Everything to know about diabetes

What is diabetes?

Diabetes is a chronic condition that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. This essential hormone regulates blood sugar levels. Persistent hyperglycemia, if left untreated, leads to severe complications affecting multiple systems, such as nerves and blood vessels, and intermediate conditions like hypertension and cardiovascular diseases.

How is diabetes defined?

The World Health Organization (WHO) defines this condition as a “chronic disorder characterized by the body’s improper use of insulin or an insufficient production of this hormone.” This dysregulation of blood glucose leads to prolonged hyperglycemia. Over time, this condition promotes severe damage to nerves, blood vessels, and other organs. The High Authority for Health recommends regular screening, especially for at-risk populations, to prevent these outcomes.

Some epidemiological data on diabetes

This disease presents a global public health challenge. Recent studies reveal an alarming trend. Its prevalence is particularly pronounced in low- and middle-income countries, where access to healthcare and screening remains limited. In 2021, approximately 537 million adults (ages 20-79) were living with this condition, and this figure could reach 783 million by 2045 if effective measures are not implemented.

The main causes include physical inactivity, an unbalanced diet, increasing urbanization, and excess weight. In France, there are 4.3 million people affected, accounting for more than 5.6% of the population, with a rising incidence of cases.

Diabetes is also a major cause of morbidity and mortality. In 2021, it contributed to 6.7 million deaths worldwide. Without appropriate management, it can lead to serious complications such as kidney failure, amputations, blindness, and cardiovascular diseases.

What are the symptoms of diabetes?

The symptoms vary depending on the type of diabetes, but some signs are common: intense thirst, frequent urination, blurred vision, persistent fatigue, and unintentional weight loss. In the case of type 2 diabetes, these symptoms may be more subtle and develop over several years before being detected. The Haute Autorité de Santé recommends regular screening, particularly for individuals with additional risk factors such as hypertension, excess weight, or family history.

Is diabetes hereditary?

Diabetes has a hereditary component, but its mode of transmission depends on the type of diabetes. For type 1 diabetes, family history plays a role, but the risk of transmission remains relatively low. Environmental factors, such as viral infections or autoimmune triggers, are also involved in its onset.

Conversely, type 2 diabetes has a more pronounced genetic component. Individuals with a family history of this type of diabetes have a significantly increased risk, particularly if lifestyle factors such as an unbalanced diet, excess weight, or lack of physical activity are also present.

What are the different types of diabetes?

Type 1 diabetes

Formerly known as “insulin-dependent diabetes” or “juvenile diabetes,” type 1 diabetes is characterized by insufficient insulin production by the body. Patients with this type of diabetes are dependent on external insulin supplies, which they must administer daily. The exact etiologies of the onset of type 1 diabetes are not yet known, nor are there means to prevent its development.

Type 2 diabetes

Type 2 diabetes affects how the body uses glucose as fuel. It is the most common form of diabetes, primarily affecting adults, especially those who are overweight or sedentary, and is often associated with metabolic syndrome. This type of diabetes often develops slowly over time: initially, the body becomes resistant to insulin before producing it insufficiently in a later stage. A complex interplay of genetic predisposition, lifestyle, and certain health conditions can contribute to the onset of this type of diabetes.

Gestational diabetes

As the name suggests, gestational diabetes occurs in pregnant women who have no prior history of diabetes. It arises when the mother’s pancreas cannot produce enough insulin to compensate for the baby’s growth and the hormonal changes of pregnancy. Most of the time, gestational diabetes resolves after childbirth, but affected women remain at risk of developing type 2 diabetes later on.

MODY diabetes

The MODY (Maturity Onset Diabetes of the Young) is a rare form of diabetes typically diagnosed during adolescence or early adulthood. However, MODY is often misdiagnosed as either type 1 or type 2 diabetes. In reality, MODY diabetes is a distinct form from these two types, caused by a genetic mutation that leads to the dysfunction of insulin-producing beta cells.

