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Overview
Diabetes mellitus is a condition that results in elevated blood glucose levels (hyperglycaemia). Continued elevation can contribute to progressive micro- and macrovascular complications leading to renal, nerve and ocular damage, representing a significant contributor to morbidity and mortality (Bilous and Donnelly, 2010). Currently there are more than 3 million adults (aged 18–99) diagnosed with the condition in the UK, representing a population prevalence of 5.9%; 1 in 17 adults has diabetes mellitus (International Diabetes Federation (IDF), 2021).
Diabetes is a chronic, metabolic disease characterised by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves.
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Risk factors
Although 7.4% of adults in England have diabetes, the risk varies according to ethnicity and social class. Those at high risk include:
- people from ethnic minorities (Public Health England, 2014).
- South Asian and Afro-Caribbean populations living in Britain (Diabetes UK, 2010)
- older people, especially from black and ethnic minorities (BME)
- people classified as obese
- people of low socio-economic status (Public Health England, 2020).
- socially deprived groups as they are also more prone to smoking and poor blood pressure control making them more prone to developing the complications of diabetes (Diabetes UK, 2006).
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Aetiology
Type 1 diabetes
Type 1 diabetes mellitus represents approximately 10% of cases. The origin of the condition is autoimmune in nature, arising from the complete destruction of insulin-secreting beta cells within the pancreas. Type 1 diabetes results in an absolute absence of insulin and therefore blood glucose levels continue to rise because glucose cannot enter the body's cells to be metabolised and produce energy; excess glucose cannot be stored as glycogen. These individuals require insulin injections every day.
Type 2 diabetes
Type 2 diabetes mellitus accounts for the remaining 90% of cases. It causes cells to be less responsive to insulin and/or reduces insulin production by the pancreas; therefore, glucose entry into the cell is reduced resulting in increased blood glucose levels. Type 2 diabetes is caused by a combination of genetic and ethnic predispositions, but predominantly lifestyle factors such as obesity and lack of physical
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Symptoms
| Symptom | Reason |
|---|---|
| Polydipsia: excessive thirst | The body tries to reduce sugar levels by passing more urine. The person drinks more to replace lost fluid |
| Polyuria: increased urine output | The body tries to reduce sugar levels by passing more urine |
| Polyphagia: increased appetite | The body is unable to use glucose effectively and the person feels hungry |
| Tiredness and irritability | The process that converts glucose into ATP and provides energy to the cells is affected. High blood sugar prevents the body drawing on reserves of glycogen in the liver |
| Fungal infection | High sugar levels in blood and tissues in crease infection risks |
| Poor wound healing | High sugar levels affect the circulation and can slow wound healing |
| Deterioration of vision | High sugar levels affect vision |
ATP, adenosine triphosphate. This is a high energy molecule that cells use to power their various functions. One such function is muscle cell
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Diagnosis
When a person has been diagnosed as having diabetes, blood pressure and weight will be monitored, blood tests carried out to check the person's kidney (renal) function and the level of cholesterol in the blood. The person will be offered eye screening and foot checks regularly. Advice and treatment will be provided if required.
Two types of blood tests are used to check blood sugar. These are:
A random sample is taken at any time of day and may be taken before or after meals. A fasting sample is taken when the person has had no food for at least 8 hours. Fasting blood sugars are usually taken first thing in the morning before the patient has had breakfast.
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Management
Pharmacological options
Pharmacotherapy becomes necessary when lifestyle modifications alone fail to induce or maintain adequate glycaemic control. Glycaemic management in type 2 diabetes has become increasingly complex and, to some extent, controversial, with an armamentarium of pharmacological options now available (Bolen et al, 2007; Bergenstal et al, 2010; Nolan, 2010; Blonde, 2010; Nyenwe et al, 2011), along with mounting concerns about their potential adverse effects and new uncertainties on the benefits of intensive glycaemic control on macrovascular complications (Greenfield et al, 2009; Matthews and Tsapas, 2008; Skyler et al, 2009; Yudkin et al, 2011).
The National Institute for Health and Care Excellence (NICE, 2009) recommends a number of oral hypoglycaemic agents (OHAs) in the management of type 2 diabetes. This includes sulphonylureas, biguanides (metformin), thiazolidinediones (glitazones), incretin mimetics, alpha-glucosidase inhibitors to insulin.
Different classes of diabetes medications include:
- Sulphonylureas - class of oral (tablet) medications that control blood sugar
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Resources
Diabetes Genes provides information for patients and health professionals on genetic types of diabetes.
References
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013; 36(Suppl 1):S67–S74. https://doi.org/10.2337/dc13-S067
Bilous R, Donnelly R. Handbook of diabetes. (4th edn). Chichester: Wiley-Blackwell; 2010
Buchanan TA, Xiang A, Kjos SL, Watanabe R. What is gestational diabetes? Diabetes Care. 2007; 30(Suppl 2):S105–S111. https://doi.org/10.2337/dc07-s201
Diabetes UK. State of the Nation 2006. Progress made in delivering the National Diabetes frameworks. Diabetes UK, London; 2006
Diabetes UK. Diabetes in the UK 2010, Key statistics on diabetes. 2010. https://www.diabetes.org.uk/resources-s3/2017-11/diabetes_in_the_uk_2010.pdf (accessed 5 December 2022)
Holt TA, Kumar S. ABC of diabetes. (7th edn). Chichester: Wiley Blackwell/BMJ Books; 2015
International Diabetes Federation. Diabetes atlas. (10th edn). 2021. https://diabetesatlas.org/atlas/tenth-edition/https://diabetesatlas.org/atlas/tenth-edition/ (accessed 5 December 2022)
Nolan J. What is Type 2 Diabetes. Medicine. 2006; 34(2): 52–6
Public Health England Adult Obesity And Type 2 Diabetes. 2014. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/338934/Adult_obesity_and_type_2_diabetes_.pdf (accessed 5
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