Key Facts:
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The number of people with diabetes surged from 108 million in 1980 to 422 million by 2014, with the increase being more pronounced in low- and middle-income countries compared to high-income ones.
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Diabetes is a leading cause of severe health issues including blindness, kidney failure, heart attacks, stroke, and lower limb amputations.
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Between 2000 and 2019, diabetes mortality rates by age increased by 3%.
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In 2019, diabetes and related kidney disease resulted in approximately 2 million deaths.
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Preventing or delaying type 2 diabetes can be achieved through a healthy diet, regular physical activity, maintaining a normal body weight, and avoiding tobacco use.
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Diabetes management and its complications can be controlled or postponed with proper diet, physical activity, medication, and consistent screening and treatment.
Overview
Diabetes is a chronic condition that arises when the pancreas either doesn’t produce enough insulin or the body cannot effectively use the insulin it does produce. Insulin is a hormone crucial for regulating blood glucose levels. Uncontrolled diabetes often leads to hyperglycemia (elevated blood sugar), which over time can cause significant damage to various body systems, particularly nerves and blood vessels.
In 2014, 8.5% of adults aged 18 and older had diabetes. By 2019, diabetes was directly responsible for 1.5 million deaths, with 48% of these deaths occurring before the age of 70. Additionally, diabetes contributed to around 460,000 deaths from kidney disease and was linked to approximately 20% of cardiovascular deaths.
Between 2000 and 2019, age-standardized mortality rates from diabetes increased by 3%, with a 13% rise in lower-middle-income countries. In contrast, the global risk of dying from one of the four major noncommunicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, or diabetes) between ages 30 and 70 decreased by 22% during the same period.
Symptoms
Diabetes symptoms can appear suddenly, but in type 2 diabetes, they may be mild and develop over many years. Common symptoms include:
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Excessive thirst
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Frequent urination
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Blurred vision
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Fatigue
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Unintentional weight loss
Over time, diabetes can damage blood vessels in the heart, eyes, kidneys, and nerves, increasing the risk of heart attack, stroke, and kidney failure. It can also lead to permanent vision loss and foot problems, such as ulcers, which may result in amputation.
Type 1 Diabetes
Type 1 diabetes (formerly known as insulin-dependent or juvenile diabetes) is characterized by insufficient insulin production and requires daily insulin administration. In 2017, there were 9 million people with type 1 diabetes, mostly in high-income countries. Its causes and prevention methods are still unknown.
Type 2 Diabetes
Type 2 diabetes affects the body’s ability to use glucose effectively, leading to high blood sugar levels if untreated. It often results in severe damage to nerves and blood vessels. Preventable factors include being overweight, lack of exercise, and genetics. Early diagnosis through regular check-ups and blood tests is crucial to avoid severe complications. Symptoms are often mild and can take years to notice, with many cases being diagnosed after complications have developed.
Type 2 diabetes constitutes over 95% of diabetes cases and was previously known as non-insulin dependent or adult-onset diabetes. It is increasingly seen in children as well.
Gestational Diabetes
Gestational diabetes is characterized by elevated blood glucose levels during pregnancy that are not high enough to be classified as diabetes. Women with gestational diabetes face increased risks during pregnancy and delivery and may have a higher risk of developing type 2 diabetes later in life. It is typically diagnosed through prenatal screening rather than symptoms.
Impaired Glucose Tolerance and Impaired Fasting Glycemia
Impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG) are conditions where blood glucose levels are higher than normal but not high enough to be classified as diabetes. Individuals with IGT or IFG are at high risk of developing type 2 diabetes, although progression is not guaranteed.
Prevention
Lifestyle changes are key to preventing or delaying type 2 diabetes. Recommendations include:
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Maintaining a healthy body weight
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Engaging in at least 30 minutes of moderate physical activity daily
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Eating a balanced diet low in sugar and saturated fat
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Avoiding tobacco use
Diagnosis and Treatment
Early diagnosis can be achieved through cost-effective blood glucose testing. People with type 1 diabetes require insulin injections for survival. A healthy lifestyle is crucial for managing diabetes. Some individuals with type 2 diabetes may need medications to manage blood sugar levels, such as:
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Metformin
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Sulfonylureas
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SGLT-2 inhibitors
In addition to blood sugar-lowering medications, diabetes management often requires treatments for high blood pressure and cholesterol, as well as care for complications like foot ulcers, kidney disease, and retinopathy.
WHO Response
The World Health Organization (WHO) works to enhance diabetes surveillance, prevention, and control, especially in low- and middle-income countries. WHO’s efforts include:
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Providing guidelines for the prevention of major noncommunicable diseases, including diabetes
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Developing standards for diabetes diagnosis and care
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Raising awareness through initiatives like World Diabetes Day (November 14)
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Monitoring diabetes and its risk factors
In April 2021, WHO launched the Global Diabetes Compact to improve diabetes prevention and care, focusing on support for low- and middle-income countries. In May 2021, the World Health Assembly approved a resolution to strengthen diabetes prevention and control, and in May 2022, it endorsed five global diabetes targets to be achieved by 2030.
References
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Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019. Results. Institute for Health Metrics and Evaluation. 2020 (https://vizhub.healthdata.org/gbd-results/).
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Sarwar N, Gao P, Seshasai SR, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375:2215-2222.
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Global Burden of Disease Study GBD 2019 Blindness and Vision Impairment Collaborators. Causes of blindness and vision impairment in 2020 and trends over 30 years. Lancet Global Health. 2021;9
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United States Renal Data System. 2014 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2014:188–210.