LADA diabetes

LADA diabetes (Latent Autoimmune Diabetes in Adults) is a form of type 1 diabetes that manifests later in life, often in adults over the age of 30. Frequently mistaken for type 2 diabetes due to its later onset, LADA diabetes is actually an autoimmune disease, similar to type 1 diabetes.

What are the consequences of diabetes?

Diabetic retinopathy

Diabetes is a significant cause of blindness worldwide, primarily due to the development of retinopathy, which is damage to the small blood vessels in the retina.

Cardiovascular complications

Diabetic microangiopathy

Diabetes is also a significant cause of cardiovascular events such as myocardial infarction and strokes. This risk is explained by diabetic microangiopathy, which involves damage to the body’s small blood vessels.

Diabetic macroangiopathy

In the case of diabetes, the large blood vessels can also be affected, a complication known as diabetic macroangiopathy. This condition can lead to cardiovascular diseases, with myocardial infarction being one of the primary consequences of this macroangiopathy.

Neuropathy and the diabetic foot

Diabetes can also affect the peripheral nervous system, leading to diabetic neuropathy. This condition is characterized by a loss of sensation in the extremities, particularly the feet. Individuals affected by diabetes and neuropathy are at an increased risk of developing foot ulcers, which may require amputation in cases of complications, thus necessitating regular foot care.

Periodontal diseases

Finally, periodontal diseases, which refer to infections of the supporting structures of the teeth, are more common in patients with diabetes. This is primarily due to changes in blood vessels, the immune system response, and the oral microbiome.

Quels traitements sont disponibles ?

Oral antihyperglycemic agents

The choice of treatments depends on the type of diabetes and the level of blood sugar control. In the case of type 2 diabetes, the initial steps in treatment generally involve lifestyle modifications, including a healthy diet and regular physical activity. If these measures are insufficient to control blood sugar levels, oral anti-diabetic medications may be prescribed. These medications work in various ways to lower blood glucose concentrations.

Insulin therapy

For individuals with type 1 diabetes, treatment requires exogenous insulin administration because the pancreas does not produce any. This type of treatment is also known as insulinotherapy. Insulin is generally administered via injection, either by syringe or insulin pump. There are different types of insulin: rapid-acting, intermediate-acting, and long-acting, with the choice depending on the specific needs of the patient.

Pancreatic islet transplantation

Another therapeutic option, often reserved for the most severe cases of diabetes, is the transplantation of Langerhans islets. This procedure involves grafting compatible donor cells capable of producing insulin. Although this intervention can enable some patients to achieve insulin independence, it remains a last-resort option due to the risks associated with transplantation surgeries and the subsequent need for immunosuppression.

How to prevent diabetes?

The prevention of diabetes largely depends on the type of disease in question, but it primarily relies on adopting a healthy lifestyle. For type 2 diabetes, which is the most common and significantly influenced by lifestyle, the preventive measures recommended by the WHO include:

• Maintaining a normal weight: Obesity is one of the primary risk factors for developing type 2 diabetes. Even a moderate weight loss can significantly reduce this probability.
• Adopt a balanced diet: Prioritize foods that are high in fiber, such as fruits, vegetables, and whole grains, while limiting simple sugars and processed foods.
• Engage in regular physical activity: Physical exercise, at least 150 minutes of moderate activity per week, enhances insulin sensitivity and helps maintain stable blood glucose levels.
• Monitoring blood glucose levels: Individuals with a family history or a high-risk lifestyle should regularly consult a healthcare professional to detect any abnormalities early.

Regarding gestational diabetes, pregnant women can lower their risk by maintaining a healthy lifestyle before and during pregnancy. Close medical monitoring is also essential to screen for any elevation in blood glucose levels during pregnancy.

For type 1 diabetes, whose causes are predominantly autoimmune and unpredictable, preventive measures are limited. However, research is ongoing to better understand the triggering factors.

Online tools, also available on the Ameli platform, such as risk calculators, can help in better understanding predisposition factors for diabetes.