Медицина/ 4. Терапия

Medieva S.K., Murzintseva T.V. (senior teachers), Otesh I., Shayahanova N., Tugelbayeva T. (students of group 2-043 GM)

Karaganda State Medical University

Diabetes mellitus

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.

Several pathogenic processes are involved in the development of diabetes. These range from autoimmune destruction of the β-cells of the pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin action. The basis of the abnormalities in carbohydrate, fat, and protein metabolism in diabetes is deficient action of insulin on target tissues. Deficient insulin action results from inadequate insulin secretion and/or diminished tissue responses to insulin at one or more points in the complex pathways of hormone action. Impairment of insulin secretion and defects in insulin action frequently coexist in the same patient, and it is often unclear which abnormality, if either alone, is the primary cause of the hyperglycemia.

Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may also accompany chronic hyperglycemia. Acute, life-threatening consequences of uncontrolled diabetes are hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome.

Long-term complications of diabetes include retinopathy with potential loss of vision; nephropathy leading to renal failure; peripheral neuropathy with risk of foot ulcers, amputations, and Charcot joints; and autonomic neuropathy causing gastrointestinal, genitourinary, and cardiovascular symptoms and sexual dysfunction. Patients with diabetes have an increased incidence of atherosclerotic cardiovascular, peripheral arterial, and cerebrovascular disease. Hypertension and abnormalities of lipoprotein metabolism are often found in people with diabetes.

There are two principle forms of diabetes:

Type 1 diabetes (formerly known as insulin-dependent) in which the pancreas fails to produce the insulin which is essential for survival. This form develops most frequently in children and adolescents, but is being increasingly noted later in life.

Type 2 diabetes (formerly named non-insulin-dependent) which results from the body's inability to respond properly to the action of insulin produced by the pancreas. Type 2 diabetes is much more common and accounts for around 90% of all diabetes cases worldwide. It occurs most frequently in adults, but is being noted increasingly in adolescents as well.

Certain genetic markers have been shown to increase the risk of developing Type 1 diabetes. Type 2 diabetes is strongly familial, but it is only recently that some genes have been consistently associated with increased risk for Type 2 diabetes in certain populations.

The body usually is able to keep glucose concentrations stable. The normal fasting blood sugar is usually between 3.5-6.7mmol/l. After a meal it would rarely exceed 8mmol/l. Normally there is no glucose in urine since the normal threshold above which glucose would appear in the urine would be 10mmol/l. Below a concentration of 10mmol/l the kidneys reabsorb glucose back into the blood stream and so glucose does not appear in the urine unless the blood concentration of glucose is high.

To confirm the diagnosis, one of the following tests must be done:

1. Fasting blood glucose level - diabetes is diagnosed if it is higher than 126 mg/dL twice. Levels between 100 and 126 mg/dL are called impaired fasting glucose or pre-diabetes. These levels are risk factors for type 2 diabetes.

2. Hemoglobin A1c test:

Normal: Less than 5.7%

Pre-diabetes: 5.7% - 6.4%

Diabetes: 6.5% or higher

Screening for type 2 diabetes in people who have no symptoms is recommended for:

· Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years

· Overweight adults who have other risk factors

· Adults over age 45, repeated every 3 years

With type 2 diabetes, the disease may be reversed with lifestyle changes, especially losing weight through exercising and eating healthier foods.  

A periodic blood test estimates glucose levels in blood over the previous three months. It's used to help identify overall glucose level control and the risk of complications from diabetes, including organ damage.

Having type 1 diabetes does require significant lifestyle changes that include:

· Frequent testing of blood sugar levels

· Careful meal planning

· Daily exercise

· Taking insulin and other medications as needed

Treating both type 1 diabetes and type 2 diabetes involves medicines, diet, and exercise to control blood sugar level.

Getting better control over blood sugar, cholesterol, and blood pressure levels helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.

The goal of diabetes management is to keep blood glucose levels as close to normal as safely possible. Since diabetes may greatly increase risk for heart disease and peripheral artery disease, measures to control blood pressure and cholesterol levels are an essential part of diabetes treatment as well.

People with diabetes must take responsibility for their day-to-day care. This includes monitoring blood glucose levels, dietary management, maintaining physical activity, keeping weight and stress under control, monitoring oral medications and, if required, insulin use via injections.

In Kazakhstan, the number of diabetics has reached 207 935 people. Diabetes is the cause of one death every 7 seconds and more than 4.6 million deaths per year. According to IDF by the year 2030 one out of 10 people will suffer from diabetes without quick and prompt management.

The screening for the early detection of diabetes among people older than 40 years has been held since 2011. More than 15 000 new patients with diabetes mellitus have been revealed within 6 months of 2012. According to the International Diabetes Federation (IDF) 366 million people in the world suffer from diabetes today, that is more than 7% of the adult population. In Kazakhstan, according to the national register of diabetes, the incidence of DM has reached 207 935 people.

First World Day against diabetes was held by IDF (International Diabetes Federation) and WHO (World Health Organization) on November 14, 1991 to coordinate the fight against diabetes in the world.

"Despite the availability of proven evidence that a significant number of diabetes cases and its complications can be prevented through a healthy diet, regular physical activity, supporting normal body weight and a ban on tobacco use, these measures are not widely used,"- Leila Zhubandykova, the President of the Diabetes Association.

Literature:

1. http://care.diabetesjournals.org/content/27/suppl_1/s5.full

2. http://www.who.int/mediacentre/factsheets/fs138/en/

3. R. Souhami, J. Moxham, Diabetes Mellitus and disorders of lipid and intermediary metabolism. Churchill Livingston, London, 1994.