Diabetes mellitus (DM) is a generalised metabolic disorder. This disorder affects not only carbohydrates (sugars), but also lipids with proteins. Its aetiology is multifactorial and heterogeneous. The common denominator of all conditions that eventually lead to the onset of Diabetes Mellitus is a complete or relative lack of insulin. Complete insulin deficiency is observed in cases of failure of the pancreas to produce even minimal amounts of insulin. This occurs in type 1 diabetes and LADA type diabetes, where there is autoimmune destruction of beta cells in the pancreas. Relative insulin deficiency occurs when, although there are adequate levels of insulin in the blood, there is not enough to meet metabolic needs. This is because there is resistance to the action of insulin. A typical case is type 2 diabetes mellitus. Worldwide there are an estimated 462 million patients with type 2 diabetes mellitus, a number that is expected to increase in the coming decades. Western lifestyles, sedentary lifestyles, lack of physical activity, over-consumption of calories and obesity contribute to this.
There are different types of diabetes mellitus. The most common is type 2 diabetes mellitus (90% of cases). Type 1 & LADA type Diabetes Mellitus refers to 6-8% of all Diabetes Mellitus cases. Other rarer forms of Diabetes Mellitus include: neonatal DM, MODY type diabetes, DM from genetic disorders in insulin action, DM in the context of endocrinopathies, DM in the context of infections, drug-induced DM, gestational DM.
Diagnostic Criteria for Diabetes Mellitus:
- Morning glucose after 8 hours of fasting above 126 mg/dL
- Glycosylated haemoglobin above 6.5%
- Blood sugar above 200 mg/dL 2 hours after oral loading with 75 g of glucose (blood sugar curve)
- Blood sugar above 200 mg/dL measured at random in a person with typical symptoms of DM (polyuria, polydipsia, polyphagia, unexplained weight loss)
The blood glucose curve, in combination with simultaneous measurement of insulin levels, is the most sensitive method of detecting DM or even people who are prone to DM (prediabetes)
Pre-diabetic people are defined as those with:
- Morning blood sugar after 8 hours of fasting between 100-125mg/dL
- Sugar between 140-199mg/dL 2 hours after oral loading with 75g of glucose (sugar curve)
Early detection and treatment of prediabetic individuals is very important as they are at significantly increased risk of cardiovascular disease compared to the general population. Adopting a healthy lifestyle in the prediabetic phase may completely reverse the adverse complications of DM.
Non-pharmaceutical means are a cornerstone and a prerequisite for successful treatment of type 2 diabetes mellitus. They are also recommended for people who are in a Pre-diabetic state. These measures include:
- Reduction of body weight by 5-10%
- Moderate intensity physical exercise 30-40 minutes 4 times a week
- Reduce total fat intake and trans fatty acid intake
- Increasing the intake of fibre in the daily diet
- Stop smoking
- Long-term adoption of a healthy lifestyle
The complications of Diabetes Mellitus are related to the cardiovascular system. Either smaller vessels or larger vessels of the human body are involved. Thus, retinopathy, nephropathy, neuropathy, coronary artery disease, vascular brain disease, carotid artery disease, peripheral arterial disease may result.
Nowadays there is a plethora of treatment options in the treatment of patients with Diabetes Mellitus. Each patient is unique and treatment is individualized according to the needs, desires, lifestyle and therapeutic goal of each patient. Regular medical monitoring, complication control and doctor-patient interaction lead to the regulation of Diabetes Mellitus, prevention of complications and consequently improvement of the patients' Quality of Life.