama#e to the small blood !essels in the retina resultin# in loss of !ision. Findin#s consistent from study to study ma'e it possible to su##est that after 15 years of diabetes appro1imately *- of people become blind while about 1,- de!elop se!ere !isual handicap. ?oss of !ision due to certain types of #laucoma and cataract may also be more common in people with diabetes than in those without the disease. 2ood metabolic control can delay the onset and pro#ression of diabetic retinopathy. ?oss of !ision and blindness in persons with diabetes can be pre!ented by early detection and treatment of !ision(threatenin# retinopathy: re#ular eye e1aminations and timely inter!ention with laser treatment or throu#h sur#ery in cases of ad!anced retinopathy. %here is e!idence that e!en in de!eloped countries a lar#e proportion of those in need is not recei!in# such care due to lac' of public and professional awareness as well as an absence of treatment facilities. .n de!elopin# countries in many of which diabetes is now common such care is inaccessible to the ma3ority of the population. Diabetes is amon# the leadin# causes of 'idney failure but its frequency !aries between populations and is also related to the se!erity and duration of the disease. "e!eral measures to slow down the pro#ress of renal dama#e ha!e been identified. %hey include control of hi#h blood #lucose control of hi#h blood pressure inter!ention with medication in the early sta#e of 'idney dama#e and restriction of dietary protein. "creenin# and early detection of diabetic 'idney disease are an important means of pre!ention. :eart disease accounts for appro1imately 5,- of all deaths amon# people with diabetes in industriali=ed countries. 4is' factors for heart disease in people with diabetes include smo'in# hi#h blood pressure hi#h serum cholesterol and obesity. Diabetes ne#ates the protection from heart disease which pre(menopausal women without diabetes e1perience. 4eco#nition and mana#ement of these conditions may delay or pre!ent heart disease in people with diabetes. Diabetic neuropathy is probably the most common complication of diabetes. "tudies su##est that up to 5,- of people with diabetes are affected to some de#ree. 6a3or ris' factors of this condition are the le!el and duration of ele!ated blood #lucose. Neuropathy can lead to sensory loss and dama#e to the limbs. .t is also a ma3or cause of impotence in diabetic men. Diabetic foot disease due to chan#es in blood !essels and ner!es often leads to ulceration and subsequent limb amputation. .t is one of the most costly complications of diabetes especially in communities with inadequate footwear. .t results from both !ascular

and neurolo#ical disease processes. Diabetes is the most common cause of non(traumatic amputation of the lower limb which may be pre!ented by re#ular inspection and #ood care of the foot.

Prevention
?ar#e population(based studies in /hina Finland and @"< ha!e recently demonstrated the feasibility of pre!entin# or delayin# the onset of diabetes in o!erwei#ht sub3ects with mild #lucose intolerance &.2%). %he studies su##est that e!en moderate reduction in wei#ht and only half an hour of wal'in# each day reduced the incidence of diabetes by more than one half. Diabetes is a serious and costly disease which is becomin# increasin#ly common especially in de!elopin# countries and disad!anta#ed minorities. :owe!er there are ways of pre!entin# it and/or controllin# its pro#ress. >ublic and professional awareness of the ris' factors for and symptoms of diabetes are an important step towards its pre!ention and control.