Diabète
The number of people with diabetes has increased from 108 million in 1980 to 422 million in 2014.
The global prevalence of diabetes in adults over 18 years of age has increased from 4.7% in 1980 to 8.5% in 2014 (1).
Between 2000 and 2016, premature mortality due to diabetes increased by 5%.
The prevalence of diabetes has increased more rapidly in low- and middle-income countries than in high-income countries.
Diabetes is a major cause of blindness, kidney failure, heart attack, stroke and lower limb amputation.
An estimated 1.6 million deaths were directly caused by diabetes in 2016, while 2.2 million deaths were attributable to hyperglycemia in 2012.
Nearly half of deaths due to hyperglycemia occur before the age of 70. The WHO estimates that diabetes was the seventh leading cause of death in 2016.
Eating a healthy diet, regular physical activity, maintaining a normal weight and avoiding tobacco use can help prevent or delay the onset of type 2 diabetes.
A healthy diet, physical activity, medication, regular screening and treatment of complications can treat diabetes and prevent or delay its consequences.
Overview
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body does not properly use the insulin it produces. Insulin is a hormone that regulates blood sugar levels. Hyperglycemia, or high blood sugar levels, is a common effect of uncontrolled diabetes that over time leads to serious damage to many body systems, especially nerves and blood vessels.
In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2016, diabetes directly caused 1.6 million deaths, while hyperglycemia caused 2.2 million deaths in 2012.
Between 2000 and 2016, premature mortality due to diabetes increased by 5%. In high-income countries, the rate of premature mortality due to diabetes decreased from 2000 to 2010 but increased from 2010 to 2016. In lower-middle-income countries, the rate of premature mortality due to diabetes increased in both periods.
In contrast, the probability of dying from one of the four major types of non-communicable diseases (cardiovascular disease, cancer, chronic respiratory disease or diabetes) between the ages of 30 and 70 decreased by 18% globally between 2000 and 2016.
Type 2 diabetes
Type 2 diabetes (formerly known as non-insulin-dependent or adult-onset diabetes) is the result of the body misusing insulin. Type 2 diabetes accounts for the majority of cases of diabetes. It is largely the result of being overweight and lack of physical activity.
Its symptoms may be similar to those of type 1 diabetes but are often less severe. As a result, the disease can be diagnosed several years after its onset, once complications are already present.
Until recently, this type of diabetes was only seen in adults, but it is now increasingly occurring in children as well.
Type 1 diabetes
Type 1 diabetes (formerly known as insulin-dependent or juvenile diabetes) is characterized by an insufficient production of insulin, which must be administered daily. The cause of type 1 diabetes is not known, and according to current knowledge, it is not preventable.
Symptoms include excessive urine excretion (polyuria), feelings of thirst (polydipsia), constant hunger, weight loss, impaired vision and fatigue. These symptoms may appear suddenly.
Gestational diabetes
Gestational diabetes is characterized by the occurrence of hyperglycemia, an increase in blood glucose levels during pregnancy above normal levels but below the levels that lead to the diagnosis of diabetes.
Women with gestational diabetes have an increased risk of complications during pregnancy and childbirth. They and their child's risk of developing type 2 diabetes later in life also increases.
It is very often diagnosed during prenatal screening and not because of the occurrence of symptoms.
Impaired glucose tolerance and fasting glucose levels
Impaired glucose tolerance and impaired fasting glucose are intermediate conditions at the borderline between normal and diabetes. People with impaired glucose tolerance and fasting glucose levels are at high risk of developing type 2 diabetes, although this is not inevitable.
Health Consequences
Over time, diabetes can lead to damage to the heart, blood vessels, eyes, kidneys and nerves.
In adults, diabetes doubles or triples the risk of heart attack and stroke (1).
Neuropathy affecting the feet, combined with reduced blood flow, increases the likelihood of ulcers, infection and, ultimately, amputation.
Diabetic retinopathy, a major cause of blindness, occurs as a result of damage to the small blood vessels of the retina. Diabetes accounts for 2.6% of blindness worldwide (2).
Diabetes is one of the leading causes of kidney failure (3).
Prevention
Simple lifestyle changes have been shown to prevent or delay the onset of type 2 diabetes. To prevent type 2 diabetes and its complications, it is necessary to :
Achieve a normal weight and not gain weight;
physical activity - at least 30 minutes a day of regular, moderate-intensity activity. More intense physical activity is necessary to lose weight;
eat a healthy diet and avoid sugar and saturated fats; and
abstain from smoking - smoking increases the risk of diabetes and cardiovascular disease.
Diagnosis and treatment
Early diagnosis can be made by measuring blood glucose levels, which is relatively inexpensive.
The treatment of diabetes requires a healthy diet and physical activity as well as reducing blood glucose and other risk factors for blood vessel damage. Smoking cessation is also important to avoid complications.
Cost-effective and feasible interventions in low- and middle-income countries include the following:
blood glucose control, especially for people with type 1 diabetes. People with type 1 diabetes need insulin, while those with type 2 diabetes can take oral therapy, but may also need insulin ;
blood pressure control; and
foot care (the patient should ensure foot hygiene, wear appropriate footwear, seek professional ulcer management and have regular foot examinations by health care professionals).
Other cost-effective interventions include
Screening for retinopathy (which causes blindness);
blood lipid control (to regulate cholesterol levels);
screening for early signs of diabetes-related kidney disease and treatment.
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