What is Diabetes mellitus (diabetes)

Diabetes mellitus is a metabolic disorder that occurs when the body is unable to properly regulate blood sugar (glucose) levels and is associated with a 3-fold to 4-fold increment in cardiovascular morbidity and mortality. It is characterized by elevated levels of blood glucose, or sugar, and occurs due to insufficient insulin production by the pancreas (Type 1 diabetes), or the body’s inability to effectively use insulin (Type 2 diabetes).  The disease is chronic and affects metabolism of carbohydrate, protein, fat, water, and electrolytes. It is frequently associated with permanent and irreversible functional and structural changes in the cells of the body, with the vascular system particularly susceptible. Diabetes-related complications can impact organs such as the eyes, kidneys, nerves, and blood vessels. Diabetic retinopathy, nephropathy, neuropathy, and cardiovascular complications are common examples of conditions resulting from these cellular changes.

Insulin is a hormone produced by the beta cells of the pancreas and plays a crucial role in regulating blood glucose levels in the body. Its primary function is to facilitate the uptake of glucose by cells from the bloodstream, allowing them to use it for energy. As such, the release of insulin from the pancreas is stimulated by elevated blood glucose concentrations.

Gestational diabetes is another type of diabetes that can occur during pregnancy, and while usually temporary does require specific attention. A diagnosis of gestational diabetes may increase the risk of developing diabetes later in life for both mother and child.

Signs and symptoms of diabetes

Symptoms can vary in severity and not always present in every individual with diabetes. Symptoms include:

• frequent urination, especially at night
• excessive thirst, even after drinking fluids
• unexplained weight loss
• increased hunger, even after eating
• fatigue and persistent lack of energy
• blurred vision
• slow healing of wounds
• tingling or numbness
• recurrent infections

Specific to Type 1 diabetes:

• sudden onset
• nausea or vomiting
• breath odour typically sweet or fruity on the breath (ketones)

Specific to Type 2 diabetes:

• gradual onset
• darkened skin patches, often in skin folds
• high blood pressure

Treatment and management of diabetes – today’s landscape

The general goals in the treatment of diabetes are to normalize blood sugar levels, prevent associated complications, decrease mortality, and maintain a good quality of life. The treatment and management of diabetes has evolved to include new technologies and community-based strategies for more tailored treatment plans based on individual needs.

Medical approaches

Insulin Therapy: Insulin remains a cornerstone for managing Type 1 diabetes and is also used in Type 2 diabetes when lifestyle modifications and oral medications are insufficient.

Oral Medications: Various classes of oral medications, such as metformin, sulfonylureas, SGLT-2 inhibitors, and DPP-4 inhibitors, are used to manage Type 2 diabetes. Newer medications with different mechanisms of action continue to be developed.

Technological advances

Continuous Glucose Monitoring (CGM): CGM systems provide real-time data on blood glucose levels, helping individuals make informed decisions about diet, exercise, and insulin dosing.

Insulin pumps: Insulin pump technology has advanced, offering more precise insulin delivery with features like automated insulin delivery algorithms.

Telehealth and digital health

Remote Monitoring: Telehealth and digital health platforms allow healthcare providers to remotely monitor patients’ glucose levels, use real-time data analysis to adjust medications, and provide ongoing support.

Mobile apps: There are numerous mobile applications for diabetes management, including those for tracking blood glucose, meals, and physical activity.

Personalized medicine

Genetic and biomarker testing: Advances in genetic testing and biomarker analysis contribute to personalized treatment plans, helping to identify individual responses to medications and potential risk factors

Lifestyle Interventions

Nutritional guidance: Focus on individualized dietary plans, considering factors like glycaemic index, carbohydrate counting, and overall balanced nutrition.

Physical Activity: Regular exercise is emphasized for its positive impact on blood glucose levels and overall health.

Patient education and support

Diabetes Education Programs: Educational initiatives empower individuals with diabetes to manage their condition effectively, covering topics like medication management, monitoring, and lifestyle modifications.

Preventive measures

Prevention programs: Efforts to prevent Type 2 diabetes include community-based programs promoting healthy lifestyles and early identification of individuals at risk.

New frontiers in development of treatments for diabetes

Beyond the integration of telemedicine and digital health tools the new frontiers in the development of treatments for diabetes include:

Artificial pancreas systems

The development of closed-loop or artificial pancreas systems aims to automate insulin delivery in response to real-time glucose levels, enhancing precision and reducing the burden of constant monitoring.

Advanced insulin formulations

These include ultra-rapid-acting and ultra-long-acting insulin formulations to better mimic the body’s natural insulin response and provide more flexibility in diabetes management.

Gene therapy

Gene therapy focused on modifying or replacing faulty genes associated with insulin production or regulation hopes to address the underlying causes of diabetes.

 Beta cell regeneration

Research is focused on stimulating the regeneration of insulin-producing beta cells in the pancreas, aiming to restore natural insulin production in individuals with diabetes.

Incretin-based therapies

Novel incretin-based therapies that target the regulation of glucose metabolism, potentially offering improved efficacy and fewer side effects compared to current medications.

Stem cell therapy

Stem cell research is investigating the potential of using stem cells to generate insulin-producing cells, providing a renewable and potentially curative source for individuals with diabetes.

Immunotherapies

Immunotherapies are being explored to modulate the immune response in Type 1 diabetes, with the goal of preventing the autoimmune attack on insulin-producing cells.

Glucose-responsive insulin

Research is focused on development of ‘’smart” insulin formulations that respond to changes in blood glucose levels, releasing insulin only when needed. This could improve precision and reduce the risk of hypoglycaemia.

Microbiome research

Research shows promise that gut microbiome’s role in metabolic health may open new avenues for diabetes treatment by understanding the impact of gut bacteria on glucose metabolism.