DIABETES



Identifying Current Issues



Identifying Current Issues

Diabetes is a Major Health Issue

Diabetes Mellitus is a major health issue which has affected millions of people worldwide. The estimated number of patients for 2011, was 366 million and by 2030, it is expected to involve more than 552 million people worldwide (Diabetes UK, 2012, pp. 4).

Etiology and Pathogenesis

Diabetes mellitus is a metabolic disorder associated with multiple etiologies. The main contributing factors in its pathogenesis are hyperglycemia, impaired metabolism of carbohydrate, fat and protein. It presents clinically as increased thirst, increased urine frequency and weight loss. If the blood sugar levels are not controlled, it can lead to keto-acidosis or hyperosmolar non-ketotic coma. Often symptoms may be mild or absent (Holt et. al., 2011, pp. 30-40).

Diabetes mellitus is associated with impaired insulin secretion and insulin resistance, which causes hyperglycaemia. If hyperglycaemia is not managed, patient may develop microvascular complications such as renal failure, neuropathy and blindness and macrovascular complications such as MI and atherosclerotsis (Shaw & Cummings, 2012 pp.165).

The clinical studies about diabetes suggest, that management of glucose level is effective in reducing microvascular and macrovascular complications. The mechanism by which these complications develops is may be due to direct toxic effects of hyperglycaemia, dyslipidaemia , oxidative stress damage to vessels and chronic inflammation. The presence of glycated bio molecules and free ROS are important risk factors in the pathogenesis of DM ( Marchasson et. al., 2012 pp.135).

Effects of Lifestyle on Diabetes

Type 1 is mostly related to diabetes during pregnancy ( medication, infections, complications, hormonal therapy, coffee, cola , tea consumption, alcohol, and smoking) or gestational age greater than 41 weeks and introduction of supplementary milk (Šipetic et.al., 2005, pp. 117-122)

T2DM is directly linked to obesity. As the central body fat is related to defects in insulin-mediated glucose uptake and lipid oxidation. Sedentary lifestyle, eating behaviours , reduced physical activity, intake of foods of low nutritional quality predispose to T2DM. Technology products like television, computers and cars promote sedentary lifestyle and contribute to obesity and ultimately to DM (Greena, 2012, pp 13-23).

Dietary restriction of <800 kcal/day can decrease the level of hyperglycaemia and VLCDs, which improves insulin sensitivity, regresses hepatic triglyceride deposits and causes improvement in lipid profile .Weight reduction can improve the metabolic efficiency by controlling the BMR (Day & Bailey , 2012 pp.149).

Classification of Diabetes

The first real attempt to classify diabetes came with the WHO Expert Committee on Diabetes, which classified it on the basis of age into juvenile-onset or Type-1 and maturity onset disease or Type-2.Type-I is caused by ß-cell destruction and insulin resistance .In Europids > 90% show the evidence of autoimmunity with anti-glutamine acid decarboxylase (anti-GAD) or anti islet cell antibodies. It shows strong association with alleles at DQ-A and DQ-B loci of HLA complex. Along with autoimmunity, sometimes there is complete loss of ß-cell function as evident by low C- peptide levels. This group is under the age of 30 years. They are mostly non-obese (Holt et. al., 2011, ...