By Ernst Lamothe Jr
Diabetes is a chronic health condition that affects millions of people worldwide, making it a significant topic in healthcare. About 422 million adults live with diabetes. The number is expected to rise, according to the World Health Organization. In addition, diabetes can lead to blindness, kidney failure, heart attacks, stroke and lower limb amputation. The impact of diabetes on an individual’s quality of life and the healthcare system is profound, emphasizing the urgent need for prevention, early detection and management strategies.
The main difference between Type 1 and Type 2 diabetes is the type of insulin problem a person has. Type 1 diabetes is an autoimmune condition that occurs when the body’s immune system attacks and destroys the pancreas’ insulin-producing cells. It can start at any age, but it often begins in childhood or adolescence. Type 2 diabetes occurs when the body doesn’t produce enough insulin, or the body’s cells don’t react to insulin properly. It can develop at any age, but it’s more common in adults.
Physician Susanne Miedlich, associate professor of medicine at the University of Rochester Medical Center, discusses five aspects of diabetes.
1. Symptoms
Classical symptoms of diabetes are increased thirst and urination, fatigue, blurry vision and possibly weight loss. These symptoms can be subtle and may develop gradually over months or years, especially in people with the much more common Type 2 diabetes, which are characterized by resistance to insulin and a slow decline of insulin secretion by the pancreatic beta cells. The latter fact emphasizes the need for screening for diabetes in people at risk for diabetes, such as people with obesity, for instance.
“On the other hand, people with Type 1 diabetes present most often with the relatively sudden occurrence of the above symptoms,” said Miedlich. “Type 1 diabetes is caused by a relatively rapid decline in beta cell function and thus, insulin production as a result of an abnormal immune response that triggers the destruction of the insulin-producing beta cells.”
2. Treatment
Patients with Type 1 diabetes are treated with insulin. Thanks to the advances of modern biotechnology, we now have insulins that act within minutes of injection, insulins whose glucose-lowering effects last for several days after just one injection and insulin pumps, which deliver insulin according to a computer algorithm that incorporates information about the blood glucose trends and the insulin needed to lower glucose levels.
“Lifestyle measures that include a healthy diet, regular exercise, sufficient sleep and stress reduction can greatly improve insulin resistance in patients with early Type 2 diabetes or prediabetes,” said Miedlich. “People with obesity benefit tremendously from weight loss, achieved by lifestyle measures, medications or weight loss surgery. All of the above measures have the potential to reverse Type 2 diabetes. There is a growing number of oral and injectable medications other than insulin that increase insulin sensitivity and secretion or promote glucose removal by the kidneys and thus lower blood glucose levels in people with Type 2 diabetes. Controlling blood glucose levels in people with diabetes is critical to preventing diabetes complications, such as damage to the nerves, eyes, kidneys, and heart.”
3. Trends in diabetes
The incidence and prevalence of diabetes, both Type 1 and Type 2, is increasing. The increased incidence and prevalence of Type 2 diabetes in particular, is noted alongside an increased incidence and prevalence of obesity in both adolescent and adult people. According to the CDC, new cases of both Type 1 and Type 2 diabetes in young people in the United States increased from 2002 to 2018. The number of new cases of Type 1 diabetes per 100,000 young people increased from 20 to 22 per year and the number of new cases of Type 2 diabetes increased from nine to 18 per year.
“The reasons for increased incidence and prevalence of Type 1 diabetes are less clear but may be associated with increased exposure to environmental agents and viruses,” said Miedlich.
4. Prevention
Lifestyle measures such as healthy nutrition, regular exercise, sufficient sleep and stress reduction can prevent Type 2 diabetes. For people with obesity, successful weight loss, either through lifestyle measures, medications, or weight loss surgery, can prevent Type 2 diabetes. The FDA recently approved a new medication that controls the cell-based immune system and delays the onset of Type 1 diabetes in people at risk for over two years. Understanding the complexities of diabetes and its implications can help healthcare professionals provide better care and support for those affected.
5. Family history
Compared to someone without a family member with diabetes, a person with a family member with Type 2 diabetes has a significantly increased risk of developing diabetes later in life. That said, lifestyle measures, as detailed above, can reduce this risk. For rare forms of monogenic diabetes, which is caused by a singular gene mutation and different from both Type 1 and Type 2 diabetes, the risk of a first-degree family member developing diabetes is very high. The same cannot be said for Type 1 diabetes.
“While a family history of Type 1 diabetes does increase the risk of diabetes in other family members, this risk is much lower than for people with a family history of Type 2 diabetes or monogenic diabetes,” said Miedlich.