“My doctor was shocked, and so was I. I didn’t think you could be fit—and have diabetes.” -Art Cutting, 59 years old
A BRIEF HISTORY
Diabetes is an illness that has ravaged millions of lives in our modern era. Coined from the Greek word “diabainein” which means “siphon or to pass through” as in the passage of excess liquid from the body, diabetes describes a disease of excess urination.
According to WHO in 2020, diabetes mellitus (the more common form of diabetes, often used interchangeably with the word diabetes itself) was ranked the ninth leading cause of mortality. Yearly, its epidemiology continues to skyrocket, placing it as the 7th leading cause of mortality in more recent times with predictions of more severe lethality in years to come.
Thus, the world Diabetes Day was established. Marked every year on the 14th of November, the date was chosen in honour of the birthday of Sir Fredrick Banting, who co-discovered insulin along with his student, Charles Best in 1922. It became an official United Nations day in 2006 after the UN resolution on diabetes to promote the activities of the International Diabetes Foundation (IDF) and propagate the importance of joint and intense actions towards combating diabetes as a critical global issue.
THE BURDEN
So far, statistical records from the 10th edition of the IDF Diabetic Atlas have revealed that:
- 537 million adults were living with diabetes (about 1 in 10 persons), with type 2 making up 90% of the value.
- About 240 million adults with diabetes are undiagnosed (with a majority having type 2 diabetes).
- More than 1.2 million children and adolescents (0 – 19 years) live with type 1 diabetes.
- 541 million adults are at risk of developing Type 2 diabetes.
- 1 in 6 live births (about 21 million) are affected by hyperglycemia in pregnancy.
- In 2021 alone, one diabetes-related death occurred every five seconds.
- The prevalence of diabetes is highest in low and middle-income countries. Therefore, practical knowledge of the disease is vital for the Nigerian population.
THE DISEASE
The spectrum of diabetes encompasses two distinct diseases: diabetes insipidus (DI) and diabetes mellitus (DM).
DI occurs due to a defect in the secretion of antidiuretic hormone (ADH) leading to excessive urination.
DM on the other hand is a chronic disease that occurs due to disorders in the metabolism of glucose (sugar) in the body which leads to an increase in the blood glucose levels and excretion of a large amount of sweet urine -thus the added term “mellitus”, the Latin word for “sweet”.
There are 3 major types of DM; Type 1, also known as juvenile-onset diabetes because it is commonly diagnosed in individuals below the age of 20 years, accounts for about 5 to 10% of diabetes cases. Its occurrence stems from an impairment in the production of insulin due to the destruction of pancreatic beta cells. The end result is a severe deficiency of insulin. Diabetic ketoacidosis is also rampant in type 1 patients due to increased production of ketone bodies. When discovered in adults, Type 1 is diagnosed as Latent Autoimmune Diabetes of Adults (LADA). This type of diabetes requires a patient to depend on external sources of insulin (insulin replacement therapy) for survival. Several times, on administration of insulin, patients are faced with episodes of hypoglycemia (low blood sugar), hence there is a need for strict monitoring of blood glucose levels for proper management.
Type 2 diabetes, also called adult-onset diabetes, accounts for about 95% of worldwide diabetes cases, according to WHO. In this case, there is not only abnormal production of insulin but defective insulin receptors. Thus the tissues become unresponsive to the presence of insulin and do not metabolize glucose.
Gestational diabetes occurs during pregnancy when an individual becomes less sensitive to insulin. According to the Centers for Disease Control and Prevention (CDC), between 2–10% of pregnancies each year result in gestational diabetes, with obese women bearing elevated risk. The CDC also adds that around 50% of people with gestational diabetes will later develop type 2 diabetes, and babies of mothers with the condition if left untreated may suffer from congenital heart anomalies, defects of the central nervous system, respiratory distress syndrome, malformation of skeletal muscles, and increased risk of developing Type 2 diabetes later in life. In severe cases, perinatal death may occur.
RISK FACTORS
- Unlike Type 1 disease with sudden onset, Type 2 is progressive and asymptomatic until it becomes severe -the reason behind its widespread prevalence. Type 2 is a disease of indulgence, arising mainly due to unhealthy lifestyle choices and partly due to genetics. Risk factors for Type 2 include:
- Obesity
- Excessive alcohol consumption
- Sedentary living
- Poor diet (high sugar and trans fat intake)
- Family history of diabetes
- Psychological stress
- Urbanization
- Ethnicity
- Smoking
- Hypertension
- Polycystic ovarian syndrome (PCOS)
- Antipsychotics
- Infections and disorders of the pancreas
Obesity is a major risk factor, linked to 80% of cases. Psychological stress also plays a role in suppressing insulin sensitivity. Persons of black ethnicity have been found to have a higher incidence than others and the air pollution and fast food seen in urban regions have also been noted to alter the function of endothelium, trigger inflammation and cause insulin resistance.
Like Art Cutting who was quoted at the beginning of this article, many people tend to think they are safe until proven otherwise by a chance screening or onset of symptoms. This leaves one wondering, if the supposedly fit are not spared, what is the fate of the obviously unfit? As such, the best defence against the disease is information. Knowing one’s risk factors, especially for Type 2 diabetes can help delay or prevent the onset of the disease when appropriate actions are taken.
Aladi Victoria & Ojeniyi Esther