What is diabetes and how is it managed?

From the Guidelines

Diabetes is a chronic condition where the body either doesn't produce enough insulin or cannot effectively use the insulin it produces, resulting in elevated blood sugar levels, and its management involves a combination of lifestyle modifications and medications, with the goal of preventing or delaying complications and optimizing quality of life, as stated in the most recent guidelines 1.

Definition and Pathophysiology

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both, leading to long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels, as described in 1.

Signs and Symptoms

Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with polyphagia, and blurred vision, and impairment of growth and susceptibility to certain infections may also accompany chronic hyperglycemia, as noted in 1.

Diagnosis

The diagnosis of diabetes is based on the degree of hyperglycemia, which may change over time, depending on the extent of the underlying disease process, and a disease process may be present but may not have progressed far enough to cause hyperglycemia, as explained in 1.

Management

Management of diabetes involves a combination of lifestyle modifications, including regular physical activity, a balanced diet limiting refined carbohydrates, regular blood glucose monitoring, and maintaining a healthy weight, as well as medications, such as metformin, SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, or sulfonylureas, with the goal of keeping blood glucose levels within target ranges, typically 80-130 mg/dL before meals and under 180 mg/dL after meals, to prevent both short-term complications like hypoglycemia and long-term damage to organs and blood vessels, as recommended in 1 and 1.

• Key aspects of diabetes management include:
  • Lifestyle modifications, such as regular physical activity and a balanced diet
  • Medications, such as metformin and SGLT-2 inhibitors
  • Regular blood glucose monitoring and maintaining a healthy weight
  • Regular medical check-ups to monitor for complications
• The goals of treatment for diabetes are to prevent or delay complications and optimize quality of life, as stated in 1.
• Diabetes self-management education should be patient-centered, respecting and reflecting the patient's personal preferences, needs, and values, and should be provided by diabetes educators who have received standard training, as recommended in 1.

From the Research

Definition of Diabetes

• Diabetes mellitus is a chronic heterogeneous metabolic disorder with complex pathogenesis, characterized by elevated blood glucose levels or hyperglycemia 2.
• It is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both 3.
• Type 2 Diabetes Mellitus (T2DM) is characterized by chronically elevated blood glucose (hyperglycemia) and elevated blood insulin (hyperinsulinemia) 4.

Pathophysiology of Diabetes

• The chronic hyperglycemia of diabetes mellitus is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels 3.
• Hyperglycemia manifests in various forms with a varied presentation and results in carbohydrate, fat, and protein metabolic dysfunctions 2.
• The pathophysiology of T2DM involves chronically elevated blood glucose and insulin levels, which can be improved with treatments that lead to reductions in blood insulin levels 4.

Signs and Symptoms of Diabetes

• The signs and symptoms of diabetes are not explicitly stated in the provided studies, but it is mentioned that hyperglycemia serves as the primary biomarker for the diagnosis of diabetes 2.
• The management of diabetes is complicated and depends on diligence in blood glucose monitoring, frequent adjustment of medications, adherence to a regular diet and exercise plan, and treatment of comorbid conditions such as hypertension and hyperlipidemia 3.

Diagnosis of Diabetes

• Hyperglycemia is the primary biomarker for the diagnosis of diabetes 2.
• The diagnosis of diabetes can be made based on blood glucose levels, with a blood glucose concentration of 100 milligrams/deciliter or higher indicating hyperglycemia 4.
• HbA1C levels are also used to diagnose and monitor diabetes, with a level of 7% (53 mmol/mol) or higher indicating inadequate glycemic control 5.

Management of Diabetes

• The management of diabetes involves lifestyle modifications, such as a healthy, plant-based diet and regular exercise, as well as antidiabetic medications 6.
• Treatments for T2DM that lead to improvements in glycemic control and reductions in blood insulin levels are sensible based on the pathophysiologic perspective 4.
• Medications such as metformin, glucagon-like peptide-1 receptor agonists, and insulin can be used to manage diabetes, with the choice of medication depending on the individual patient's needs and characteristics 6, 5.