Diabetes is a growing disease worldwide and, in Italy, affects over 3.5 million patients (5.9% of the entire population)

The spread of diabetes mellitus is caused by the sum of several factors, particularly in western countries.

These include, on the one hand, the progressive ageing of the population, unhealthy eating habits and the resulting increase in obese people; on the other hand, the increase in early diagnosis and, conversely, the decrease in the mortality rate of diabetic patients.

What is diabetes and what are its causes?

Diabetes is a chronic disease characterised by an increase in blood glucose (the amount of glucose in the blood) due to a defect in the secretion or inadequate action of insulin, the hormone produced by the cells of the pancreas and responsible for controlling sugar levels.

There are two different types of diabetes mellitus: type 1 diabetes, which affects between 5% and 10% of diabetics, and type 2 diabetes, which is more common and affects more than 90% of diabetes patients.

These are two very different diseases, both in terms of their mode of onset and treatment and their impact on patients’ lives.

Although diabetes mellitus is a sometimes insidious disease, which can arise without manifest symptoms and remain silent for some time, in acute cases, the presenting symptoms include

• fatigue
• increased urinary volume (polyuria), resulting in increased thirst (polydipsia)
• drop in body weight;
• abdominal pain;
• increased hunger (polyphagia);
• nausea and vomiting;
• blurred vision;
• acetonemic breath (smell of ripe fruit).

The long-term consequences of hyperglycaemia lead to the appearance of the dreaded complications of diabetes: retinopathy, nephropathy, neuropathy and cardiovascular diseases (coronary artery disease, stroke, lower limb arteriopathy).

To make a diagnosis of diabetes mellitus, a simple blood glucose test with a normal blood sample is sufficient.

What is type 1 diabetes?

Type 1 diabetes tends to occur particularly during childhood and adolescence (but more rarely also in patients who are already adults) and is caused by a total lack of insulin, caused by the destruction of the beta cells of the pancreas due to the appearance of autoantibodies.

We do not yet know the actual causes of this abnormal immune response, but it would appear to be associated with hereditary factors on which environmental determinants (e.g. certain viral infections) act.

Type 2 diabetes: what it is

Type 2 diabetes is a multifactorial disease that tends to occur after the age of 30-40 years.

Several mechanisms are implicated in the genesis of this metabolic disease, but classically the initial defect is insulin resistance, i.e. reduced action of insulin at the target organs leading on the one hand to an excess of hepatic glucose production and on the other to its reduced utilisation by the muscles.

Among the most relevant risk factors for the onset of type 2 diabetes are a family history of the disease, a sedentary lifestyle, a diet too rich in fat and sugar, and being overweight.

Hyperglycaemia in type 2 diabetes can have a gradual onset, which is why the disease can behave silently for several years before leading to the development of symptoms, and often the typical complications of the disease may already be present at the onset.

How can it be prevented?

Unfortunately, it is not currently possible to prevent the onset of type 1 diabetes, although studies are underway on the possibility of intervening in the earliest stages of the disease.

Instead, type 2 diabetes can be prevented by adopting a healthy, low-fat, low-calorie diet, engaging in regular physical activity, and avoiding being overweight.

These precautions in the case of type 2 diabetes are particularly effective: there are studies confirming that a proper lifestyle is more effective than pharmacological intervention in lowering blood glucose.

Insulin: the cure for type 1 diabetes

Type 1 diabetes can only be cured with insulin.

Insulin can be administered either with classic subcutaneous injections or with continuous infusion systems (the pump).

With this treatment, which must be continuous and last a lifetime, patients can lead a normal daily life.

It is very important, however, to refer to specialised and multidisciplinary centres, both for the treatment of diabetes itself and for the treatment of complications that may arise in association with this disease.

How to treat type 2 diabetes?

For the treatment of type 2 diabetes, on the other hand, we have several therapeutic options at our disposal, and indeed the last few years have seen the introduction on the market of numerous new ‘innovative’ drugs that are now widely recommended by the main guidelines, having also proved to have a significant benefit on cardiovascular risk, which is the major cause of mortality in type 2 diabetes.

In particular, the reference is to analogues of GLP-1 (Glucagon-like peptide-1), a hormone that has the task of facilitating the secretion of insulin, produced by intestinal cells following the ingestion of food; and to glyflozines, or inhibitors of sodium glucose co-transporter 2 (SGLT2), which promote the elimination of glucose through the urine, through their action on a renal receptor.

Research does not stop: very promising new drugs are already being studied, such as the GLP-1/GIP dual agonist.

However, it must be stated that there is no single drug therapy that is valid for all patients with type 2 diabetes: therapies must be tailored to the needs of the individual patient, based on his or her characteristics and clinical history.

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Source:

Humanitas