Diabetes Mellitus Overview

Diabetes Mellitus Definition

• Diabetes mellitus is a metabolic disorder characterized by high blood glucose levels due to either insufficient insulin production or the body's inability to effectively use insulin.

Global and Local Prevalence

• Diabetes is a major health concern globally, contributing significantly to morbidity and healthcare costs.
• Egypt is among the top 10 countries with the highest number of diabetes patients.
• The Middle East and North Africa (MENA) region is expected to see an 86% increase in diabetes cases from 2019 to 2045.
• The prevalence of diabetes in Egypt is around 20.9% among adults aged 20 to 79 years.

Diabetes Classifications

• Type 1 Diabetes: Characterized by the body's immune system attacking and destroying insulin-producing beta cells in the pancreas, leading to absolute insulin deficiency.
  • Immune-mediated: Caused by an autoimmune response.
  • Idiopathic: Cause unknown.
• Type 2 Diabetes: Occurs when the body either doesn't produce enough insulin or can't use insulin effectively, resulting in hyperglycemia.
• Predominantly insulin resistance: The body struggles to use insulin effectively.
• Predominantly insulin secretory defect: The pancreas doesn't produce enough insulin.
• Other Specific Types of Diabetes:
  • Genetic defects: Involving beta cell function (MODY 1-6) or insulin action.
  • Diseases of the exocrine pancreas: Including pancreatitis, pancreatectomy, cystic fibrosis, and hemochromatosis.
  • Endocrinopathies: Hormonal disorders like acromegaly, Cushing's syndrome, and hyperthyroidism.
  • Drug or chemical induced: Often caused by use of glucocorticoids.
  • Genetic syndromes associated with diabetes: Such as Down syndrome, Klinefelter syndrome, and Turner syndrome.
• Gestational Diabetes Mellitus (GDM): Occurs during pregnancy, often resolving after childbirth.

Insulin Resistance Syndrome (Metabolic Syndrome)

• A cluster of metabolic conditions that increase the risk of cardiovascular disease and diabetes.
• Key features include:
  • Central obesity (excess fat around the abdomen)
  • Hypertriglyceridemia (high levels of triglycerides)
  • Low high-density lipoprotein (HDL) cholesterol
  • Hyperglycemia (high blood sugar)
  • Hypertension (high blood pressure)

Prediabetes

• A condition where blood glucose levels are higher than normal but not yet meeting the criteria for diabetes.

Clinical Features

• Type 1 Diabetes:
  • Symptoms: Polydipsia (increased thirst), polyuria (frequent urination), enuresis (bedwetting), chronic weight loss, and failure to thrive in children.
  • Severe presentations: Dehydration, frequent vomiting, diabetic ketoacidosis (DKA), and shock.
• Type 2 Diabetes:
  • Symptoms: Often asymptomatic initially; polydipsia, polyuria, chronic skin infections, vaginitis, overweight or obesity, and Acanthosis nigricans (darkening of the skin).
  • Complications: Neuropathic or cardiovascular complications can sometimes be present at diagnosis.

Laboratory Findings for Diagnosis

• Plasma glucose: Fasting blood glucose, random blood glucose, and postprandial glucose.
• Oral glucose tolerance test (OGTT): Measures blood glucose levels after drinking a sugary drink.
• Glycated hemoglobin (HbA1c): Reflects average blood glucose levels over the past 2-3 months.
• Urine glucose: Detects excess glucose in the urine.
• Urine and blood ketones: Indicates breakdown of fat for energy, occurring in DKA.

Treatment Regimens

• Lifestyle Modifications:
  • Medical Nutrition Therapy (MNT): Dietary changes to control calorie intake and manage blood sugar levels.
  • Physical Activity: Regular exercise helps improve insulin sensitivity and lowers blood sugar.
• Medications for Treating Hyperglycemia:
  • Insulin Secretagogues:
    • Sulfonylureas: Stimulate insulin release from the pancreas.
    • Meglitinide Analogs: Similar to sulfonylureas, but have a shorter duration of action.
  • Insulin Sensitizers:
    • Metformin: Improves insulin sensitivity in the liver, muscles, and adipose tissue.
    • Thiazolidinediones: Enhance insulin sensitivity by increasing glucose uptake and utilization.
  • α-Glucosidase Inhibitors:
    • Acarbose: Slows down the breakdown of complex carbohydrates in the digestive system, reducing glucose absorption.
  • Incretins:
    • GLP-1 Receptor Agonists: Mimic the actions of GLP-1, a hormone that stimulates insulin release and reduces glucagon secretion.
    • DPP-4 Inhibitors: Prevent the breakdown of GLP-1 and GIP, enhancing their effects.
  • Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors: Block the reabsorption of glucose in the kidneys, increasing its excretion in urine.
• Insulin Therapy:
  • Insulin Preparations: Various types of insulin available, differing in onset, peak, and duration of action.
  • Bioavailability Characteristics: Factors influencing how quickly and effectively insulin enters the bloodstream.

Transplantation

• Pancreas Transplantation: Replacement of the pancreas with a donor one.
• Islet Transplantation: Transplantation of insulin-producing cells from a donor's pancreas.

Explore the fundamental aspects of diabetes mellitus, including its definition, global and local prevalence, and different classifications. This quiz covers important statistics regarding diabetes, especially in Egypt and the MENA region, as well as distinctions between Type 1 and Type 2 diabetes.