The global prevalence of diabetes

Diabetes, a disease affecting blood glucose control, is a growing issue worldwide. From 1980 to 2014, the number of people affected by diabetes almost quadrupled from 108 million to 422 million worldwide, or a growth in diabetes prevalence of 4.7% to 8.5% [1].

This growth trend is not estimated to stop or slow in the future. According to the IDF Diabetes Atlas, by 2040, the number of worldwide diabetics is expected to grow to 642 million, representing a potential future healthcare crisis for patients and providers [2].

Healthcare costs are also expected to balloon. Between 2007 and 2012, the healthcare costs associated with diabetes rose from $174 billion to $245 billion, or 41% in just five years [3].

Most diabetes cases occur in developing countries, representing a high proportion of the disease’s economic burden. The prevalence of diabetes in Asian countries is exceptionally high and expected to increase [4].

60% of the world’s diabetic population is concentrated in Asian countries, with socio-economic growth, industrialization, and urbanization being three of the most common factors associated with the increased prevalence of the disease [4].

Diabetes is also growing in potentially epidemic proportions in India, where over 62 million people are affected [5,6]. Genetic factors, improved living standards, and rising levels of obesity are some of the many reasons associated with diabetes growing in this geographic region [7].

What are the health effects of Diabetes?

The short- and long-term health effects associated with diabetes are many, and each of these health effects worsens with poor glycemic control. Managing diabetes appropriately with prescribed therapies, diet, and lifestyle changes is crucial for reducing the progression of associated symptoms.

Short-term health effects

• Hypoglycemia is when a patient has low blood sugar levels. In diabetes, this may result if blood glucose is poorly managed, either by using too much insulin or missing a meal. It can also be affected by behavior such as alcohol consumption and exercise. Hypoglycemia can occur in some patients who have yet to be diagnosed. Symptoms include confusion, raised heart rate, anxiety, headache, lethargy, and potentially a loss of consciousness.
• Ketoacidosis: If the body has little insulin to draw glucose from the bloodstream and refuel cells, it will metabolize fat into acidic ketones. If this is allowed to continue, levels of ketones will become too high and cause ketoacidosis, while the liver will produce glucose to combat the problem, leading to high glucose levels in the bloodstream. Symptoms include high thirst, increased urination, vomiting, and comas. Generally, this condition is seen in type 1 diabetes patients or patients with type 2 diabetes who produce only small amounts of insulin.
• Hyperosmolar hyperglycemic state (HHS): Often caused by illness or ineffective diabetes medication, hyperosmolar hyperglycemic states are characterized by a blood glucose level over 40 mmol/l. This high blood sugar level causes severe dehydration and requires fluids to treat. Symptoms include increased thirst and urination, nausea, disorientation, a high risk of complications, and coma.

Long-term health effects

• Diabetic retinopathy: Poorly managed type 2 diabetes can result in prolonged high blood glucose, damaging the small vessels in the eye’s retina and causing diabetic retinopathy. If left untreated, this disorder can lead to blindness. Once retinopathy has set in, treatments are generally limited to intraocular laser photocoagulation therapy and anti-VEGF injections into the eye. Therefore, proper management of diabetes is the best preventative measure.
• Cardiovascular disease: People with diabetes are at an increased risk for developing cardiovascular disease (CVD) due to inflammation, oxidative stress, HbA1c, and a multitude of other associated factors [8]. Chronic hyperglycemia (high blood sugar) triggers inflammation and oxidation, contributing to the pathogenesis of endothelial dysfunction. This is one reason why managing diabetes is crucial for reducing future morbidity and mortality.
• Nephropathy: Kidney disease, or nephropathy, is a common long-term complication of diabetes. Hyperglycemia can cause the filtering of too much blood through the kidneys, which can contribute to kidney damage. These filters can start to leak small amounts of protein into urine, which is called microalbuminuria. More significant amounts of blood sugar will leak into the bloodstream if blood sugar remains high, called macroalbuminuria. In its later stages, end-stage renal disease may result. Symptoms of nephropathy include fluid buildup, insomnia, upset stomach, fatigue, and difficulty concentrating [9].
• Neuropathy: Affecting the nerves, neuropathy is a long-term complication also associated with chronic and uncontrolled diabetes. Hyperglycemia can cause damage to small blood vessels supplying the nerves, precluding the delivery of essential nutrients. Three types of neuropathy exist: sensory, autonomic, and motor [10].

People with diabetes can take measures to reduce their blood sugar and prevent the progression of short- and long-term health effects. Exercise improves cells’ sensitivity to insulin in type 2 diabetes and enhances a well-rounded treatment protocol consisting of a healthy diet and pharmacological (insulin therapy) support [11].

Regular analytic measurements with a glucose analyzer can help monitor the effect of therapy and assess the most appropriate strategy based on a patient’s needs.

• [1] Global report on diabetes. World Health Organization. http://www.who.int/diabetes/global-report/en/.
• [2] Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, Cavan D, Shaw JE, Makaroff LE. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017 Jun;128:40-50. doi: 10.1016/j.diabres.2017.03.024.
• [3] The Cost of Diabetes. American Diabetes Association. https://diabetes.org/about-us/statistics/cost-diabetes.
• [4] Ramachandran A, Snehalatha C, Shetty AS, Nanditha A. Trends in prevalence of diabetes in Asian countries. World J Diabetes. 2012;3(6):110-117.
• [5] Kumar A, Goel MK, Jain RB, Khanna P, Chaudhary V. India towards diabetes control: Key issues. Australas Med J. 2013;6(10):524-531.
• [6] Joshi SR, Parikh RM. India–diabetes capital of the world: now heading towards hypertension. J Assoc Physicians India. 2007;55:323-324.
• [7] Kaveeshwar SA, Cornwall J. The current state of diabetes mellitus in India. Australas Med J. 2014;7(1):45-48.
• [8] Mannucci E, Dicembrini I, Lauria A, Pozzilli P. Is glucose control important for prevention of cardiovascular disease in diabetes? Diabetes Care. 2013;36 Suppl 2:S259-263.
• [9] Kidney Disease (Nephropathy). American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html.
• [10] Nerves (neuropathy). Diabetes UK. https://www.diabetes.org.uk/Guide-to-diabetes/Complications/Nerves_Neuropathy/.
• [11] Dubé JJ, Allison KF, Rousson V, Goodpaster BH, Amati F. Exercise dose and insulin sensitivity: relevance for diabetes prevention. Med Sci Sports Exerc. 2012;44(5):793-799.