Info Nuggets
DIABETES MELLITUS: AN OVERVIEW
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Diabetes Mellitus is a chronic metabolic disorder characterised by elevated levels of blood glucose (hyperglycaemia), either due to insufficient insulin production or ineffective utilisation of insulin by the body. It is a major non-communicable disease (NCD) with growing prevalence globally and in India.
Diabetes mellitus and diabetes insipidus are distinct conditions, despite sharing similar names and symptoms like increased thirst and frequent urination.
Diabetes Mellitus: This condition involves problems with blood sugar regulation due to issues with insulin production or use. There are two main types: Type 1, where the body doesn’t produce enough insulin and Type 2, where the body doesn’t respond properly to insulin.
Diabetes Insipidus: This is a rare disorder that affects the kidneys’ ability to balance fluids, leading to excessive urination. It’s caused by problems with the hormone vasopressin (also known as antidiuretic hormone or ADH), which helps the kidneys control the amount of water the body releases in urine.
In short, diabetes mellitus is about blood sugar, while diabetes insipidus is about water balance.
TYPES OF DIABETES MELLITUS
1. Type 1 Diabetes (Insulin-dependent diabetes)
• Cause: Autoimmune destruction of beta cells in the pancreas.
• Onset: Typically occurs in children or young adults.
• Insulin production: Absent or minimal.
• Treatment: Requires lifelong insulin therapy.
2. Type 2 Diabetes (Non-insulin dependent diabetes)
• Cause: Insulin resistance and/or relative insulin deficiency.
• Onset: More common in adults, often linked to obesity and lifestyle.
• Insulin production: Present but inefficiently used.
• Treatment: Lifestyle changes, oral hypoglycaemics and sometimes insulin.
3. Gestational Diabetes
• Occurs during pregnancy and usually resolves after childbirth.
• Risk of developing type 2 diabetes later in life.
4. Other Specific Types
• Includes monogenic diabetes (e.g., MODY), secondary diabetes due to pancreatic diseases, drug-induced diabetes, etc.
DIFFERENCE BETWEEN TYPE 1 & TYPE 2 DIABETES
Feature | Type 1 Diabetes | Type 2 Diabetes |
Age of onset | Childhood or adolescence | |
Insulin production | Absent or severely reduced | Present, but ineffective |
Cause | Autoimmune | Insulin resistance, lifestyle |
Treatment | Insulin | Lifestyle drugs ± insulin |
Prevention | Not preventable | Often preventable |
Onset | Sudden | Gradual |
DIAGNOSIS OF DIABETES
As per WHO and ADA (American Diabetes Association):
• Fasting Blood Glucose ≥ 126 mg/dL
• Postprandial (2-hour after meal) ≥ 200 mg/dL
• HbA1c (Glycated H
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a
emoglobin) ≥ 6.5%
• Random Glucose ≥ 200 mg/dL (with symptoms)
PROPAGATION AND RISK FACTORS
Diabetes does not spread person-to-person but propagates in the population due to:
• Genetic predisposition
• Urbanisation and sedentary lifestyle
• Unhealthy diet (high sugar, processed foods)
• Obesity
• Lack of physical activity
• Stress and smoking
IMPACTS
Health Impact
• Major cause of cardiovascular diseases, kidney failure, blindness and amputations.
• Increases vulnerability to infections, including TB and COVID-19.
Socio-economic Impact
• High out-of-pocket health expenditure.
• Loss of productivity due to chronic illness and disability.
• Burden on healthcare infrastructure.
Global and Indian Context
• India is the “Diabetes Capital of the World” with over 100 million diabetics (ICMR-INDAIB study, 2023).
• WHO estimates that diabetes will be the 7th leading cause of death by 2030.
CURE AND MANAGEMENT
Is there a cure?
• No permanent cure exists.
• Type 1 diabetes requires lifelong insulin.
• Type 2 diabetes can be reversed or well managed with: • Diet control • Physical activity • Weight loss • Medication/Insulin • Monitoring blood sugar levels
GOVERNMENT INITIATIVES
• NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke)
• Ayushman Bharat – Health and Wellness Centres screen for diabetes.
• Eat Right Movement, Fit India Movement and lifestyle awareness campaigns.
GENERAL FACTS AND FIGURES
• Over 537 million adults worldwide (IDF 2021) have diabetes.
• 1 in 2 adults with diabetes is undiagnosed.
• Diabetes contributes to premature mortality and multimorbidity.
• Urban areas show higher prevalence than rural.
PRACTICE QUESTIONS
SHORT ANSWER TYPE QUESTIONS
1. What is the difference between Type 1 and Type 2 Diabetes?
2. What are the diagnostic criteria for diabetes?
3. What is gestational diabetes and how is it managed?
LONG ANSWER TYPE QUESTIONS
1. Discuss the rising burden of diabetes in India and its socio-economic consequences.
2. Examine the role of lifestyle and diet in the management and prevention of Type 2 Diabetes.
3. Highlight the key government initiatives to control diabetes in India.
ANALYTICAL/ESSAY TYPE QUESTIONS
1. “Diabetes is not just a medical condition; it is a developmental challenge.” Discuss with reference to India.
2. Evaluate the effectiveness of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in addressing non-communicable diseases in India.
3. With reference to the global rise in diabetes, examine the role of urbanization and changing lifestyles in the epidemiology of non-communicable diseases.
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