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 year and the number of people diagnosed is rising dramatically.
There are two 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 example diabetic retinopathy, nerve damage (peripheral neuropathy), cardiovascular disease and kidney 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 Day is concentrating on the importance of screening for diabetes, early diagnosis and treatment to help prevent serious complications. To mark the occasion, ISRCTN is 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 approximately 90% of people diagnosed 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 becomes insulin 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.
The D-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 ongoing Norfolk Diabetes Prevention Study is 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 feel devastating. 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 over 600 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
People suffering from type 1 and type 2 diabetes are 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 causes damage to blood vessels, making them more susceptible to atherosclerosis. People with diabetes develop atherosclerosis younger and to a greater degree than people without diabetes.
The multidisciplinary diabetic care program looked 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.
Diabetic retinopathy 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 and proliferative retinopathy. Early detection and treatment of diabetic retinopathy is vital in helping prevent visual impairment and even blindness.
This recent UK study looked 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 various treatments available and there is a considerable amount of research in this area. A recently registered study from 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 by peripheral neuropathy), combined with poor circulation can lead to foot ulcers and, ultimately, amputation of the affected limb. There are a number of ways in this can be prevented including wearing especially designed footwear or orthoses.
For example, in this study participants 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 the University Hospital Ayr have been looking at improving the design of insoles for patients with diabetic peripheral neuropathy of the foot.
The take home message
Diabetes is a serious disease, potentially seriously affecting quality of life and causing premature 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.